1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical- Surgical Nursing, 10/e 01/16 Pg 625 Unit 10 Chapter 43: Caring for Clients with Ear Disorders By: P.K. Williams, RN

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 19 Words to Know 02/16 Pg 624 Acoustic neuromaCochlear implantLabyrinthitis MastoidectomyMastoiditisMyringotomy Meniere’s diseaseOtalgia*Otitis externa Otitis mediaOtosclerosisOtotoxicity PresbycusisSign languageStapedectomy Speech readingTinnitusTympanotomy

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 11 Objectives 03/16 Pg 624 On completion of this chapter, you will be able to: 01 List types of hearing impairment and the acuity levels for each. 02 Name techniques that clients with impaired hearing use to communicate with others. 03 Give examples of support services available for the hearing impaired. 04 Discuss the role of the nurse in caring for clients with a hearing loss. 05 Name conditions that involve the external ear.

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 11 Objectives 04/16 Pg 624 06 Explain the technique for straightening the ear canal of adults to facilitate inspection and the administration of medication. 07 Discuss methods for preventing or treating disorders of the external ear. 08 Name conditions that affect the middle ear. 09 Describe nursing interventions appropriate for managing the care of a client with ear surgery. 10 Explain the pathophysiology of Ménière’s disease, and name some consequences of this inner-ear disorder. 11 Discuss the nursing management of clients with Ménière’s disease.

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hearing Impairment 05/16 Pg 624 Mild, Moderate, Severe, or Profound Causes: Excessive noise; Conductive loss; [Sensorineural loss] Consequences Depend on Age, Severity –<3 years: Affects language development, communication, safety Medical Management: Hearing aids; Sign language; Speech reading; Technology; Assist dogs Surgical Management: Cochlear implant; Bone conduction device; Semi-implantable hearing aid Nursing Management

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cochlear Implant*** 06/16 Pg 626

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Impacted Cerumen*** 07/07 Pg 627 Pathophysiology, Etiology –Interferes with sound carried on airwaves Assessment Findings –Otalgia; Diminished hearing –Orange-brown accumulation of cerumen Medical Management: Hydration; Irrigation; Removal (cerumen spoon) Nursing Management

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Foreign Objects*** 08/16 Pg 634 Pathophysiology, Etiology –Scratched skin; Blunt penetration of eardrum; Local tissue inflammation Assessment Findings: Discomfort; Diminished hearing; Feeling movement; Buzzing sound Diagnostic Findings: Inspection (Penlight, otoscope) Medical Management: Mineral oil instillation (insects); Removal of solid object (small forceps) Nursing Management

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Otitis Externa*** 09/16 Pg 628 Pathophysiology, Etiology –Overgrowth of pathogens; Infected hair follicle Assessment Findings –Redness; Edema; Diminished hearing –Fever; Enlarged lymph nodes behind ear Diagnostic Findings: Otoscope examination; C & S Medical Management –Warm soaks; Analgesics; Antibiotics Nursing Management

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Otitis Media*** 10/16 Pg 629 Pathophysiology, Etiology –Respiratory allergies; Enlarged adenoids; Eardrum pressure Assessment Findings: History: Recent upper respiratory infection; Seasonal allergies; Fever; Tinnitus; Malaise; Earache; Diminished hearing Medical, Surgical Management: Prevention of rupture of the eardrum –Antibiotics; Needle aspiration; Myringotomy; Tympanotomy; Myringoplasty Nursing Management

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Otosclerosis*** 11/16 Pg 629 Pathophysiology, Etiology –Decreased vibration of stapes  diminished transmission of sound to inner ear Assessment Findings: Signs and Symptoms –Progressive, bilateral hearing loss; Nighttime tinnitus; Pinkish-orange eardrum Diagnostic Findings: Audiometric tests; CT scan Medical, Surgical Management –Hearing aids; Stapedectomy Nursing Management

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Otosclerosis 12/16 Pg 630

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Ménière’s Disease 13/16 Pg 631 Pathophysiology, Etiology –Changes of fluid volume within labyrinth Assessment Findings –Vertigo; Tinnitus; Hearing loss; N/V –Nystagmus; Preattack headache Medical, Surgical Management –Low-sodium diet; Bed rest; Medication therapy; Surgery Nursing Management

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Ototoxicity*** 13/16 Pg 634 Medications –Salicylates; Loop diuretics –Quinidine; Quinine –Aminoglycosides Signs and Symptoms –Tinnitus; Sensorineural hearing loss –Vestibular toxicity: Lightheadedness; Vertigo; N/V Nursing Management

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Acoustic Neuroma*** 15/16 Pg 634 Pathophysiology, Etiology: Rare; Unknown cause; Cochlear nerve compression; Blood supply interruption Assessment Findings: Gradual hearing loss; Vertigo; Impaired facial movement, sensation; Tinnitus Diagnostic Findings: MRI; CSF studies Medical, Surgical Management: Neurectomy –Retain cranial nerve VIII function Nursing Management [Classification of neuroma based on specific portion of nerve effected]

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation Now NCLEX By: P.K. Williams, RN 16/16 Pg 634 pkwilliams@DNI. edu