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What is cerumen?

- a waxy substance that lubricates the ear canal

What are six age related changes to the ear/hearing?

1. Pinna elongation
2. ↑ hair growth external ear
3. cerumen impaction (b/c not enough fluid so dryer & impacts easier)
4. ↓ elasticity of tympanic membrane (may appear dull)
5. ↓ hearing acuity
6. lose high frequency sounds first

What five general assessment factors should look at related to the ear/hearing?

1. age
2. Gender
3. Occupation = usual loud noises
4. Leisure = concerts
5. Medical problems = many ear infections, a lot of antibiotics

What three specific history factors should you look at related to ear/hearing?

1. Drugs (drug induced hearing loss)
a. Antibiotics (gentamyacin)
b. Diuretics
c. NSAIDs
d. Chemotherapy agents
2. Genetic
3. Current health

What three things should you look at during physical exam for ears/hearing?

1. S/S of compensatory actions = leaning forward, tilting head
2. Appearance = pinna, ear canal, cerumen wax, tympanic membrane
3. Palpate mastoid process & pinna

What are 3 tests you can perform to test hearing acuity?

1. voice test = whisper to patient while they block one ear canal
2. watch test = used to test for high-frequency. can patient hear ticking watch from 5" away
3. click fingernails = if no ticking watch is present, use fingernails

Women are more prone to what ear disorder?

otosclerosis disease

Men are more prone to what ear disorder?

meniere's disease

What are 4 categories of drugs that can cause ototoxicity?

1. antibiotics
2. diuretics
3. NSAIDS
4. Chemotherapuetic agents

What should you palpate for tenderness during the physical exam for the ear?

mastoid process & tragus

What does Audiometry test?

- measurement of hearing acuity
- intensity (expressed in decibels) & pitch/frequency (highness or lowness of tones)

What does Dix-Hallpike test?

- Tests for vertigo. benign positioning vertigo (BPV)
- quick repositioning from sitting to supine causes twitching of the eye (Nystagmus)

What does a Electronystagmography identify?

- inner ear problems, vestibular problems
- tests for nystagmus (involuntary eye movements) & if it doesn't occur then there is an abnormality

What does an Auditory Brainstem Evoked Response identify?

- hearing loss in infants
- used for patients who are unable to indicate or are unreliable to indicate their recognition of sound

What is Meniere's disease?

- incapacitating, usually UNILATERAL, inner ear disorder
- ringing in the ears

What are five characteristics of Meniere's Disease?

- Tinnitus
- One sided hearing loss
- Vertigo
- Pain or pressure in the affected ear
- headache, N&V, diarrhea, abdominal pain

What is the pathophysiology of Meniere's disease? (2)

1. Cause theories = viral infections & autoimmune
2. increased endolymph causes dilation and sometimes rupture of the labyrinth leading to impaired motion perception and hearing loss

Increased ___ causes dilation and sometimes rupture of the labyrinth leading to impaired motion perception and hearing loss

endolymph

what are three diagnostic tests for Meniere's disease

1. hearing test
2. balance test
3. MRI

What are five nursing diagnoses for Meniere's disease?

1. Disturbed sensory perception: Auditory
2. Risk for injury
3. Anxiety (r/t loss of control)
4. Fear
5. Powerlessness (r/t loss of control)

Diet for disturbed auditory perception (3)

- low Na
- adequate fluids
- Restrict triggers = Hydrops diet (no alcohol, caffine, chocolate, or sugar)

What type of drug is used to reduce endolymph volume for disturbed auditory perception and powerlessness?

Diuretics
Drug therapy for Meniere's disease

What drug causes vasodilation decreasing pressure for disturbed auditory perception and powerlessness?

Niacin
Drug therapy for Meniere's disease

What type of drug has a drying effect and decreases the severity of symptoms of disturbed auditory perception and powerlessness?

Antihistamines
Drug therapy for Meniere's disease

What type of drugs are used sparingly and as a last resort for disturbed auditory perception?

Steroids = helps control manifestations
Drug therapy for Meniere's disease

List 3 alternate therapies for disturbed auditory perception and powerlessness

Acupuncture
Ginger
Chiropractic manipulation

List the drug therapies for Risk for Injury/Anxiety

- Antianxiety
- Antiemetics (for nausea)
- Gentamycin (stops vertigo signals to the brain, can cause permanent hearing loss)

What is the Meniett device (for Meniere's disease)?

This device applies low pressure micro pulses to the inner ear, this displaces fluid to improve vertigo and balance

What are the three surgical interventions for Meniere's disease?

1. Endolymphatic decompression = drainage & shunt
2. Vestibular nerve resection = radical procedure/last resort
3. Labyrinthectomy = radical procedure/last resort

What type of hearing loss can be corrected?

conductive

What is Conductive Hearing Loss (2)?

- sound waves do not pass to inner ear (physical obstruction, retracted or bulging tympanic membrane, or fused ossicles)
- inflammation or infection

What is Sensorineural Hearing Loss (3)?

- Damaged auditory nerve (CN 8) or inner ear hair cells
- defect to cochlea or brain
- ototoxicity to drugs/HTN/prolonged fever

what are five clinical manifestations of hearing loss?

1. difficulty understanding conversations, especially if a lot of people or a lot of background noise
2. accuse people of mumbling
3. respond to question inaccurately
4. fail to respond to request/question
5. May have pain, sensation of fullness, vertigo, tinnitis

Diagnostic test: what is weber test

- tuning fork placed on top of head, which ear hears the best or is it equal
- test for sensorineural hearing loss

Diagnostic test: what is rinne test

- place tuning fork on mastoid process, timing when the patient can no longer hear the sound then move the fork to the ear and time when patient can no longer hear (should be 2 -3 times longer)
- test for conductive hearing loss

Diagnostic test: what is laboratory?

- typically nothing but an increase in WBC might indicate acute or chronic otitis media

Diagnostic test: what is otoscopic examination?

looking for obstructions

Diagnostic test: what is Imaging?

determine non-auditory problems affecting hearing

Diagnostic test: what is Audiometry?

distinguish between conductive or sensorineural

What are seven nursing diagnoses for hearing loss?

1. Disturbed sensory perception (auditory)
2. Impaired verbal communication
3. Deficient knowledge
4. Social isolation
5. Risk for injury
6. Acute pain (r/t inflammatory process)
7. Impaired physical mobility (r/t vertigo)

What are two interventions for Disturbed sensory perception (auditory)

1. Halt the pathologic process =
a. antibiotics
b. antiemetic, antihistamine, anti-anxiety drugs
2. Improve auditory perception =
a. Assistive devices = amplifiers, flashing lights & hearing aids
b. cochlear implant

Nursing Interventions Impaired verbal communication r/t to Hearing Impaired

- sit directly in front of them
- sign language
- speak clearly, short sentences
- assistive devicess
- repeat over & over same exact way
- use side of best ear
- don't shout
- minimize background noise

What type of hearing loss is a cochlear implant for & what are the three parts?

- sensorineural loss
1. headpiece
2. speech processor
3. receiver with electrodes

What are two surgical options for hearing loss?

1. Tympanoplasty = reconstructs middle ear to improve conductive hearing loss
2. Stapedectomy = replace stapes with prosthesis. Most effective with hearing loss from otosclerosis

How many decimals can cause hearing loss?

85 or above

Multiple ____ decimals or higher for 1 minute can cause permanent hearing loss?

100

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