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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 Elsevier items and derived items © 2006 by Elsevier Inc. 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 Elsevier items and derived items © 2006 by Elsevier Inc. 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. Elsevier items and derived items © 2006 by Elsevier Inc. Otitis Media • Three types of otitis media include: – Acute otitis media – Chronic otitis media – Serous otitis media Elsevier items and derived items © 2006 by Elsevier Inc. Nonsurgical Management • Quiet environment • Bedrest with limited head movement • Heat and cold applications • Systemic and topical antibiotic therapy • Analgesics • Antihistamines • Decongestants Elsevier items and derived items © 2006 by Elsevier Inc. 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. Elsevier items and derived items © 2006 by Elsevier Inc. Mastoiditis • Infection of the mastoid air cells caused by untreated or inadequately treated otitis media • Nonsurgical management: antibiotics (Continued) Elsevier items and derived items © 2006 by Elsevier Inc. 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 Elsevier items and derived items © 2006 by Elsevier Inc. 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. Elsevier items and derived items © 2006 by Elsevier Inc. 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. Elsevier items and derived items © 2006 by Elsevier Inc. 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. Elsevier items and derived items © 2006 by Elsevier Inc. 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. Elsevier items and derived items © 2006 by Elsevier Inc. 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 Elsevier items and derived items © 2006 by Elsevier Inc. 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) Elsevier items and derived items © 2006 by Elsevier Inc. 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. Elsevier items and derived items © 2006 by Elsevier Inc. Acoustic Neuroma • Benign tumor of eighth cranial nerve • Surgical removal via craniotomy • Extreme care taken to preserve the function of the facial nerve Elsevier items and derived items © 2006 by Elsevier Inc. 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) Elsevier items and derived items © 2006 by Elsevier Inc. 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. Elsevier items and derived items © 2006 by Elsevier Inc. Assessments • Tuning fork tests • Otoscopic examination • Psychosocial assessment • Laboratory tests • Radiographic assessment • Other diagnostic assessments such as audiogram Elsevier items and derived items © 2006 by Elsevier Inc. Treatment of Hearing Loss • Drug therapy • Assistive devices • Hearing aids • Cochlear implants (Continued) Elsevier items and derived items © 2006 by Elsevier Inc. 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. Elsevier items and derived items © 2006 by Elsevier Inc. 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) Elsevier items and derived items © 2006 by Elsevier Inc. 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. Elsevier items and derived items © 2006 by Elsevier Inc. Impaired Verbal Communication • Assistive devices for hearing compensation • Lip reading, sign language • Managing anxiety Elsevier items and derived items © 2006 by Elsevier Inc.