ACENA, JOBELLE C.

ALTERED COGNITIVE-PERCEPTUAL PATTERNS: CLIENT WITH AUDITORY

DISORDERS

Acena, Jobelle C.

Union Christian College

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The Ear: Hearing and Balance

At first glance, the machinery for hearing and balance appears very crude.

Anatomy of the Ear

Anatomically, the ear is divided into three major areas: the external, or outer, ear; the middle ear,
and the internal, or inner, ear.

External (Outer) Ear

The external, or outer, ear is composed of the auricle and the external acoustic meatus.

 Auricle. The auricle, or pinna, is what most people call the “ear”- the shell-shaped
structure surrounding the auditory canal opening.
 External acoustic meatus. The external acoustic meatus is a short, narrow chamber
carved into the temporal bone of the skull; in its skin-lined walls are the ceruminous
glands, which secrete waxy, yellow cerumen or earwax, which provides a sticky trap for
foreign bodies and repels insects.
 Tympanic membrane. Sound waves entering the auditory canal eventually hit the
tympanic membrane, or eardrum, and cause it to vibrate; the canal ends at the ear drum,
which separates the external from the middle ear.

Middle Ear
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The middle ear, or tympanic cavity, is a small, air-filled, mucosa-lined cavity within the temporal
bone.

 Openings. The tympanic cavity is flanked laterally by the eardrum and medially by a

bony wall with two openings, the oval window and the inferior, membrane-covered round
window.
 Pharyngotympanic tube. The pharyngotympanic tube runs obliquely downward to link
the middle ear cavity with the throat, and the mucosae lining the two regions are
continuous.
 Ossicles. The tympanic cavity is spanned by the three smallest bones in the body, the
ossicles, which transmit the vibratory motion of the eardrum to the fluids of the inner ear;
these bones, named for their shape, are the hammer, or malleus, the anvil, or incus, and
the stirrup, or stapes.

Internal (Inner) Ear

The internal ear is a maze of bony chambers, called the bony, or osseous, labyrinth, located deep
within the temporal bone behind the eye socket.

 Subdivisions. The three subdivisions of the bony labyrinth are the spiraling, pea-sized
cochlea, the vestibule, and the semicircular canals.
 Perilymph. The bony labyrinth is filled with a plasma-like fluid called perilymph.
 Membranous labyrinth. Suspended in the perilymph is a membranous labyrinth, a
system of membrane sacs that more or less follows the shape of the bony labyrinth.
 Endolymph. The membranous labyrinth itself contains a thicker fluid called endolymph.

Mechanisms of Equilibrium

The equilibrium receptors of the inner

ear, collectively called the vestibular
apparatus, can be divided into two
functional arms- one arm responsible for
monitoring static equilibrium and the
other involved with dynamic
equilibrium.

Static Equilibrium

Within the membrane sacs of the

vestibule are receptors called maculae
that are essential to our sense of static
equilibrium.
ACENA, JOBELLE C. 4

 Maculae. The maculae report on changes in the position of the head in space with respect
to the pull of gravity when the body is not moving.
 Otolithic hair membrane. Each macula is a patch of receptor (hair) cells with their
“hairs” embedded in the otolithic hair membrane, a jelly-like mass studded with otoliths,
tiny stones made of calcium salts.
 Otoliths. As the head moves, the otoliths roll in response to changes in the pull of
gravity; this movement creates a pull on the gel, which in turn slides like a greased plate
over the hair cells, bending their hairs.
 Vestibular nerve. This event activates the hair cells, which send impulses along the
vestibular nerve (a division of cranial nerve VIII) to the cerebellum of the brain,
informing it of the position of the head in space.

Dynamic Equilibrium

The dynamic equilibrium receptors, found in the semicircular canals, respond to angular or
rotatory movements of the head rather than to straight-line movements.

 Semicircular canals. The semicircular canals are oriented in the three planes of space;
thus regardless of which plane one moves in, there will be receptors to detect the
movement.
 Crista ampullaris. Within the ampulla, a swollen region at the base of each membranous
semicircular canal is a receptor region called crista ampullaris, or simply crista, which
consists of a tuft of hair cells covered with a gelatinous cap called the cupula.
 Head movements. When the head moves in an arclike or angular direction, the
endolymph in the canal lags behind.
 Bending of the cupula. Then, as the cupula drags against the stationary endolymph, the
cupula bends- like a swinging door- with the body’s motion.
 Vestibular nerve. This stimulates the hair cells, and impulses are transmitted up the
vestibular nerve to the cerebellum.

Mechanism of Hearing

The following is the route of sound waves through the ear and activation of the cochlear hair
cells.

 Vibrations. To excite the hair cells in the organ of Corti in the inner ear, sound wave
vibrations must pass through air, membranes, bone and fluid.
 Sound transmission. The cochlea is drawn as though it were uncoiled to make the events
of sound transmission occurring there easier to follow.
 Low frequency sound waves. Sound waves of low frequency that are below the level of
hearing travel entirely around the cochlear duct without exciting hair cells.
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 High frequency sound waves. But sounds of higher frequency result in pressure waves
that penetrate through the cochlear duct and basilar membrane to reach the scala tympani;
this causes the basilar membrane to vibrate maximally in certain areas in response to
certain frequencies of sound, stimulating particular hair cells and sensory neurons.
 Length of fibers. The length of the fibers spanning the basilar membrane tune specific
regions to vibrate at specific frequencies; the higher notes- 20, 000 Hertz (Hz)- are
detected by shorter hair cells along the base of the basilar membrane.

APPLICATION OF THE NURSING PROCESS

A. ASSESSMENT
1. SUBJECTIVE DATA
a. Nursing History
 Sebaceous cyst behind the ear - A sebaceous cyst is a rounded swollen area of the
skin formed by an abnormal sac of retained excretion (sebum) from the sebaceous
follicles.
 Tophi - A nodular mass of uric acid crystals. Tophi are characteristically deposited in
different soft tissue areas of the body in chronic (tophaceous) gout. Even though tophi
are most commonly found as hard nodules around the fingers, at the tips of the
elbows, and around the big toe, they can appear anywhere in the body. They have
been reported in unexpected areas such as in the ears, in the vocal cords, and around
the spinal cord.
 Impacted Cerumen - when earwax (cerumen) builds up in the ear and blocks the ear
canal; it can cause temporary hearing loss and ear pain.
 Discharge in the canal - Ear discharge, also known as otorrhea, is any fluid that
comes from the ear.
 Swelling of pinna, pain - Perichondritis of the ear can be a diffuse inflammatory, but
not necessarily infectious, process resulting in diffuse swelling, redness, and pain of
the pinna, or an abscess between the cartilage and the perichondrium.
 Scalling of lesions - Scaling skin is dry, cracked, or flaky skin. Also known as
desquamation, scaling skin happens when the outer layer of the skin, called the
epidermis, begins to flake off. Scaling skin may arise when an injury or a medical
condition damages the outer layer of skin.
 Exostosis - also known as bone spur, is the formation of new bone on the surface of a
bone. Exostoses can cause chronic pain ranging from mild to debilitatingly severe,
depending on the shape, size, and location of the lesion.
 Retracted, bulging perforated eardrum - eardrum gets pushed inward toward your
middle ear

B. Functional Health Problems

2. OBJECTIVE DATA
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a. Physical assessment for Auditory System

The external ear is examined by inspection and direct palpation, and the tympanic
membrane is inspected with an otoscope and indirect palpation with a pneumatic
otoscope. Until the advent of middle ear endoscopy, inspection of the middle ear was
impossible. Evaluation of gross auditory acuity also is included in every physical
examination.

1. Inspection and Palpation

 External Ear - Inspection of the external ear is a simple procedure, but it is

often overlooked. The auricle and surrounding tissues should be inspected for
deformities, lesions, and discharge, as well as size, symmetry, and angle of
attachment to the head.

 Ear Canal Direct Observation

o Otoscopy
 Place the largest speculum that comfortably fits in the patient's ear
on the head of the otoscope and turn on the light source.
 Angle the otoscope handle either directly downward or towards the
patient's forehead.
 Stabilize your otoscope hand by placing the fourth and fifth digits
on the patient's head.
 With your free hand, pull the ear up and in a posterior direction to
straighten the canal as you insert the otoscope at a slightly
downward angle.

Interpretation

 Inspect for the presence of discharge, redness, cerumen, swelling, and foreign

bodies. 
 The tympanic membrane normally reflects the otoscope's light, which is known as
the light reflex (or “cone of light”). 
 See otitis externa, otitis media, and tympanosclerosis for additional findings.
 A pneumatic bulb allows for assessment of tympanic membrane mobility. 

 Test for Auditory Acuity

Screening assessments

o Whispered voice test: While standing behind the patient, whisper a phrase or numbers in
each ear → Ask the patient to repeat what you whispered.
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o Finger rub test: Place your fingers several centimeters from either ear → Rub your
fingertips together and ask the patient if they heard it.

Tuning fork tests

o Performed in order to distinguish between conductive hearing loss and sensorineural

hearing loss.
 Weber test: tests for lateralization (sound is heard louder in one ear than the
other)
o Place the base of a vibrating tuning fork on the middle of the
forehead and ask the patient from which ear the sound is louder.
o The sound is normally heard equally in both ears.

Interpretation

o Lateralization → asymmetric hearing loss

o No lateralization → normal hearing or bilateral hearing loss

 Rinne test: tests for air conduction vs bone conduction in the examined ear
o Place the base of a vibrating tuning fork on the mastoid process of the
ear. Once the patient no longer hears a tone, immediately hold the
“U” part of the fork over the outer ear and ask the patient if they can
still hear it.
o Air conduction is normally greater than bone conduction, so the
patient should still be able to hear the tuning fork next to the outer
ear after they can no longer hear it when placed on the mastoid
process.

Interpretation

 Unable to hear the tuning fork → There is conductive hearing

loss (bone conduction > air conduction) in the examined ear (Rinne
test is negative) 
 Still able to hear tuning fork over the outer ear → There
is no conductive hearing loss (Rinne test is positive);
possible sensorineural hearing loss (air conduction > bone conduction)
if there is diminished hearing in the examined ear

 Test for Vestibular Acuity

o Romberg Test
 The Romberg test is an appropriate tool to diagnose sensory
ataxia, a gait disturbance caused by abnormal proprioception
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involving information about the location of the joints. It is also

proven to be sensitive and accurate means of measuring the
degree of disequilibrium caused by central vertigo, peripheral
vertigo and head trauma.
o Tandem Test
 The Sharpened or Tandem Romberg test is a variation of the
original test. The implementation is mostly the same. For this
second test, the patient has to place his feet in heel-to-toe
position, with one foot directly in front of the other. As with
the original Romberg test, the assessment is performed first
with eyes open and then with eyes closed. The patient crosses
his arms over his chest, and the open palm of the hand lies on
the opposite shoulder. The patient also distributes his weight
over both his feet and holds his chin parallel with the floor
 Past-pointing Test
o a test for defective functioning of the vestibular nerve in which a
subject is asked to point at an object with eyes open and then closed
first after rotation in a chair to the right and then to the left and which
indicates an abnormality if the subject does not past-point in the
direction of rotation
 Test for Nystagmus
o Nystagmus is described in terms of:
 Direction (of the faster, corrective phase).
 Amplitude (fine or coarse).
 Frequency (high, moderate or low).
 Waveform (jerk, pendular or mixed).
 Symmetry and conjugacy (if bilateral).

Note in which position of gaze it occurs:

 Primary position - looking straight ahead.

 Secondary positions - looking straight up/down, straight
right or left.
 Tertiary positions - these are the four oblique positions: up
and right, down and right, up and left, down and left.
 Cardinal positions - these include all the secondary and
tertiary positions.
 Examine the patient sitting facing you: observe the nystagmus
in the primary position.
 Using a small fixation target, observe the nystagmus in all
positions of gaze.
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 Ask the patient to comment on visual symptoms as the eyes

move (eg, blurring, double vision).
 Enquire about the 'null' point: this is an angle which some
patients find minimises their visual impairment - it often
results in abnormal head positioning.
 Check oculocephalic reflex (doll's head phenomenon):
 This reflex is produced by moving the patient's head left to
right or up and down. When the reflex is present, the eyes
remain stationary while the head is moved, moving in
relation to the head.
 An alert patient normally does not have the doll's-eye
reflex because it is suppressed. Inability to suppress the
oculocephalic reflex suggests vestibular imbalance.
 The test may be performed by having the patient extend the
arm out in front of the body and fixate on the outstretched
thumb:
o Patients should be instructed to rotate their torso
such that the thumb remains in front of the body at
all times.
o Patients with the ability to suppress the
oculocephalic reflex should be able to maintain
fixation on their thumb while rotating.
o An abnormal test result would show the patient
continuously losing fixation of the thumb.
 Other tests of the vestibular system include Romberg's test
and caloric testing (see 'Vestibular nystagmus', below).
 Carry out a full neurological examination.
 Other examination depends on findings.

2. Diagnostic Assessment

Non-invasive Test

o Test for Aural Structure

 ICT
 MRI
o Test for Auditory Function
 Audiometric Test
 Audiometry is the single most important diagnostic instrument.
Audiometric testing is of two kinds: pure-tone audiometry, in which the
ACENA, JOBELLE C. 10

sound stimulus consists of a pure or musical tone (the louder the tone
before the patient perceives it, the greater the hearing loss), and speech
audiometry, in which the spoken word is used to determine the ability to
hear and discriminate sounds and words.
 Audiography
o Weber
 The Weber test uses bone conduction to test lateralization of sound. A
tuning fork (ideally, 512 Hz), set in motion by grasping it firmly by its
stem and tapping it on the examiner’s knee or hand, is placed on the
patient’s head or forehead. A person with normal hearing will hear the
sound equally in both ears or describe the sound as centered in the middle
of the head. In cases of conductive hearing loss, such as from otosclerosis
or otitis media, the sound is heard better in the affected ear. In cases of
sensorineural hearing loss, resulting from damage to the cochlear or
vestibulocochlear nerve, the sound lateralizes to the better-hearing ear.
The Weber test is useful for detecting unilateral hearing loss
o Rinne
 In the Rinne test (pronounced rin-ay), the examiner shifts the stem of a
vibrating tuning fork between two positions: 2 inches from the opening of
the ear canal (ie, for air conduction) and against the mastoid bone (ie, for
bone conduction) (Fig. 59-6). As the position changes, the patient is asked
to indicate which tone is louder or when the tone is no longer audible.
Normally, sound heard by air conduction is audible longer than sound
heard by bone conduction. The Rinne test is useful for distinguishing
between conductive and sensorineural hearing losses. With a conductive
hearing loss, bone-conducted sound is heard as long as or longer than air-
conducted sound, whereas with a sensorineural hearing loss, air-conducted
sound is audible longer than bone conducted sound. In a normal hearing
ear, air-conducted sound is louder than bone-conducted sound.
o Tympanometry
 A tympanogram, or impedance audiometry, measures middle ear muscle
reflex to sound stimulation and compliance of the tympanic membrane by
changing the air pressure in a sealed ear canal. Compliance is impaired
with middle ear disease.
o Brain Stem responses
 The auditory brain stem response is a detectable electrical potential from
cranial nerve VIII and the ascending auditory pathways of the brain stem
in response to sound stimulation. Electrodes are placed on the patient’s
forehead. Acoustic stimuli, usually in the form of clicks, are made in the
ear. The resulting electrophysiologic measurements can determine at
ACENA, JOBELLE C. 11

which decibel level a patient hears and whether there are any impairments
along the nerve pathways (eg, tumor on cranial nerve VIII).
 Electroencephalography
 Oto-acoustic emissions
o Test for Vestibular Function
 Platform post urography
 Platform posturography is used to investigate postural control
capabilities. The integration of visual, vestibular, and proprioceptive
cues (ie, sensory integration) with motor response output and
coordination of the lower limbs is tested. The patient stands on a
platform, surrounded by a screen, and different conditions such as a
moving platform with a moving screen or a stationary platform with
a moving screen are presented. The responses from the patient on
six different conditions are measured and indicate which of the
anatomic systems may be impaired. Preparation for the testing is the
same as for electronystagmography.
 Rota chair assessment
 Sinusoidal harmonic acceleration, or a rotary chair, is used to assess
the vestibulo-ocular system by analyzing compensatory eye
movements in response to the clockwise and counter clockwise
rotation of the chair. Although such testing cannot identify the side
of the lesion in unilateral disease, it helps identify disease and
evaluate the course of recovery. The same patient preparation is
required as for electronystagmography.

Invasive Test

 Arteriography
 Test for vestibular function
o Electro-nystagmography
 Electronystagmography is the measurement and graphic recording
of the changes in electrical potentials created by eye movements
during spontaneous, positional, or calorically evoked nystagmus.

Laboratory Tests

 Blood Tests.
 Cultures (ear drainage)
 Test for the presence of CSF
 Tissue specimen
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C. PLANNING FOR HEALTH PROMOTION, RESTORATION AND

MAINTENANCE
1. Planning for Health Promotion
 Ear Protection
o Sound intensity is measured in decibels (db); frequency by hertz (hz).
Ordinary speech is about 50 db.
o Discourage irrigation of the ears because of cerumen accumulation; it affords
some protection for the middle ear.
o Instruct individual on precautionary measures against infection, injuries, and
proper care of the ears.
 Proper Blowing of the Nose
o Blow gently with both nares and eyes open. Excessive pressure occurs when
the nostrils are closed and forces infected secretions up to the Eustachean tube
o Sign of ear infection
o Pain in the external ear
o Presence of tenderness
o Itching in the ear canal
o Inflammation can be detected by an otoscope
o Presence of drainage
 Proper Rest and Adequate Nutrition
o 8 to 10 hours of sleep and rest
o Vitamin C (ascorbic acid)
 Care of Health Ear
o External ear may be washed with soap and water daily while bathing or
showering
o Wax serves as a protective mechanism
o Cerumen lubricates the skin and traps foreign material that enters the canal
o Clean the auditory canal only with a wet wash cloth over the tip of the finger
o Do not insert anything into the auditory canal beyond the extent of vision
o Wash hands before and after caring for the patient’s ears and between
procedures for both ears to prevent cross contamination
o Be gentle when manipulating the external ear
o Do not place anything, especially water, in the ear canal without a physician’s
order
o Solutions for instillation or irrigation should be at body temperature’
 Periodic Auditory Examination
o Periodic (every 2 to 3 years) ear examination for evaluation of hearing is
important in the adult because aging frequently causes degenerative changes
in the ear as well as in other body tissues.
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 Exposure to noise levels below 85 db usually does not affect hearing

o Hearing returns to normal levels after a period of rest from hazardous noise
o Exposure to more than 85 db to 95 db of sound for several hours a day can
lead to progressive or permanent hearing loss.
o Exposure to more than 100 db for an extended time can damage the hearing,
and level about 120 db may cause damage even if one is exposed to sounds
for only a short period.
o Sounds over 130 db can produce severe pain in the ear.
o People with noise –induced hearing loss can hear speech but not clearly, they
tend not to hear high frequency consonants such as sh and ch.
o Clients who are affected are usually not aware of the changes until the noise
exposure has been of sufficient severity and duration to affect speech
frequency range.
 Consequences that may result in hearing problems when not detected early
o The child may fail to develop normal language and speech. Hearing is
essential if the child is to learn how to talk. Distorted speech is likely to result
when only partial sounds are heard.
o The child becomes deprived of the give-and-take relationship with the family
and surroundings, which is basic for speech and language development and
for personal growth and satisfaction.
o This educational process will be interfered with if language cannot be
comprehended. If the child fails to achieve, he or she may be classified as
mentally retarded.
o Adjustment problems may manifest. Children may become aggressive,
disobedient or withdrawn.
o Family relationships may be affected because of anxiety, guilty feelings or
shame about the impairment.
 Prevention of hearing loss
o Ear plugs have been proven to reduce noise by 20 to 35 db; however, to be
effective, the plugs must fit directly in the meatus. When plugs are worn,
instructions should be given regarding the importance of keeping them clean
so that the chances of developing ear infections are decreased.
o Earmuffs are advisable if a noise level is reaching 140 db, such as around
jetplanes. Noise-induced hearing loss is caused by progressive destruction of
sensory cells in the ears and cannot be medically or surgically repaired,
therefore, prevention is the key to avoid noise-induced hearing loss. Exposure
to noise level above 90 db for over 8 hours in a day is considered excessive.
o Rubber, plastic, and wax-impregnated cotton are helpful in providing a similar
form of protection like earplugs and earmuffs.
ACENA, JOBELLE C. 14

2. Planning for Health Maintenance and Restoration

 Administration of Ear Drops
o Medications of the ear should be warmed near body temperature (37.7℃)
to prevent discomfort. DO NOT OVERHEAT; too high temperature may
cause vertigo.
o Instruct patient to turn head so that it is tilted away from the affected side.
o After drops are instilled; the head is kept tilted for a few minutes to
prevent leakage of drops from the ear.
o For child: pull the pinna downward and backward
o For adult: pull the pinna upward and backward
o Pressure should be low to prevent damage to the eardrum by the height of
the container or force applied to the bulb must be controlled.
 Softening and Removing Cerumen Deposits
o Daily instill a few drops of Hydrogen Peroxide or warmed Glycerin.
Carbamide (urea) peroxide in glycerol (Debrox) may be used..
 Ear irrigation – prescribed to:
o Clean the external auditory canal
o Remove impacted cerumen
o Apply heat or cold to the ear
o Apply antiseptic solutions to the auditory canal
o Remove foreign bodies
 Never irrigate to remove vegetable foreign objects as moisture
causes vegetable matter to swell; irrigations are not prescribed if
the eardrum is punctured
 Tap water, normal saline, or solution of bicarbonate soda may be
prescribed as irrigating solutions
 Procedure: position the person so that the head tilts slightly
forward and toward the affected ear. Straighten the auditory canal;
place the tip of the syringe or tube just inside the meatus and direct
a slow, steady stream of solution against the roof of the auditory
canal (this prevents forcing plugged materials further into the canal
and injuring the eardrum).

D. COMMON HEALTH PROBLEMS

1. Disturbance in the external and middle ear
 Conductive hearing loss
o Conductive hearing loss usually results from an external ear disorder, such as
impacted cerumen, or a middle ear disorder, such as otitis media or
otosclerosis.
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External Ear and Canal Trauma

 External Otitis
o External otitis, or otitis externa, refers to an inflammation of the external
auditory canal. Causes include water in the ear canal (ie, swimmer’s ear);
trauma to the skin of the ear canal, permitting entrance of organisms into the
tissues; and systemic conditions, such as vitamin deficiency and endocrine
disorders.
 Obstruction Cerumen
o Cerumen normally accumulates in the external canal in various amounts and
colors. Although wax does not usually need to be removed, impaction
occasionally occurs, causing otalgia, a sensation of fullness or pain in the ear,
with or without a hearing loss. Accumulation of cerumen is especially
significant in the geriatric population as a cause of hearing deficit.
 Foreign Bodies
o Some objects are inserted intentionally into the ear by adults who may have
been trying to clean the external canal or relieve itching or by children who
introduce the objects. Other objects, such as insects, peas, beans, pebbles,
toys, and beads, may enter or be introduced into the ear canal. In either case,
the effects may range from no symptoms to profound pain and decreased
hearing.
 Otitis Media
o Acute
 Acute otitis media is an acute infection of the middle ear, usually
lasting less than 6 weeks. The primary cause of acute otitis media is
usually Streptococcus pneumoniae, Haemophilus influenzae, and
Moraxella catarrhalis, which enter the middle ear after eustachian tube
dysfunction caused by obstruction related to upper respiratory
infections, inflammation of surrounding structures (eg, sinusitis,
adenoid hypertrophy), or allergic reactions (eg, allergic rhinitis).
Bacteria can enter the eustachian tube from contaminated secretions in
the nasopharynx and the middle ear from a tympanic membrane
perforation. A purulent exudate is usually present in the middle ear,
resulting in a conductive hearing loss.
o Chronic
 Chronic otitis media is the result of repeated episodes of acute otitis
media causing irreversible tissue pathology and persistent perforation
of the tympanic membrane. Chronic infections of the middle ear
damage the tympanic membrane, destroy the ossicles, and involve the
mastoid. Before the discovery of antibiotics, infections of the mastoid
ACENA, JOBELLE C. 16

were life-threatening. The use of medications in acute otitis media has

made acute mastoiditis a rare condition in developed countries
o Effusion
 Serous otitis media (ie, middle ear effusion) implies fluid, without
evidence of active infection, in the middle ear. In theory, this fluid
results from a negative pressure in the middle ear caused by eustachian
tube obstruction. This condition is found primarily in children. When it
occurs in adults, an underlying cause for the eustachian tube
dysfunction must be sought. Middle ear effusion is frequently seen in
patients after radiation therapy or barotrauma and in patients with
eustachian tube dysfunction from a concurrent upper respiratory
infection or allergy. Barotrauma results from sudden pressure changes
in the middle ear caused by changes in barometric pressure, as in
scuba diving or airplane descent. A carcinoma (eg, nasopharyngeal
cancer) obstructing the eustachian tube should be ruled out in an adult
with persistent unilateral serous otitis media.
 Mastoiditis
o Mastoiditis is a serious infection in the mastoid process, which is the hard,
prominent bone just behind and under the ear. Ear infections that people fail to
treat cause most cases of mastoiditis. The condition is rare but can become
life-threatening without treatment.
 Otosclerosis
o Otosclerosis involves the stapes and is thought to result from the formation of
new, abnormal spongy bone, especially around the oval window, with
resulting fixation of the stapes. The efficient transmission of sound is
prevented because the stapes cannot vibrate and carry the sound as conducted
from the malleus and incus to the inner ear. More common in women and
frequently hereditary, otosclerosis may be worsened by pregnancy
 Tympanosclerosis
o Tympanosclerosis represents the end stage of any chronic inflammatory
process affecting the ear. It is a condition that may occur in the middle ear,
tympanic membrane, and mastoid and has very little chance of spontaneous
resolution. It may become significant enough to create a permanent
conductive hearing loss due to calcification.

2. Disturbance in the inner ear

 Sensorineural Hearing Loss
o A sensorineural loss involves damage to the cochlea or vestibulocochlear
nerve
 Labyrinthitis
ACENA, JOBELLE C. 17

o Labyrinthitis, an inflammation of the inner ear, can be bacterial or viral in

origin. Although rare because of antibiotic therapy, bacterial labyrinthitis
usually occurs as a complication of otitis media. The infection can enter
the inner ear by penetrating the membranes of the oval or round windows.
Viral labyrinthitis is a common medical diagnosis, but little is known
about this disorder, which affects hearing and balance. The most
commonly identified viral causes are mumps, rubella, rubeola, and
influenza. Viral illnesses of the upper respiratory tract and herpetiform
disorders of the facial and acoustic nerves (ie, Ramsay Hunt syndrome)
also cause labyrinthitis.
 Ménière’s disease
o Ménière’s disease is an abnormal inner ear fluid balance caused by a
malabsorption in the endolymphatic sac. Evidence indicates that many
people with Ménière’s disease may have a blockage in the endolymphatic
duct. Regardless of the cause, endolymphatic hydrops, dilation in the
endolymphatic space, develops. Either increased pressure in the system or
rupture of the inner ear
 Acoustic Neuroma
o An acoustic neuroma is a slow-growing, benign tumor of cranial nerve
VIII, usually arising from the Schwann cells of the vestibular portion of
the nerve. Most acoustic tumors arise within the internal auditory canal
and extend into the cerebellopontine angle to press on the brain stem.
Acoustic neuromas account for 5% to 10% of all intracranial tumors and
seem to occur with equal frequency in men and women at any age,
although most occur during

E. IMPLEMENTATION

1. Pharmacological Therapeutics

 Anti-infective
 Anti-inflammatory agents
 Anti-glaucoma agents
 Mydriatics
 Local anesthetics

2. Complementary and Alternative Therapy

 a. Bilberry

3. Nutritional and Diet Therapy

ACENA, JOBELLE C. 18

 Antioxidants plus Zinc

 Phytochemicals
 Fruits
 Vegetables
 Carotenoids
 Vitamin C
 Vitamin E

4. Client Education

 Disease process
 Physical Activity
 Meal Planning
 Medication Compliance
 Monitoring Laboratory Tests
 Risk Reduction
 Psychosocial
ACENA, JOBELLE C. 19

References

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https://patient.info/doctor/nystagmus#nav-5

Moreels, B. (n,d). Romberg Test, Physiopedia. Retrieved on June 3, 2020 from

https://www.physio-pedia.com/Romberg_Test

No Author. (n.d). Examination of the Ears. Retrieved on June 3, 2020 from

https://www.amboss.com/us/knowledge/Head_and_neck_examination

Smeltzer, S., Bare, B., Hinkle, J., & Cheever, H. (2008). Brunner & Suddarth’s Textbook of

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Special Senses Anatomy and Physiology, Nurseslabs. Retrieved on June 3, 2020 from

https://nurseslabs.com/special-senses-anatomy-physiology/

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https://www.healthline.com/health/retracted-eardrum