NEUROLOGICAL DISORDER, EAR DISORDERS. PPTX

EAR DISORDERS

2. External ear*
Middle ear*
Inner ear**
*Hearing only
**Hearing and Balance

5. used to visualize the external auditory meatus and the tympanic
membrane

6. guidelines:
tilt the head slightly away
and hold the otoscope
modern otoscopes are
directly connected to a
large monitor

7. guidelines:
straighten the ear canal
> 3 years old:
pull pinna and
< 3 years old:
pull pinna and

8. normal findings of the
and without lesions
has various amounts of and

9. normal findings of the
, ,
slightly

10. atmospheric transmission of sound to the inner ear (via ear
canal)
sound waves are transmitted to the inner ear by
without traveling through the air in the ear canal
remember:
sound is transmitted by air conduction and bone conduction
air conduction is longer than bone conduction

11. ask the client to external canal
the examiner stands away and quickly
the client is asked to
each ear is tested separately

13. Assesses

14. 1.strike tuning fork on hand
2.place tip of handle or stem on
of client’s
3.ask patient if he can hear the
tone equally, right ear, or left ear

15. the bones of the skull will carry
the sound to both cranial
nerves (VIII) then to the brain
normal:
sound is in both
ears (bone conduction)

16. (air conduction)
hearing loss:
sound is heard better in
ear
(nerve conduction)
hearing loss:
sound is heard better in
ear

17. air conduction to
bone conduction
helps conduction
from sensorineural hearing
loss

18. 1.strike tuning fork on hand
2.place tip of handle or stem on client’s
(bone conduction)
bony prominence located
immediately behind the ear

19. 3.when client can no longer hear bone
conduction, move tuning fork
(air conduction)
4.ask client which tone is louder?: bone
or air?

20. normal:
than bone
conduction
for sound than bone
“positive result”
AC > BC

21. than air conduction
“negative result”
than bone conduction
(normal)

23. The examiner asks the
client to with the
,
, and
The client normally remains
erect with slight swaying

24. Abnormal result:
significant swaying
fall

25. normal:
the client can easily
return to the point of
reference

26. a client with vestibular
function problem lacks a
normal sense of position
sense and is
to the extended
fingers to the point of
reference

27. findings
the fingers instead
either goes to the right
or left of the reference
point

28. examine the client’s eyes as
they look straight ahead, 30
degrees to each side,
upward & downward

29. abnormal findings
any spontaneous
* is a (+) result
*a constant involuntary
eye movement in any
direction
represents a problem in
the vestibular system

30. assesses for
or
while sitting, head is
rotated to one side
then while
observing the eyes for

31. abnormal findings
presence of nystagmus
after 5 to 10 seconds

32. determines CN VIII (Vestibular) and brainstem function
C/I for perforated TM

33. remember:
C.O.W.S.

34. is introduced in the ear canal via syringe
normal: eyes (nystagmus) move to the of
irrigation and quickly to midline
abnormal: no eye movement or eyes move towards the
irrigated side during cold irrigation

35. is introduced in the ear canal via syringe
normal: eyes (nystagmus) move to the of
irrigation and quickly to midline
abnormal: no eye movement or eyes move opposite the
irrigated side during cold irrigation

36. VERY uncomfortable (if patient is conscious), producing severe
vertigo, which persists even after nystagmus is no longer
present

38. assesses the mastoid, middle ear, and inner ear structures
multiple x-rays of the head are done with or without contrast
medium

39. nursing management:
All
are used to cover the cornea to diminish the
radiation to the eyes
The client must remain still in a

40. measures ,
between sound
intensities, and
earphones are fitted carefully
over the ears and the test is
then carried out on each ear

41. subject is required to indicate
whether he/she can just hear
or cannot hear a certain sound
the sound level may be
increased from a very low
level or reduced from a high
level

43. administering ear drops
briefly on hand or in a pocket
warming medication promotes comfort
ask patient to or on unaffected side

44. administering ear drops
< 3 years old: pull the pinna down and back
> 3 years old: pull the pinna up and back
administer prescribed number of drops
remain in said position for
place a small piece of in the meatus

46. MC disability in the U.S.
is not an actual disease but a

47. classifications:

48. results when sound waves
are blocked or interfered in
the and
disorders
with no damage
to hearing, or minimal
permanent hearing loss

49. etiologies:
ear wax (MC)
infection
foreign body
e.g. tympanosclerosis

50. etiologies:
e.g. Otosclerosis

51. due to impairment in the
that lead to
the cerebral cortex
results from a disorder in
the:

52. is
measures must be taken to
reduce further damage or
to attempt to amplify sound
as a means of improving
hearing to some degree

53. etiologies:
congenital and
hereditary factors
noise injury; prolonged
exposure to loud noise
aging and degenerative
processes

54. etiologies:
Meniere’s disease
ototoxicity
autoimmune diseases
syphilis (neurosyphilis)

55. etiologies:
DM
active and passive
smoking

56. etiologies:
certain medications:
aminoglycosides
diuretics
NSAIDs
alcohol
caffeine
nicotine

57. also known as conductive-
sensorineural hearing loss

58. may be due to an or from
insertion of into the ear canal can create:
further impaction of ear wax
trauma to ear canal or ear drum

59. are more susceptible
in the ear becomes coarser and traps the wax

60. cotton or insects
small toys
beads
food (corn)

61. Otitis media
infection of the middle ear
Allergic reactions
fluid accumulation in the middle ear
Scarring of TM due to infection

62. abnormal
stapes and the oval window become fixed and immobile
making sound transmission dampened
of the tympanic membrane and the ossicles

63. can and
may be due to:
hand slap
falling in water
sports injuries
cleaning the ear with sharp instrument
industrial accidents (welding sparks)

64. degenerative changes of the inner ear
usually permanent, bilateral, and total

65. chronic repeated acoustic trauma from loud noise
industrial
firearms
listening to loud music
can also be due to sudden loud noise (blast)

66. Acoustic neuroma (MC)
CN VIII tumor
temporal bone tumor
brain tumors
metastasis

67. endolymph
can also cause vertigo

68. manifestations:
frequently asking people to
answering questions
failing to respond when not looking in the direction of the
sound
inability to distinguish
; shouting in conversations (SNHL)

69. manifestations:
to hear
or when listening
ringing or roaring sensation in the ears ( )
SNHL
listening to the television or radio at

70. manifestations:
patient listens better in small groups
serous from the ear (TM perforation)

71. Voice quality Soft voice Loud voice
Speech discrimination Good Poor
Ability to hear on
telephone
Good Poor
Lateralization on Weber’s
test
To diseased ear To normal ear
Result on Rinne test
Negative,
AC < BC
Positive,
AC > BC

72. medical management:
(if due to infection)
except aminoglycosides
(if due to trauma or immunologic process)
medications

73. medical management:
mostly used for the client with
can help the client with SNHL, although it is not as
effective*
makes sound louder but does not improve the quality
amplifies all background noises

74. medical management:
client education on hearing aids
Adjust the volume to a to prevent
feedback squeaking
Instruct the client to clean ear with
Try to keep the hearing aid clean and dry

75. medical management:
client education on hearing aids
the hearing aid and when not
in use
Keep on hand

76. medical management:
no successful treatment has been reported
management is focused on by the
nurse and SO
diversional therapy

77. medical management:
directed toward teaching the client to use the other senses
more effectively

78. medical management:
of the client before you begin to speak
the client when speaking
move close to the client,
talk in a room without distracting noises

79. medical management:
talk in ,
sentences and information
Use

80. medical management:
keeping hands and other objects
when talking
encourage the client to when talking to
someone to improve vision for lip reading

81. used for sensorineural
hearing loss
a small computer converts

82. electrodes are placed by
the internal ear with a
computer device attached
to the external ear
electronic impulses directly
stimulate nerve fibers

83. electrodes are placed by
the internal ear with a
computer device attached
to the external ear
electronic impulses directly
stimulate nerve fibers

84. MC ear infection
inflammation of the external ear (ear
canal or external auditory meatus)
can lead to conductive hearing loss

85. etiologies:
Pseudomaonas aeruginosa (MC)
cleaning ear canal with a sharp
object

86. risk factors:
people who spend significant time in the water
wearing ear plugs, hearing aids, head- or ear-phones
removes protective layer of cerumen
has anti-microbial properties
makes it vulnerable to infection

87. risk factors:
can easily spread to nearby structures (cartilage and bone)

88. manifestations:
feeling or feeling of
in the ear
/ ear discharge
(watery or purulent)
(conductive)

89. manifestations:
severe
(earliest manifestation)
*in otitis media, pain is
unchanged with
manipulation
on auricle and
ear canal

90. nursing management:
thorough of ear canal if drainage or debris is present*
topical (otic drops) or if due to infection
administer medications for pain and itching

91. nursing management:
*instruct client that beyond
washing with soap and water
ear canals perform self-cleaning
teach client to on affected ear until fully
healed
usually around 7 to 10 days

92. nursing management:
Instruct the client to use for swimming
immediately dry the ears after swimming
to shake water out of the ear
use a to further dry the ear
Instruct the client that irritating agents such as or

93. nursing management:
Instruct the client that
lead to trauma to the
canal
may push debris or
cerumen further
s dryness

94. inflammation of the middle ear

95. associated with
and
, causing:
impairs function of E-
tube (normalizes
pressure in middle ear)

96. associated with
and
, causing:
ear via E-tube
infants and children are
more prone
Eustachian tubes are
shorter, wider, and
straighter

97. risk factors:
during:
air travel
deep sea diving
unable to adapt to sudden change in pressure

98. complications:
Conductive hearing loss
Mastoiditis
Brain abscess
Meningitis
Rupture of tympanic membrane

99. manifestations:
hearing loss
inflamed and bulged
tympanic membrane
pain
bleeding

100. manifestations:
fever
vertigo (severe)
tinnitus (severe)
purulent ear discharge
(TM rupture)

101. manifestations:
among infants:
irritability
rolling of head from side to side
pulling on or rubbing the ear

102. nursing management:
encourage
provide and have the child
to  edema
instruct patient to temporarily
to  pain sensation
instruct patient to
may indicate TM perforation

103. nursing management:
administer medications:
antibiotics
analgesics
corticosteroids
antipyretics
anti-histamines or decongestants*

104. surgical management:
intended to clients

105. surgical management:
MD
to TM to:
in middle ear
and

106. part of the temporal bone,
adjacent to the middle ear
full of cavities called

107. inflammation of the Mastoid
process / Mastoid air cells
usually secondary to
common among clients with

108. may (rarely) lead to
due to the advent of

109. manifestations:
recurrent ear pain and
hearing loss
(behind
the ear)
swelling of the auricle

110. manifestations:
fever
signs of otitis media

111. nursing management:
practice by
stress the importance of

112. surgical management:
Mastoidectomy with
Tympanoplasty
surgical removal of
mastoid air cells or
process with possible
removal of ossicles

113. surgical management:
Mastoidectomy with
Tympanoplasty
surgical
reconstruction of
middle ear

114. post-op nursing care:
asses for evidence of infection or bleeding
hearing may temporarily or permanently be impaired
family and other hospital staff
because vertigo is not unusual post-op

115. post-op nursing care:
and position client on the
Monitor for signs of meningitis (or )

116. bony overgrowth of the tissue
surrounding the ossicles causing:
the
common among and

117. manifestations:
conductive hearing loss
slow
progressive
bilateral
tinnitus
Rinne test reveals BC > AC

118. manifestations:
reddish-blue discoloration
of the tympanic membrane

119. surgical management:
with prosthesis
and a
prosthesis is connected
between the incus and the
footplate
sounds cause the prosthesis
to vibrate in the same
manner as the stapes

120. post-op nursing care
Inform the client that after surgery
and no noticeable improvement in hearing may occur for as
long as
Inform the client that the used after surgery
interferes with hearing but is used to
during the first 1 to 2 days after surgery
Rasie when the client is in bed

121. post-op nursing care
Administer medications as ordered
Assess for facial , weakness, changes in taste
sensation, vertigo, N/V
Instruct when changing positions

122. post-op nursing care
Lie on with
Instruct to , or
Instruct to refrain from using to clean the external
ear canal
Instruct caused by
quick head movements, sneezing, nose blowing, straining &
changes in altitude

124. perception that either oneself or one’s surroundings are
involves feelings of
feeling that you are about to or
client does not feel that he or his surroundings are moving

125. types:
involves problems of the
involves problems in the and

126. *types of Peripheral Vestibular Disorders

127. head movement creates a (vertigo)
usually
weeks to months

128. inflammation of the inner ear
(Labyrinth)
exact etiology is

129. manifestations:
triad
(severe and sudden)
sensorineural hearing loss
(+) caloric test

130. in vestibule and semi-circular canals
 (endolymphatic) pressure can cause degeneration of
structures

131. etiologies:
viral and bacterial
production or drainage of endolymph

132. risk factors:
sodium intake
stress
allergies
vasoconstriction
PMS

133. manifestations:
triad:
(recurrent)
(becomes worse during vertigo attack)
(roaring or ringing)

134. manifestations:
feelings of fullness in the ear
N/V
nystagmus
sweating

135. medications:
()
to  endolymphatic pressure
given to Meniere’s disease
or

136. nursing management:
in a quiet darkened room
cause vasoconstriction
turn the whole body rather than just the head

137. nursing management:
if vertigo occurs
if driving, and wait for symptoms
to subside
provide e with walking
for tinnitus listen from a radio or sound system

138. foreign objects placed in the
external canal may exert pressure
on the tympanic membrane and
cause perforation

139. the tympanic membrane has a
limited stretching ability and
gives way under high pressure
ossicles may also be damaged
depending on the damage
to the ossicles, hearing loss
may or may not return

140. to the basal skull
ear ear can damage the middle
ear structures through
fractures
and
that occur
with non-pressurized air flights
can increase pressure in the
middle ear

141. (–) vertigo or tinnitus

142. nursing management:
Tympanic perforations usually
Surgical reconstruction may be performed to improve hearing
if ossicles are dmaged

143. CERUMEN / EAR WAX
the most common cause of impacted canals / ear obstruction

144. FOREIGN BODIES
can include vegetables, beads, pencil erasers, and insects
medical emergency

145. manifestations:
sensation of with or without hearing loss
, or

146. nursing management:
remove the wax via
irrigation is
contraindicated in
clients with a history of
tympanic membrane
perforation

147. nursing management:
add 3 gtts to
the ear at bedtime and 3
gtts of
BID
after few days the ear is
irrigated

148. nursing management:
if the foreign matter is vegetable, irrigation is used with care
insects are killed before removal unless they can be coaxed out
by or a
or is instilled to suffocate the insect which
is then removed with ear forceps

149. nursing management:
use to
remove the object and