Pediatric Problems Otitis Media Foreign bodies -beads, pencil erasers, insects Treatment -carefully remove foreign body (if able) -seek medical care

Ménière's Disease Ménière's Disease: entire inner ear canal system affected Population at risk: - usually first occurs in people aged 20 – 50 yrs old -more common in men and in white people S & S: three main features -Tinnitus - one-sided sensorineural hearing loss - vertigo

Treatment for Ménière's Disease Nonsurgical management includes: -slow head movements -diet and lifestyle changes -smoking cessation.

Drug Therapy Nicotinic Acid Antihistamines: -diphenhydramine hydrochloride (Benadryl) Antiemetics: -chlorpromazine hydrochloride (Thorazine) Intratympanic therapy: gentamicin & steroids Other Measures: Meniett device

Meniett’s Device Treatment with Meniett’s device -tympanostomy tube inserted into eardrum -pulses of pressure delivered to inner ear -self directed for 5 mins. TID -studies shown effective in reducing vertigo * *Gates,G., Verrall,A., Green,J.D., Tucci, D.L., & Telian, S.A.(2006). Meniett clinical trial:Long –term follow-up. Archives of Otolaryngology-Head and Neck Surgery, 132(12),

Ménière’s Disease: Surgical Management Endolymphatic decompression. Surgical management: last resort because hearing in the affected ear is often lost from the procedure Labyrinthectomy

Hearing Loss Types of hearing loss Conductive r/t inflammation or obstruction of external or middle ear Sensorineural r/t loud noise, drugs, medical problem Population at risk: older adult

Anatomy of Hearing Loss

Treatment for Hearing Loss Non-surgical -hearing aids -assistive devices using amplifiers Surgical Interventions -tympanoplasty -stapedectomy

Tympanoplasty

Nursing Interventions: Pre-op Free of infection Ear flushes Pt. Education: post op expectations -hearing diminished initially -medications

Nursing Interventions Post-op Monitor dressings Avoid increased pressure on ear Medications Positioning -Tympanoplasty: lie flat with operative ear face up Potential complication for stapedectomy -Assess for facial nerve damage or muscle weakness

Community-Based Care Home care management Health teaching Health care resources Worldwide

NURSING DIAGNOSES FOR ALTERED HEARING Risk for injury related to altered auditory perception Social Isolation related to decreased hearing Anxiety related to loss of hearing