BHU DISORDERS OF THE EAR & EYE 400 LEVEL.pptx

Eye and ear disorder

1. DISORDERS OF THE EAR IMPACTED CERUMEN / WAX DEFINITION: This is the dryness of wax and the blockage of the auditory canal with cerumen that reduces the hearing ability of the affected individual CAUSES: (1) Poor personal hygiene (2) Endocrine disorders TYPES: (1) S oft wax (2) Hard wax (3) Very hard wax

2. SIGNS & SYMPTOMS: Discomfort in the ear (2) Itching (3) Difficulty in hearing (4) Tinnitus (5) Pain MANAGEMENT OF IMPACTED CERUMEN Application of ear drop Ear irrigation & Syringing Ear cleaning with cotton wool stick Surgical removal of wax under anaesthesia

3. FOREIGN BODIES IN THE EAR DEFINITION: This is the presence of foreign object in the ear. It is commonly seen in children in which they introduce foreign body such as chalk, beans seed, beads, pencil cleaner, pin etc into the ear. SIGNS & SYMPTOMS: (1)Presence of foreign object in the ear (2) Pain (3) Bleeding (4) Discomfort in the ear (5) Difficulty of hearing

4. MANAGEMENT OF FOREIGN BODIES IN THE EAR Removal of foreign bodies with auditory forceps Removal under anaesthesia by Otologist Oral or topical Antibiotics to prevent infection e.g genticin ear drop Analgesics such as Tabs paracetamol ii tds to relief pain COMPLICATIONS: Perforation of the ear drum Ear injury Ear Infection ( e.g otitis media) Hard of hearing or deafness

5. VERTIGO DEFINITION: This is a sensation of abnormal movement of the surrounding objects in relation to the affected person. That is a sudden feeling of movement or spinning of surrounding object round or up and down infront of the affected person. This is often followed by vomiting, collapse & sweating but without loss of conciousness CAUSES: (1) Meniere’s disease (dilation of labyrinth & destruction of sensory cells) (2) Ear injury (3) Positional vertigo (4) Labyrinthitis (5) Chronic otitis media (6) Diseases of cerebellum (7) Diseases of CNS

6. DIAGNOSTIC PROCEDURES: Medical & surgical history General physical examinations Audiogram X – Ray of internal auditory meatus Neurological test to exclude diseases of CNS MANAGEMENT IN THE ACUTE STAGE: (1) B ed rest (2) Tabs Avomine 25mg 6 hrly IN SEVERE CASES: (1) Admission & bed rest (2) Inj Phernegan 25mg 12 hrly (3) Inj Chlorpromazine 1.25mg 6 hrly

7. ADVICE: (1) Reduce fluid intake (2) Stop salt intake (3) Stop smoking (4) Rest SURGICAL MANAGEMENT: Myringotomy & insertion of grommet Ultrasonic destruction of the Labyrinth leaving the cochlea intact

8. TINNITUS DEFINITION: This is the perception of sound in the absence of acoustic stimulus which may be intermittent, continuous or pulsatile. TYPES: (1) Subjective tinnitus (2) Objective tinnitus CAUSES: (1) Noise trauma (2) Drugs toxin e.g salicylates, quinine & streptomycin (3) Head injury (4) Ischemia (5) Meniere’s disease (6) DM (7) Disorders of CNS (8) Impacted wax (9) Secretory otitis media (10) Otosclerosis (11) Carotid artery tumors ( Glomus tumors) (12) Severe anaemia

9. (13) Hypotension (14) Psychogenic causes ( e.g Depression, Anxiety) SIGNS & SYMPTOMS: (1) Hearing of abnormal sound (2) Episode may be intermittent, continuous or pulsatile (3) Hearing loss DIAGNOSTIC PROCEDURES: (1) Medical & surgical Hx (2) Audiological examination (3) Complete haemogram /CBC (4) CT Scan (5) X- Ray MANAGEMENT: Treat the cause MEDICAL MGT: (1) Antianxiety & Anticonvulsants ( e,g Carbamezapine or Tegretol ) (2) Sedatives ( e.g Diazepam at night) (3) Vasodilators ( e.g Vasoprin ) (4) Tocainide is a common drug used for RX of tinnitus

10. SURGICAL MGT: Endolymphatic sac decompression Intratympanic injection of alcohol Cryotherapy for cochlear destruction Cochlear nerve section Use of tinnitus maskers ( e.g headphone) COMPLICATION: Psychological problems Attempted suicide

11. MENIERE’S DISEASE DEFINITION: Is a chronic disease of the inner ear characterised by recurrent vertigo, tinnitus and hearing loss CAUSES: (1) Unknown/Idiopathic (2) Genetic disorders (3) Trauma (4) Syphilis (5) Otosclerosis (6) Infection INCIDENCE: Common among adults between 30 – 60 years of age. It may initially be unilateral but becomes bilateral after 2 – 5 years of unilateral onset SIGNS & SYMPTOMS: (1) Vertigo (2)Worsening tinnitus (3) Nausea & Vomiting (4) Sensory hearing loss (5) Feeling of fullness or pressure in the affected ear (6) Intolerance to loud noises

12. DIAGNOSTIC TESTS: (1) Medical & Surgical history (2) X – Ray (3) Neurological test PATHOPHSIOLOGY: Due to overproduction or decrease absorption of endolymph there is destruction of the neural end organ of the labyrinth and cochlea which causes rupture of the labyrinth. The rupture allows endolymph into the perilymphatic space causing a temporary paralysis of sensory structures leading to symptoms of meniere’s disease. MANAGEMENT: SURGICAL MGT: (1) Decompression of endolymphatic sac (2) Labyrinthectomy (3) Vestibular neurectomy MEDICAL MGT: (1) Anticholinergic for relief of vertigo

13. (2) Antiemetics e.g avomine (3) Sedatives e.g Diazepam (4) Duiretics e.g Lasix (5) Antihistamin e.g Phernegan (6) Vasodilator e,g Vasoprin NURSING MGT: Admission & bed rest (2) Safety precautions (3) HE on avoidance of sudden head movement (4) Diet: Low sodium diet to reduce fluid retention (5) Physical care (6) Psychological care (7) Medications (8) Advice on discharge (9) Follow up care/Home visits COMPLICATION: Progressive hearing loss

14. LABYRINTHITIS DEFINITION: This is an inflammation or infection of the inner ear that involves the cochlear or vestibular portion of the labyrinth. TYPES: (1) Serous labyrinthitis (2) Diffuse labyrinthitis CAUSES: (1) Drugs intoxication (2) Alcohol intoxication (3) Acute otitis media (4) Chronic otitis media (5) Ear or mastoid surgery complication RISK/PREDISPOSING FACTORS: Nasal or ear surgery (2) Viral infections (3) Chronic ear infections

15. SIGNS & SYMPTOMS: Vertigo (2) Tinnitus (3) Sensorineural hearing loss (4) Dizziness (5) Nystagmus (Abnormal rhythmic jerking movement of the eyes) (6) Pain (7) Fever (8) Nausea & Vomiting (9) Ataxia PATHOPHYSIOLOGY: In both serous and diffuse labyrinthitis cellular infiltration of serous fluid or serofibrinous exudate occurs leading to destruction of soft tissue structures resulting in total, permanent hearing loss if not identified and treated. In chronic labyrinthitis the internal ear is filled with granulations which may change to fibrous tissue and then calcify into new bone in the labyrinth space leading to complete loss of hearing

16. DIAGNOSTIC TESTS: (1) Medical & Surgical history (2) X – Ray (3) Audiometry MEDICAL MANAGEMENT: Antibiotics to treat infection as a cause Antiemetics to treat N & V Vestibular suppressant & Antivertigo medications NURSING MANAGEMENT: Rest to reduce turning and movement of the head Safety precautions to prevent falls Psychological care COMPLICATIONS: (1) Dehydration (2) Falls (3) Electrolyte imbalance (4) Deafness

17. OTOSCLEROSIS DEFINITION: This is a disease of the bony labyrinth in which the normal haversian bone is replaced by vascular bone laid down irregularly which later becomes sclerotic. Involvement of the oval window causes fixation of the stapes, footplate thus preventing sound waves from reaching the inner ear leading hearing loss. MANAGEMENT: Hearing aid Stapedectomy operation Tabs Avomine to relief vomiting and vertigo