2. On completion of this chapter, the learner will be able to:
1. Describe methods used to assess hearing and to diagnose
hearing and balance disorders.
2. List the manifestations that may be exhibited by a person
with a hearing disorder.
3. Identify ways to communicate effectively with a person with
a hearing disorder.
4. Differentiate problems of the external ear from those of the
middle ear and inner ear.
3. On completion of this chapter, the learner will be able to:
5. Compare the various types of surgical procedures used for
managing middle ear disorders and appropriate nursing
care.
6. Describe the teaching topics that need to be addressed for
patients undergoing middle ear and mastoid surgery.
7. Describe the different types of inner ear disorders,
including the clinical manifestations, diagnosis, and
management.
4.
5.
6.
7.
8.
9.
10.
11. External auditory canal
Tympanic membrane
Ossicles
Oval window
Cochlea
Organ of Corti
Vestibulocochlear nerve
Central nervous system
12. Cerumen accumulates in the external ear leading to
hearing loss.
Degeneration of the receptor cells in the Organ of Corti.
Ossicles become less movable and interfere with
transmission of sound waves.
Decrease in cochlear branch of the cranial nerve VII
contribute to hearing loss, reduction in the vestibular
branch interferes with balance and coordination.
Bacterial and viral infections in the temporal bone may
cause sensorineural hearing loss.
13.
14.
15.
16.
17.
18. FREQUENCY
20 to 20,000 Hz
PITCH
100 Hz is considered of low pitch,
and a tone of 10,000 Hz is considered of high pitch
INTENSITY
Critical level of loudness is approximately 30 dB
80 dB can be damaging to the inner ear
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37. Irritable, hostile or hypersensitive in interpersonal
relations.
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 and
straightened.
38. Family history of sensorineural impairment
Congenital malformations of the cranial structure (ear)
Low birth weight (1500 g)
Use of ototoxic medications (e.g., gentamycin, loop
diuretics)
Recurrent ear infections
Bacterial meningitis
Chronic exposure to loud noises
Perforation of the tympanic membrane
39. 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.
40. Talk directly to the person facing him/her.
Speak in clearly enunciated words using normal tone of
voice.
Use gestures with speech.
Do not whisper to anybody in front of the hearing –
impaired patient.
Do not avoid conversation with a person who has
hearing loss.
Do not show annoyance by careless facial expression.
41. Move closer to the person or toward the better ear if
he/she does not hear you.
Do not smile, do not chew gum or cover the mouth
when talking to the person.
Encourage the use of hearing aid if the person has one.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51. Patients may require analgesic medications for the first
48 to 92 hours.
If the external canal is edematous, a wick should be
inserted to keep the canal open so that liquid
medications (eg, Burow’s solution, antibiotic otic
preparations) can be introduced.
For cellulitis or fever, systemic antibiotics may be
prescribed.
For fungal disorders, antifungal agents are prescribed.
52. Instruct patients not to clean the external auditory canal
with cotton-tipped applicators.
Avoid getting the canal wet when swimming or
shampooing the hair.
Infection can be prevented by using antiseptic otic
preparations after swimming (eg, Swim Ear, Ear Dry),
unless there is a history of tympanic membrane
perforation or a current ear infection.
53.
54. Control of the diabetes, administration of antibiotics
(usually intravenously), and aggressive local wound
care.
Standard parenteral antibiotic treatment includes the
combination of an antipseudomonal agent and an
aminoglycoside.
Local wound care includes limited débridement of the
infected tissue, including bone and cartilage, depending
on the extent of the infection.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69. Limit foods high in salt or sugar.
Eat meals and snacks at regular intervals to stay
hydrated.
Eat fresh fruits, vegetables, and whole grains. Limit the
amount of canned, frozen, or processed foods with high
sodium content.
Drink plenty of fluids daily. Water, milk, and low-sugar
fruit juices are recommended. Limit intake of coffee, tea,
and soft drinks.
78. The ear mold is the only part of the hearing aid that may
be washed frequently.
Wash ear mold daily with soap and water.
Allow the ear mold to dry completely before it is
snapped into the receiver.
Clean the cannula with a small pipe cleaner–like device.
Proper care of the ear device and keeping the ear canal
clean and dry can prevent complications.
79. Inadequate amplification, a whistling noise, or pain from
the mold can occur when a hearing aid is not functioning
properly.
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 the
hearing aid dealer.
80. If the unit requires extended time for repair, the dealer
may lend you a hearing aid until the repair can be
accomplished.
81. Common medical complications include external otitis
media and pressure ulcers in the external auditory
canal. Signs and symptoms of these infections include
painful ear, especially when the external ear is touched;
canal swelling; redness; difficulty hearing; pain radiating
to the jaw area; and fever.
If any of these symptoms are present, notify your health
care provider for evaluation. You may need medication
to treat infection, pain, or both.
