14 Chapter 54Ear and Hearing Disorders _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
6
READ – Textbook (pp. 1269-1270)
REVIEW
• Box 54-2: Ototoxic Drugs (p. 1269)
ANSWER – Study Guide
• Part IC: 1-10 (p. 372)
• Part IIG: 30, 36, 37 (pp. 375-376)
• Part IIIH: 1 (p. 377)
7
READ – Textbook (pp. 1260-1269)
REVIEW
• Nursing Care Plan 54-1: Patient with Ménière Disease (p. 1268)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7 (p. 1271)
ANSWER – Study Guide
• Part IIG: 29, 33 (p. 375)
50-Minute Lesson Plan
Lecture Outline 20 minutes
5
&
6
Slide 17
Types of Hearing Loss
• Conductive hearing loss
• Interference with the transmission of sound waves from the external or middle ear to
the inner ear
• Sensorineural hearing loss
• Disturbance of the neural structures in the inner ear or the nerve pathways to the
brain
• Mixed hearing loss
• A combination of conductive and sensorineural losses
• Central hearing loss
• Problem in the central nervous system
TALKING POINTS:
• Factors that may cause conductive hearing loss include obstruction of the external canal
or eustachian tube and otosclerosis.
Slide 18
Signs and Symptoms
• Complaints that their hearing is good but others mumble
• Leaning or turning one ear toward the speaker
• May fail to follow directions, speak while others are speaking, or turn the radio/TV up very
loud
________________________________________________________ Chapter 54Ear and Hearing Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
Slide 19
The Impact of Hearing Impairment
• Those who had impairments in early childhood usually have speech difficulties
• When a person refuses to admit to a hearing loss, family members and others may stop
trying to communicate
• Hearing-impaired person may alienate those who would like to be close and supportive
• People with severe hearing impairment probably suffer the most severe social isolation of
those with sensory disorders
5
&
7
Slide 20
• Handheld computers print out messages typed by the user
Adaptations to Hearing Loss
• Hearing aids—some improvement in hearing
• Many patients read lips and observe body language
• Sign language uses a universal set of hand signals
Slide 21
Care of the Patient with Impaired Hearing
• Interventions
• Impaired verbal communication
• Social isolation
• Ineffective coping
• Deficient knowledge
Slide 22
Foreign Bodies and Cerumen
• Foreign bodies can get into the external ear canal
• Most small objects can be flushed by gentle irrigation
• Insects can be killed by instilling a small amount of mineral oil; they can then be
flushed from the canal
• Alternative is to hold a flashlight near the auricleBecause insects are often
attracted to light, they may move out of the canal
Slide 23
Foreign Bodies and Cerumen (cont.)
Impacted cerumen is one of the most common causes of obstruction
• Provider may order ear drops to soften the cerumen before irrigation
• Provider can use ear forceps or a cerumen spoon to remove it
Foreign Bodies and Cerumen (cont.)
• Nursing care
• Inspect ear canal for impacted cerumen
TALKING POINTS:
• The dry cerumen may be gold to dark brown.
• How is a foreign body or cerumen removed from the external auditory canal?
16 Chapter 54Ear and Hearing Disorders _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
Slide 25
External Otitis or Swimmer’s Ear
• Infection/inflammation of lining of external canal
• Signs and symptoms
• Pain that increases when the auricle is pulled
• Dizziness, fever, and drainage
• Medical treatment
• Topical antibacterial or antifungal drugs
• Corticosteroid drops
• Interventions
• Acute pain
• Deficient knowledge
TALKING POINTS:
• What may cause external otitis?
Slide 26
Acute Otitis Media
• Middle ear infection; usually develops with colds
• Edema: blockage of the eustachian tubes
• Fluid accumulates in the middle ear, causing painful pressure on tympanic membrane
• Membrane may rupture, resulting in scarring and subsequent hearing loss
• Patient often has a fever and headache
• More common in children than in adults
Slide 27
Acute Otitis Media (cont.)
• Medical treatment
• Oral antibiotics
• Topical ear drops
• Antihistamines
• Myringotomy
TALKING POINTS:
• Prior to administering the drops, the canal should be cleared of debris.
• Antihistamines may be ordered if allergies are thought to be contributing to the problem.
• Myringotomy is the creation of a small opening in the tympanic membrane.
• What is the purpose of a myringotomy?
Chronic Otitis Media
• Hearing loss and continuous or intermittent drainage
• Eardrum usually perforated (ruptured) or shows signs of a healed perforation
TALKING POINTS:
• An audiogram may detect some conductive hearing loss if the bones in the middle ear
have been damaged by the chronic infection.
• Does the patient with chronic otitis media usually experience pain?
________________________________________________________ Chapter 54Ear and Hearing Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
Slide 29
Chronic Otitis Media (cont.)
• Medical treatment
• Systemic antibiotics and, if the eardrum is intact, irrigations to remove debris
• Tympanoplasty if tympanic membrane does not heal
• Mastoidectomy if the infection has extended to the mastoid bone
Slide 30
Care of the Patient Having a Mastoidectomy
• After surgery on the middle ear: comfort, safety, prevention of infection, and prevention of
pressure on the tympanic membrane
• Nausea common
• Inspect the dressing and describe drainage but do not disturb or remove the dressing
TALKING POINTS:
• If the patient does have to cough or sneeze, what advice should be given to prevent
injury?
Slide 31
Otosclerosis
• A hereditary condition in which an abnormal growth causes the footplate of the stapes to
become fixed
• Fixed stapes cannot vibrate, so sound waves cannot be transmitted to inner ear
• Effect is a conductive hearing loss
TALKING POINTS:
• If the disease also involves the inner ear, the patient has sensorineural hearing loss as
well.
• What population is otosclerosis most common in?
Slide 32
Otosclerosis (cont.)
• Signs and symptoms
• Slowly progressive hearing loss in the absence of infection
• In the early stages, patient may report tinnitus
• Rinne test reveals bone conduction to be greater than air conduction
• Medical treatment
• Stapedectomy
TALKING POINTS:
Slide 33
Care of the Patient Having a Stapedectomy
• After surgery, pain relief, safety, prevention of infection, and avoidance of pressure in the
ear
TALKING POINTS:
• When is the packing commonly removed?
18 Chapter 54Ear and Hearing Disorders _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
Slide 34
Care of the Patient Having a Stapedectomy (cont.)
• After dressing and packing removed, patient advised to keep the ear dry for at least 2
weeks
• Swimming and showering not permitted for 6 weeks
TALKING POINTS:
• Vertigo may persist after discharge and you must help the patient plan for assistance with
activities of daily living.
• How soon will hearing improvement occur?
Slide 35
Labyrinthitis
• Inflammation of the labyrinth
• Acute labyrinthitis usually follows an acute upper respiratory infection, acute otitis media,
pneumonia, or influenza
• Also can be an adverse effect of drugs
Slide 36
Labyrinthitis (cont.)
• Signs and symptoms
• Vertigo, nausea, vomiting, headache, anorexia, nystagmus, and sensorineural
hearing loss on the affected side
TALKING POINTS:
• A typical episode lasts 3 to 6 weeks.
• What is nystagmus?
• Additional symptoms of suppurative labyrinthitis are tinnitus and hearing loss.
Slide 37
Labyrinthitis (cont.)
• Nursing care
• Assess symptoms
• Monitor intake and output, daily weights if possible, and food intake if persistent
TALKING POINTS:
• If vomiting persists, the patient is at risk for development of fluid and electrolyte
imbalances (hypokalemia, fluid volume deficit).
• How is fluid and electrolyte imbalance treated?
________________________________________________________ Chapter 54Ear and Hearing Disorders 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
Slide 38
Labyrinthitis (cont.)
• Nursing care
• Interventions
• Risk for injury
TALKING POINTS:
• How can the nurse provide for patient safety when a patient is experiencing labyrinthitis?
Slide 39
Ménière Disease
• A disorder of the labyrinth
• The cause is unknown
• Symptoms related to an accumulation of fluid in the inner ear
• Attack triggers: alcohol, nicotine, stress, and certain stimuli such as bright lights and
sudden movements of the head
TALKING POINTS:
• More than 2 million Americans are thought to have attacks of Ménière disease.
• At what age does Ménière disease usually occur?
Slide 40
Ménière Disease (cont.)
• Signs and symptoms
• Hearing loss and vertigo accompanied by pallor, sweating, nausea, and vomiting
• Hearing loss is unilateral
TALKING POINTS:
• Acute attacks occur at intervals and last for hours to days.
• Hearing usually improves between attacks, but some loss of low-frequency sounds may
remain.
• What may occur if sudden movements are made during a vertigo attack?
Ménière Disease (cont.)
• Medical diagnosis
20 Chapter 54Ear and Hearing Disorders _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
Slide 42
Ménière Disease (cont.)
• Medical treatment
• Drugs: atropine, epinephrine, benzodiazepines such as diazepam (Valium),
antihistamines, antiemetics, anticholinergics, vasodilators, and diuretics
• Low-sodium diet
TALKING POINTS:
• Caffeine, nicotine, and alcohol are discouraged.
• How is vestibular rehabilitation performed?
Slide 43
Ménière Disease (cont.)
• Surgical treatment
• Surgical procedures work by draining excess fluid from the inner ear (endolymphatic
shunt) or by cutting the part of the acoustic nerve that controls balance (vestibular
nerve section)
• More destructive surgical procedures are labyrinthotomy and labyrinthectomy
TALKING POINTS:
• Surgery is usually advised only when all other measures have failed.
• What are potential complications of surgery for Ménière disease?
Slide 44
Ménière Disease (cont.)
• Assessment
• Document pattern of acute attacks
the disease, and coping mechanisms
Slide 45
Ménière Disease (cont.)
• Interventions
• Risk for injury
• Risk for deficient fluid volume
• Anxiety
• Ineffective self-health management
Slide 46
Ménière Disease (cont.)
• Postoperative care
• Carefully check provider’s orders for position and activity limitations
• Safety, comfort, and detection of complications
• Antiemetics to control nausea and vomiting
TALKING POINTS:
• The first few days after surgery, the patient’s symptoms are usually severe.
• How can the nurse assess for facial nerve damage?
________________________________________________________ Chapter 54Ear and Hearing Disorders 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
Slide 47
Presbycusis
• Hearing loss associated with aging
• Result of changes in one or more parts of the cochlea
• Signs and symptoms
• May hear well in quiet surroundings but poorly in noisy places
Slide 48
Presbycusis (cont.)
• Medical diagnosis and treatment
• Hearing evaluation for the older person whose hearing seems to be declining
• Many with presbycusis benefit from hearing aids
• Devices available to improve hearing: phone amplifiers and personal earphones for
radios and televisions
TALKING POINTS:
Slide 49
Presbycusis (cont.)
• Nursing care
• Educate about hearing loss and aging
• Work to overcome the resistance that many people have to admitting hearing loss
• Once problem diagnosed, nurses can help the patient adapt and learn to use
supportive devices
6
Slide 50
Ototoxicity
• Damage to the ear or eighth cranial nerve caused by specific chemicals, including some
drugs
• Common ototoxic drugs are salicylates (aspirin) and aminoglycoside antibiotics
• From reversible tinnitus to permanent hearing loss
• The primary symptom of ototoxicity with salicylates is tinnitus, which disappears when the
drug is discontinued
• Extent depends on dosage and how long it was given
• Patients who have poor renal function are at special risk for ototoxicity because drugs are
excreted more slowly
TALKING POINTS:
• Aminoglycosides can cause permanent hearing loss.
• Besides hearing, what else may be affected by ototoxicity?
Slide 51
Ototoxicity (cont.)
• Nursing care
• Primary are early detection and prevention of progressive hearing loss caused by
ototoxic drugs
• To reduce risk of ototoxicity, be familiar with these drugs. Instruct patients to report
hearing loss, tinnitus, or problems with balance
22 Chapter 54Ear and Hearing Disorders _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
Activities
Classroom Choose from below to make 30 minutes
5
DISCUSS
• Discuss the nurse’s role in helping the
patient and the patient’s family cope with
hearing loss.
• Discuss the symptoms and treatments for
disorders of the outer ear, the middle ear,
and the inner ear.
PRACTICE:
• Divide the class into two groups. Assign one
6
DISCUSS
• Discuss the nurse’s role in educating
patients about prevention of hearing loss.
PRACTICE
• Divide the class into small groups and have
each group develop a public service
7
DISCUSS
• Discuss a typical day for a patient with
frequent attacks of Ménière disease.
PRACTICE
• Divide the class into small groups. Have
each group refer to the Nursing Diagnoses,
Goals, and Outcome Criteria: Ménière
________________________________________________________ Chapter 54Ear and Hearing Disorders 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 54.2
Critical Thinking Question
At the urging of his family, an older man comes into the clinic to have his hearing tested.
The patient tells the nurse that he is afraid that he will need a hearing aid and does not want
to use one. How might the nurse address the patient’s fears?
Discussion Guidelines: The nurse can explain that hearing loss results from many different
some of which are contained completely within the ear.
Instructor Notes/Student Feedback
24 Chapter 54Ear and Hearing Disorders _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
54
Assessments for
Ear and Hearing Disorders
CHAPTER OBJECTIVES
Lesson 54.1:
2. Describe the tests and procedures used to diagnose disorders of the ear, hearing, or balance.
4. Explain the nursing care for patients receiving common therapeutic measures for disorders of the ear,
5. Describe the pathophysiology, signs and symptoms, complications, and medical or surgical treatment
for selected disorders.
7. Assist in the development of a nursing care plan for a patient with a disorder of the ear, hearing, or
balance.
Assessments by Lesson & Objective
1
Study Guide
• Part IF: 1-6 (p. 373)
• Part IIG: 36 (p. 376)
Evolve Instructor Resources
• Test Bank: 2, 9, 10
• Open Book Quiz: 3, 4
3
Study Guide
• Part IIG: 32 (p. 375)
Evolve Instructor Resources
• Test Bank: 8
Evolve Student Resources
• Prioritization: 1, 4, 5
________________________________________________________ Chapter 54Ear and Hearing Disorders 25
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IA: 5, 6 (p. 371)
• Part IIG: 9-17, 41, 42 (pp. 374-376)
• Part IIIH: 3, 8, 9 (pp. 377, 378)
Evolve Instructor Resources
• Test Bank: 7, 11-13, 15, 28
• Open Book Quiz: 5, 6
Evolve Student Resources
Lesson 54.2
5
Study Guide
• Part IB: 1 (p. 372)
• Part IIG: 18-28, 31, 32, 34, 35, 39, 40, 43, 44 (pp. 374-377)
• Part IIIH: 6, 7, 10 (pp. 377-378)
Evolve Instructor Resources
• Test Bank: 4, 6, 16, 21, 22, 24, 27, 29
• Open Book Quiz: 7, 8, 10
Evolve Student Resources
• NCLEX Review: 1
7
Study Guide
• Part IIG: 29, 33 (p. 375)
• Part IIIH: 2, 4, 5 (p. 377)
• Part III I: 1, 3 (p. 378)
26 Chapter 54Ear and Hearing Disorders _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
Instructor’s Notes/Student Feedback