The Ear
The Ear
The Ear
Reyes, PTRP,
RN,MAN
Medical Surgical nursing
Copyright JMDairo08
Hearing
Hearing- is a special sensory function that
incorporates the sound transmitting of the
external canal.
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Physiology of hearing
Sound waves enter the ear canal and strike the
tympanic membrane, causing it to vibrate; these
vibrations sequentially move the malleus, incus
and stapes
Movement of the stapes against the oval window
into which it fits starts a ripple in the perilymph,
which is transmitted to the endolymph inside the
cochlear duct and stimulates the organ of Corti
Cochlear
nerve
conducts
impulses from
the organ of
Corti to the
brain;
Hearing
occurs when
impulses
reach the
auditory area
in temporal
Interpretation of sounds
Loudness: neurologic or psychologic
interpretation of intensity, the greater
the intensity, the greater the size of
nerve impulse
Pitch: corresponds to frequency; the
higher the frequency, the higher the
pitch of the sound
Quality: sound rarely represents a pure
tone but many frequencies occurring
simultaneously
Auditory assessment
External ear
examination
- inspect and palpate the
auricle, auditory canal
and eardrum
- visualization is easier
by straightening the
auditory canal
Normal eardrum is
slightly conical
(externally concave),
shiny, and pearly gray
in
CHANGE IN COLOR MAY INDICATE
DISEASE
BLUE- blood in the middle ear
(chemotympanum)
YELLOW OR AMBER- serum in the
middle ear
RED OR PINK- indicates middle ear
infection
Sound is measured in terms of
frequency and intensity
Frequency- is expressed by cycles /
seconds or Hertz.
normal individual can perceive only
from 20- 20,000 cycles, within this
only 500-2,000 are important in
understanding daily speech
Intensity or pitch- force movement of
vibrations measured by decibels
comfortable decibel is from 40 – 65
decibels
ordinary conversation is from 40-50
decibels
jet plane- 140 decibels
Anatomy of the ear
External ear
Pinna
Eardrum
Middle Ear
3 bones
Malleus
Incus
Stapes
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Middle ear
Tympanic
membrane- is thick
transparent sheet
tissue that provides
barrier between the
external ear and the
middle ear.
Eustachian tube-
opens into the
middle ear and
allows for
equalization of
pressure on both
sides of the tympanic
membrane.Copyright JMDairo08
Anatomy of the ear
Inner ear
Cochlea- is the spiral shape organ of
hearing.
Semicircular canal- contains
the membranous semicircular canals in
which located the crista ampullaris, the
sense organ for sensations of equilibrium
and head movements; vestibular nerve
supplies the crista
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Semicircular canals contain
fluids and hairs cells connected
to the sensory nerve fibers on
the vestibular portion of the
eight cranial nerve.
-The inner ear maintains sense
of balance or equilibrium.
-The cochlea is the spiral shape
organ of hearing.
-Eight cranial nerve
•The cochlear branch of the
nerve transmits neuroimpulses
from the cochlea to the brain
where they are interpreted as
sounds.
•Vestibular branch maintains
balance and equilibrium.
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Assessment of Ear
Inspection of the ear
Adults: Pull pinna BACKWARD and UPWARD
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Assessment of Ear
Otoscopy
Eardrum is conical.
Pearly gray and
shiny
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Assessment of Ear
Audiometer
Test of hearing
Measured in decibels
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Nursing Modalities for the
ear
Ear irrigation**
Use of peroxide or
normal saline
Solution should be
warmed
With a steady
stream, direct the
stream of solution
against the roof of
the canal
Position on the
irrigated side to
promote drainage
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Nursing Modalities for the
ear
Eardrops instillation
Use warm solution
Position patient on the side with the affected
ear uppermost
Straighten the ear by pulling pinna up and
back
Hold position for 5 minutes
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Hearing loss
Hearing loss- represents impairment of the
ability to detect and perceive sound.
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Conductive hearing loss
A. Conductive hearing loss -occurs when the
sound waves are blocked to the inner ears
fibers because of external ear or middle ear
disorders.
Disorders can be often be corrected with no
damage to hearing or minimal permanent
hearing loss.
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Conductive hearing loss
Causes:
A. Any inflammatory process or obstruction of
the external or middle ear.(Impacted earwax
or foreign body)
B. Tumors
C. Otosclerosis
D. A build up of scar tissue on the ossicles
from the previous middle ear surgery.
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OTOSCLEROSIS
Formation of new spongy bone in the
labyrinth of the ear causing fixation
of the stapes in the oval window; this
prevents transmission of auditory
vibration to the inner ear
Common among women
Cause in unknown nut with familial
tendency
Sensorineural hearing
loss
Sensorineural hearing loss:
Description: Is a pathologic process of the
inner ear of the sensory fibers that lead to the
cerebral cortex.
Is often permanent and measures must be
taken to reduce further damage or attempt to
amplify sound as a means of improving
hearing some degree.
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Sensorineural hearing
loss
Cause: Damage of the inner ear structures
- Damage of the eight cranial nerve
- Prolong exposure to loud noise
- Medications
- Trauma
- Inherited disorders
- Metabolic and circulatory disorders
- Infection
- Surgery
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Sensorineural hearing
loss
Trauma:
- head injury
- Noise
Central nervous system infection (meningitis)
Vascular: Atherosclerosis
Ototoxic drugs: Aminoglycosides, salicylates,
loop diuretics
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Sensorineural hearing
loss
Tumors:
-Vestibular Schawannoma ( acoustic
neuroma)
-Meningioma
-Metastatic tumor
Idiopathic:
-Meniere disease
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Sensorineural hearing
loss
Meniere’s Syndrome
Diabetis mellitus
Myxedema
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Mixed hearing loss
Is also known as conductive and
sensorineural hearing loss.
Signs and symptoms:
Frequent asking others to repeat
statement
Straining to hear
Turning head or leaning forward to favor
one ear.
Shouting in conversation
Ringing in ears
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Mixed hearing loss
Failing to respond when not looking in a
direction of the sound
Answer question incorrectly
Raising the volume of the radio or TV
Avoiding large groups
Withdrawing from social interaction
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Hearing aids
Indicated for conductive hearing loss
Client education regarding hearing aids
- Encourage the client to use hearing aid
slowly
- Adjust the volume to the minimal hearing
level to prevent feedback squeaking.
-Teach the client to concentrate on the
sounds heard
- Instruct the client to clean the ear mold
with mild soap and water.
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Hearing aids
Avoid excessive wetting of the hearing aid
and try to dry after cleaning.
Clean the ear cannula with the aid
toothpick or pipe cleaner
Turn off the hearing aid when not use.
Keep extra batteries on hand
Keep hearing aid in safe place
Prevent hair sprays, oils or other hair and
face products from coming in contact with
the receiver of the hearing aid.
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Presbycusis
- Is associated with aging
- Leads to degeneration or atrophy of the
ganglion cells in the cochlea and loss of
elasticity of the basilar membranes
- Leads to compromise the vascular supply to
the inner ear with changes in several areas of
the ear structure.
Assessment:
Hearing loss gradual and bilateral
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Presbycusis
Client states that he or she has no hearing
problem with hearing but cannot understand
what the words are.
Client thinks that the speaker is numbling.
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Otitis media
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Otitis Media
Inflammation of the
MIDDLE ear
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Otitis Media
Etiologic Factors:
Strep pneumonia
Haemophilus influenzae
Moraxela catarrhalis
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Otitis Media
Pathophysiology
Inflammation
Exudative formation
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Otitis Media
Assessment
findings
Ear pain
Ear itchiness
Sense of fullness
Tinnitus/Vertigo
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Otitis Media
Assessment
findings
Decreased hearing
Redness
Drainage of exudates
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Otitis Media
Complications
Abscess
Meningitis
Mastoiditis
Conductive Hearing
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Otitis Media
Medical Management
2.Antibiotics- systemic
and ear drops
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Otitis Media
Medical Management
IF CHRONIC CASE:
Tympanoplasty
And Mastoidectomy
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Otitis Media
Nursing Interventions
2.Manage the infection
– Giving antibiotics
– cleansing of the ear
– Instillation of ear
drops
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Otitis Media
Nursing Interventions
2. Perform ear
irrigation
Neverdone if
tympanic membrane
is PERFORATED!!!
3. Promote safety
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Meniere’s Disease
The primary lesion appears to be in the
endolymphatic sac, which is thought to be
responsible endolymphatic filtration and
excretion.
- Increase production of endolymph, and
decrease production of perilymph
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Meniere’s Disease
Cause is UNKNOWN
- Proposed possible condition:
- Trauma
- Infection ( syphilis)
- Immunologic
- Endocrine ( Adrenal pituitary insufficiency
and hypothyroidism)
- Vascular disorders
- Viral or fluid transport system to the inner
ear.
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Meniere’s Disease
Pathophysiology
There is INCREASED pressure of the fluid in the
cochlea
There is INCREASED fluid pressure in the
semicircular ducts
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Meniere’s Disease
Pathophysiology
INCREASED pressure attacks of
VERTIGO, TINNITUS
and HEARING LOSS
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Meniere’s Disease
ASSESSMENT findings
Vertigo- whirling sensation
Unilateral or bilateral
hearing loss
Vomiting
Diaphoresis
Nystagmus
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Meniere’s Disease
Medical management
1.Diuretics (acetazolamide,
furosemide) are given to
REDUCE the fluid pressure
and decrease sodium
2. LOW salt diet
3. Antihistamine and anti-
vertigo
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- Suppressant drugs ( prochlorazine,
promethazine, diazepam)
Corticosteroids ( prednisone )
- may be used in satisfactory hearing and
resolved dizziness
Gentamicin therapy -ablation of the vestibular
system- effective in controlling vertigo.
Surgical method- endolymphatic shunt
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Meniere’s Disease
Nursing Management
2. Assist patient DURING attack
Stand in front
Encourage to change position
slowly
Advise to lie down
Avoid bright lights
Support patient when
ambulating
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Meniere’s Disease
Nursing Management
2. Administer medications
as prescribed
diuretics
anti-emetics
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Meniere’s Disease
Nursing Management
3. Prevent the attacks of
Meniere’s
Provide low salt diet
Encourage to stop smoking
Take medications as
prescribed
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Thank you