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Chapter 52
Interventions for Clients with
Ear and Hearing Problems
Elsevier items and derived items © 2006 by Elsevier Inc.
External Otitis
• Painful condition caused when irritating or
infective agents come into contact with the skin
of the external ear
• Commonly called swimmer’s ear
• Treatment focused on reducing inflammation,
edema, and pain with heat, bedrest, limited head
movement, topical antibiotic and steroid therapy,
and analgesics
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Furuncle
• Localized external otitis caused by bacterial
infection of a hair follicle
• Hearing impaired if the lesion blocks the canal,
most commonly cerumen (wax)
• Treatment with local and systemic antibiotics,
heat application, earwick to relieve pain, and
possible incision and drainage
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Cerumen or Foreign Bodies
• Cerumen (wax) is the most common cause of an
impacted canal.
• Other blockages include vegetables, beads,
pencil erasers, insects.
• Irrigate canal with a mixture of water and
hydrogen peroxide at body temperature for
impacted cerumen; Cerumenex softens wax.
• Carefully remove foreign object.
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Otitis Media
• Three types of otitis media include:
– Acute otitis media
– Chronic otitis media
– Serous otitis media
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Nonsurgical Management
• Quiet environment
• Bedrest with limited head movement
• Heat and cold applications
• Systemic and topical antibiotic therapy
• Analgesics
• Antihistamines
• Decongestants
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Surgical Management
• Myringotomy is a surgical opening of the pars
tensa of the eardrum.
• Operative procedure includes grommet
(polyethylene tube) placed through the tympanic
membrane.
• Postoperative care: keep external ear and canal
free of other substances while the incision is
healing and keep head dry for several days.
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Mastoiditis
• Infection of the mastoid air cells caused by
untreated or inadequately treated otitis media
• Nonsurgical management: antibiotics
(Continued)
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Mastoiditis (Continued)
• Surgical management: simple or modified
radical mastoidectomy with tympanoplasty
• Complications: damage to cranial nerves,
vertigo, meningitis, brain abscess, chronic
purulent otitis media, and wound infection
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Trauma
• Trauma and damage to the eardrum and
ossicles may occur by infection, by direct
damage, or through rapid changes in the middleear cavity pressure.
• Eardrum perforations usually heal within 24
hours.
• Use preventive measures to protect the ear from
trauma.
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Neoplasms
• Tumors are removed by surgery, which often
destroys hearing in affected ear.
• Benign lesions are removed because, with
continued growth of the neoplasm, other
structures can be affected, damaging the facial
or trigeminal nerve.
• When possible, reconstruction of the middle ear
structures is performed.
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Tinnitus
• Continuous ringing or noise perception is one of
the most common problems with ear or hearing
disorders.
• Tinnitis cannot be observed or confirmed with
diagnostic tests.
• When no cause is found, therapy focuses on
masking the tinnitus with background sound,
noisemakers, and music during sleeping hours.
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Vertigo and Dizziness
• Common manifestations of many ear disorders
• Advise client to:
– Restrict head motions and move more slowly.
– Maintain adequate hydration.
– Take antivertiginous drugs.
– Prevent loss-of-balance accidents.
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Labyrinthitis
• Infection of the labyrinth
• Meningitis a common complication of
labyrinthitis
• Treatment with systemic antibiotics, bedrest in a
darkened room, antiemetics, antivertiginous
medications, psychosocial support
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Ménière's Disease
• Tinnitus, one-sided sensorineural hearing loss,
and vertigo occur in attacks that can last for
several days.
• Nonsurgical management includes slow head
movements, salt and fluid restrictions, cessation
of smoking, mild diuretics, nicotinic acid,
antihistamines, antiemetics, diazepam.
(Continued)
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Ménière’s Disease (Continued)
• Surgical management is a last resort and
consists of labyrinthectomy or endolymphatic
decompression with drainage and shunt.
• Hearing in the affected ear is often sacrificed.
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Acoustic Neuroma
• Benign tumor of eighth cranial nerve
• Surgical removal via craniotomy
• Extreme care taken to preserve the function of
the facial nerve
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Hearing Loss
• One of the most common physical handicaps
in North America.
• Common causes of conductive hearing loss:
any inflammation process or obstruction of the
external or middle ear by cerumen or foreign
objects.
(Continued)
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Hearing Loss (Continued)
• Common causes of sensorineural hearing loss:
loud noise, drugs, presbycusis, atherosclerosis,
hypertension, prolonged fever, Ménière's
disease, diabetes mellitus, and ear surgery.
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Assessments
• Tuning fork tests
• Otoscopic examination
• Psychosocial assessment
• Laboratory tests
• Radiographic assessment
• Other diagnostic assessments such as
audiogram
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Treatment of Hearing Loss
• Drug therapy
• Assistive devices
• Hearing aids
• Cochlear implants
(Continued)
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Treatment of Hearing Loss (Continued)
• Tympanoplasty
– Postoperative care includes antiseptic-soaked
gauze packed in the ear canal, clean
dressing, client flat with head turned to the
side and the operative ear facing up for at
least 12 hours after surgery, prescribed
antibiotics, activity restrictions.
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Stapedectomy
• A partial or complete stapedectomy with a
prosthesis corrects hearing loss and is most
effective for hearing loss related to otosclerosis.
• Hearing improvement may not occur until 6
weeks after surgery.
(Continued)
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Stapedectomy (Continued)
• Damage to cranial nerves, vertigo, and nausea
and vomiting are common after surgery.
• Pain medications and antibiotics are often used.
• Safety measures and antivertiginous drugs
should be applied.
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Impaired Verbal Communication
• Assistive devices for hearing compensation
• Lip reading, sign language
• Managing anxiety
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