On completion of this chapter, the learner will be able to:1. Describe methods used to assess hearing and to diagnosehearing and balance disorders.2. List the manifestations that may be exhibited by a personwith a hearing disorder.3. Identify ways to communicate effectively with a person witha hearing disorder.4. Differentiate problems of the external ear from those of themiddle ear and inner ear.
On completion of this chapter, the learner will be able to:5. Compare the various types of surgical procedures used formanaging middle ear disorders and appropriate nursingcare.6. Describe the teaching topics that need to be addressed forpatients undergoing middle ear and mastoid surgery.7. Describe the different types of inner ear disorders,including the clinical manifestations, diagnosis, andmanagement.
External auditory canalTympanic membraneOssiclesOval windowCochleaOrgan of CortiVestibulocochlear nerveCentral nervous system
Cerumen accumulates in the external ear leading tohearing loss. Degeneration of the receptor cells in the Organ of Corti. Ossicles become less movable and interfere withtransmission of sound waves. Decrease in cochlear branch of the cranial nerve VIIcontribute to hearing loss, reduction in the vestibularbranch interferes with balance and coordination. Bacterial and viral infections in the temporal bone maycause sensorineural hearing loss.
FREQUENCY20 to 20,000 HzPITCH100 Hz is considered of low pitch,and a tone of 10,000 Hz is considered of high pitchINTENSITYCritical level of loudness is approximately 30 dB80 dB can be damaging to the inner ear
Irritable, hostile or hypersensitive in interpersonalrelations. Difficulty in following directions. Complains about people mumbling. Turns up volume on TV. Asks for frequent repetition. Answers questions inappropriately. Leans forward to hear better, face looks serious andstraightened.
Family history of sensorineural impairment Congenital malformations of the cranial structure (ear) Low birth weight (1500 g) Use of ototoxic medications (e.g., gentamycin, loopdiuretics) Recurrent ear infections Bacterial meningitis Chronic exposure to loud noises Perforation of the tympanic membrane
Loses sense of humor, becomes grim and lonely. Experiences social isolation. Develops suspicious attitude. Has abnormal articulation. Complains of ringing in the ears. Unusual soft or loud voice. Dominates conversation.
Talk directly to the person facing him/her. Speak in clearly enunciated words using normal tone ofvoice. Use gestures with speech. Do not whisper to anybody in front of the hearing –impaired patient. Do not avoid conversation with a person who hashearing loss. Do not show annoyance by careless facial expression.
Move closer to the person or toward the better ear ifhe/she does not hear you. Do not smile, do not chew gum or cover the mouthwhen talking to the person. Encourage the use of hearing aid if the person has one.
Patients may require analgesic medications for the first48 to 92 hours. If the external canal is edematous, a wick should beinserted to keep the canal open so that liquidmedications (eg, Burow’s solution, antibiotic oticpreparations) can be introduced. For cellulitis or fever, systemic antibiotics may beprescribed. For fungal disorders, antifungal agents are prescribed.
Instruct patients not to clean the external auditory canalwith cotton-tipped applicators. Avoid getting the canal wet when swimming orshampooing the hair. Infection can be prevented by using antiseptic oticpreparations after swimming (eg, Swim Ear, Ear Dry),unless there is a history of tympanic membraneperforation or a current ear infection.
Control of the diabetes, administration of antibiotics(usually intravenously), and aggressive local woundcare. Standard parenteral antibiotic treatment includes thecombination of an antipseudomonal agent and anaminoglycoside. Local wound care includes limited débridement of theinfected tissue, including bone and cartilage, dependingon the extent of the infection.
Limit foods high in salt or sugar. Eat meals and snacks at regular intervals to stayhydrated. Eat fresh fruits, vegetables, and whole grains. Limit theamount of canned, frozen, or processed foods with highsodium content. Drink plenty of fluids daily. Water, milk, and low-sugarfruit juices are recommended. Limit intake of coffee, tea,and soft drinks.
The ear mold is the only part of the hearing aid that maybe washed frequently. Wash ear mold daily with soap and water. Allow the ear mold to dry completely before it issnapped into the receiver. Clean the cannula with a small pipe cleaner–like device. Proper care of the ear device and keeping the ear canalclean and dry can prevent complications.
Inadequate amplification, a whistling noise, or pain fromthe mold can occur when a hearing aid is not functioningproperly. Check for malfunctions:• Is the switch on properly?• Are the batteries charged and positioned correctly? If the hearing aid is still not working properly, notify thehearing aid dealer.
If the unit requires extended time for repair, the dealermay lend you a hearing aid until the repair can beaccomplished.
Common medical complications include external otitismedia and pressure ulcers in the external auditorycanal. Signs and symptoms of these infections includepainful ear, especially when the external ear is touched;canal swelling; redness; difficulty hearing; pain radiatingto the jaw area; and fever. If any of these symptoms are present, notify your healthcare provider for evaluation. You may need medicationto treat infection, pain, or both.