NUR254 Communicable

Diseases,Oncology And Special

Senses
Presented By Normadihah Binti
Mohd Zainuddin Bolek
Madam Amot Liew
 Foreign Body

The ear canal is lined with hair follicles and glands that produce a
waxy oil called cerumen. Sometimes the glands produce more wax
than can be easily excreted out the ear. This extra wax may harden
within the ear canal and block the ear.
 Definition
• The external auditory canal can be obstructed
by cerumen or foreign bodies.
• The curved shape and narrow lumen of the
canal can make it particularly vulnerable to
obtruction.
 Pathophysiology
• As cerumen dries , it moves down and out of the
ear canal .
• In some individuals it tends to accumulate,
narrowing the canal.
• Aging is a risk factor for impaction,because less
cerumen is produced and it is harder and drier .
• The accumulation of cerumen is often aggravated
by attempting to remove it using cotton – tipped
swabs or hairpins,which pack it more deeply into
the ear canal.
• A variety of objects become foreign bodies in the
ear canal .
• In adults , implements used to clean the ear canal
may break and become lodged .
• Insects may also enter the ear canal and be unable
to exit .
• When the ear canal becomes occluded with either
cerumen or a foreign body ,the client experiences a
conductive hearing loss in the affected ear.
 Manifestations
• Include a sensation of fullness, along with
tinnitus and coughing due to stimulation of
the vagal nerve.
• The foreign bodies or impacted cerumen may
be visualized on otoscopy.
• Impacted cerumen appears as a yellow ,
brown, or black mass in the canal .
 Medical Management
• Treatment focuses on clearing the canal.
• If there is no evidence of tympanic membrane
perforation,irrigation of the canal is often the initial
therapy.
• Impacted wax,objects, or insects may require
physical removal using an ear curet,forceps,or right
–angle hook inserted via an otoscope and ear
speculum.
• Mineral oil or topical lidocaine drops are used to
immobilize or kill insects prior to their removal
 from their ear.
• When an organic foreign body such as a bean
or an insect is suspected ,water should not be
instilled into the ear canal, because it may
cause the object to swell,making its removal
more difficult.
• Smooth, and round objects present the
biggest challenge to remove from the ear
canal .Suction applied using a piece of soft
intravenous tubing may be effective.
Ear wax is removed by flushing the ear canal with warm fluid.
(Illustration by Argosy, Inc.)
 Nursing Care
• Nurses are often involved in identifying and
relieving obstruction of the ear
canal ,especially in outpatient and community
setting.
• Any client with evidence of new conductive
hearing loss or complaints of discomfort and
fullness in one ear should be evaluated for
possible obstruction.
• Inability to visualize the tympanic membrane
or observation of a dark , shiny mass
obstructing the canal may indicate a need for
an irrigation or other procedure to clear the
canal .
• It is important to determine the tympanic
membrane is intact before irrigating ;
-assessment by a physician or advanced
practitioner may be necessary if a ruptured
membrane is suspected .
• Because obstruction of the ear canal with
cerumen or a foreign body is generally
preventable ,teaching is a key component of
nursing care .
• Client need to know appropriate care
measures for the external ear .
• Although the ear canal rarely needs cleaning
,the client prone to cerumen impaction needs
teaching about the use of mineral oil or
commercial products to soften wax and
irrigation to remove it.
• All client should understand the importance of
not inserting anything smaller than a finger
wrapped with a washcloth into the ear canal to
avoid trauma to the canal or eardrum.
• Stress the risk of impacting cerumen against the
tympanic membrane when using cotton tipped
swabs to clean the ear canal.
• Additionally ,the swab may break and lodge in
the canal.
• If eardrops have been prescribed ,teach the
client and a family member how to instill them.