Chapter 14—Ears Assessment

Structure and Function Function: hearing; sustaining equilibrium Three distinct portions External ear: starts developing at sixth week of gestation External auditory canal; tympanic membrane Cerumen Middle ear: dampens volume; has four openings Bones: malleus, incus, and stapes Openings: tympanic membrane; cochlear window; oval window; eustachian tube

Structure and Function—(cont.) Three distinct portions—(cont.) Inner ear: responsible for sound translation to cranial nerve (CN) VIII Responsible for vestibular function Maintained in semicircular canals, vestibule Conduits Bony labyrinth Semicircular canals; vestibule; cochlea

Structure and Function—(cont.) Figure 14.2

Hearing Complex function External ear channels sound waves thru TM To inner ear ossicles via oval window, then to cochlea Which vibrates receptor hair cells of the organ of Corti Producing electrical impulses for auditory nerve Then delivers impulses to auditory cortex (in brain) Which interprets them as sound, assigns meaning Brainstem locates sound origination

Hearing—(cont.) Cochlea interprets two components of sound Amplitude (volume): change of atmospheric pressure against TM = intensity of sound Decibels = measurement of amplitude Frequency (pitch): sound waves Hertz = number of cycles per second Normal conversation: 10 to 60 dB and 200 to 5,000 Hz Sound perceived via Air conduction; bone conduction

Hearing—(cont.)

Hearing Difficulties Conductive hearing loss: sound wave transmission disrupted through external or middle ear External ear blockage: clear obstruction Middle ear: investigate for pathology Conductive loss overcome by increased amplitude Sensorineural hearing loss: problem from inner ear to auditory cortex Presbycusis Tinnitus

Vestibular Function Semicircular canals, utricle, saccule Provide proprioception, equilibrium Specialized epithelium: sense position Vertigo: Inflamed labyrinth causes loss of equilibrium. Ménière disease: vertigo with severe nausea, vomiting Exacerbation periods often last 24 hours. Followed by periods of remission

Lifespan Considerations: Older Adults Continual cartilage formation  increasing ear prominence with increasing age Fine ear hairs become coarser, stiffer. Sound wave interference  decreased hearing Cerumen impaction  decreased hearing Slowing of electrical responses in brain  increased reaction time needed Cultural considerations Cerumen differences

Question What transfers the signals into electrical impulses for the auditory nerve? A. Cochlea B. Organ of Corti C. Labyrinth D. Oval window

Answer Rationale: The basal membrane in the cochlea vibrates the receptor hair cells of the organ of Corti, which transfer the signal into electrical impulses for the auditory nerve.

Urgent Assessment Outer ear foreign object: otolaryngologist removal Foul-smelling drainage: immediate attention Chronically draining ears Cholesteatoma Can erode auditory ossicles  significant heading damage Ear trauma Hemotympanum (tympanic rupture)

Subjective Data Assessment of risk factors Personal history Medications Family history Risk factors

Risk Reduction and Health Promotion Health goals Patient teaching topics Most significant: risk assessment for general hearing loss Protective equipment Skin cancer prevention Ear cleaning

Common Symptoms Signs/symptoms Hearing loss Vertigo Tinnitus Otalgia Documentation Lifespan considerations: older adults Cultural considerations

Objective Data Common and specialty or advanced techniques Inspection; palpation Hearing acuity Otoscopic evaluation Auditory acuity Rinne test; Weber test Equilibrium Lifespan considerations Cultural considerations

Critical Thinking Common laboratory and diagnostic testing Diagnostic reasoning: Nursing diagnosis, outcomes, and interventions Outcomes (partial list) Patient is free from ear pain. Patient explains plan to accommodate hearing impairment. Nursing interventions (partial list) Turn off TV, radios when communicating. Close door to muffle loud hallway noise.

NCLEX-Style Review Question The function of the ear is for hearing and equilibrium. equilibrium and perforations. perforations and balance. balance and equilibrium

NCLEX-Style Review Question The inner ear contains the malleus, incus, and stapes. conducts sound waves to the external ear. translates sound to the nerves and brainstem. provides the body with proprioception

NCLEX-Style Review Question Cues of hearing loss include which of the following? Choose all that are correct. Using a loud or monotonous voice Asking to repeat questions Concentrating on lip movement Leaning forward to hear

NCLEX-Style Review Question Risk factors for hearing loss include which of the ­following? Choose all that are correct. Frequent ear infections Being current on immunizations Exposure to smoke Decreased age

NCLEX-Style Review Question Tinnitus is described as inability to hear well. dizziness. ringing in the ear. ear pain

NCLEX-Style Review Question Which of the following patients is most likely to have hearing loss? Caucasian man older than 70 years of age Hispanic woman older than 50 years of age Asian man younger than 30 years of age African American girl younger than 10 years of age

NCLEX-Style Review Question Which of the following differentiates the RN ­assessment from the APRN assessment? History and risk factors Symptom analysis Inspection and palpation Otoscopic assessment

NCLEX-Style Review Question A nursing diagnosis appropriate for a patient with ear problems is kinesthetic disturbed perception. disturbed sensory perception. sensory perception, gustatory. olfactory sensory perception

NCLEX-Style Review Question Which of the following is an outcome appropriate for a patient with hearing impairment? Provide a communication board or picture to assist teaching. Minimize background noise and close door. Stand in front of patient and explain procedure. Patient explains plan to accommodate hearing ­ impairment

NCLEX-Style Review Question Which of the following are appropriate interventions for the patient who is at risk for ear infection? Select all that apply. Be current on immunizations. Avoid secondhand smoke. Clean only external ear. Have audiogram yearly