CHAPTER © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 43 Assisting with Eye and Ear Care

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Learning Outcomes (cont.) 43.1 Describe the medical assistant’s role in eye exams and procedures performed in a medical office Discuss various eye disorders encountered in a medical office Identify ophthalmic exams performed in the physician’s office Summarize ophthalmologic procedures and treatments.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Learning Outcomes (cont.) 43.5 Describe the medical assistant’s role in otology Describe disorders of the ear encountered in the medical office Recall various hearing and other diagnostic ear tests Summarize ear procedures and treatments.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Introduction Think how often you use your eyes and ears Good eye and ear care is critical Ophthalmology and otology –Disorders –Exams and procedures

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Ophthalmology Specialty of the anatomy, function and diseases of the eye Ophthalmologists Medical assistant –Visual acuity –Color vision –Intraocular pressure

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Eye Diseases and Disorders Disorders of external eye structures –Blepharitis ~ chronic inflammation of the eyelid’s edges –Ptosis ~ droopy upper eyelid –Sty ~ eyelash follicle infection

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Eye Diseases and Disorders (cont.) Disorders of structures of the front of the eye –Conjunctivitis Allergic Infectious –Corneal ulcers and abrasions

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Eye Diseases and Disorders (cont.) Disorders involving internal eye structures –Cataracts ~ cloudy or opaque lens –Glaucoma ~ increased fluid pressure –Iritis ~ inflammation of the iris and sometimes the ciliary body

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Eye Diseases and Disorders (cont.) Disorders of the Retina –Retinal detachment ~ retina separate from the middle, vascular layer of the eye –Diabetic retinopathy ~ damage to small blood vessels supplying the retina –Macular degeneration ~ dark spot in the center of the field of vision

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Eye Diseases and Disorders (cont.) Disorders involving eye movement –Strabismus Deviation of one eye Children – misaligned or unbalanced muscles Adults – nerves and/or muscles –Amblyopia ~ “Lazy” eye

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Eye Diseases and Disorders (cont.) Refractive disorders –Myopia –Hyperopia –Presbyopia –Astigmatism

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge True or False An ophthalmologist specializes in treating eyes and related tissues. Blepharitis is the result of an eyelash follicle infection. Viral or bacterial conjunctivitis is not easily spread. In glaucoma, fluid pressure builds up in the eye. There is a loss of the vision in the center of the eye with retinal detachment. Presbyopia is related to aging. Visual defects are the most common eye disorders treated by ophthalmologists. ANSWER: T T T T F F F A sty macular degeneration

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Ophthalmic Exams Ophthalmoscope Tests –Visual fields –Convergence of the eyes –Glaucoma – tonometer

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Ophthalmology Exams Slit lamp Refraction exam

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Types of Vision Screening Tests Includes tests for –The ability to see clearly –The ability to distinguish shades of grey and colors Screening –Snellen chart –Jaegar chart –Ishihara book

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Types of Vision Screening Tests (cont.) Near Vision –Hyperopia –Presbyopia Contrast Sensitivity –Shades of gray –Cataracts / retinal problems Color vision –Color-blindness –Retina / optic nerve problems (Reprinted with permission of Richmond Products, Inc.)

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge Match the following: used to view the inner eye measures intraocular pressure used to examine the anterior eye verifies the need for corrective lenses Snellen chart Jaegar chart Ishihara book A.Refraction exam B.Otoscope C.Distance visual acuity D.Color-blindness E.Tonometer F.Near vision G.Slit lamp B ANSWER: E G A C F D Correct!

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Ophthalmologic Procedures and Treatments Minor injury or infection – lasting consequences Medical assistant –Proper technique –Patient education Routine care Warning signs Use of protective equipment

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Administering Medications to the Eye Purposes –Assist patients in eye tests –Reduces pressure in the eye –Relieves eye pain –Treats infections Medical assistant –Dispense eye medication –Patient instructions

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Administering Medications to the Eye (cont.) Eye irrigation –Remove foreign materials –Relieve discomfort Use sterile solution

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge When administering eye medications, you should avoid touching the tip of the dropper or tube to the eye. Why? ANSWER: Touching the tip of the dropper or ointment tube can injure the eye, cause infection, and contaminate the medication. Excellent!

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Otology Otologist – treats diseases and disorders of the ears Medical assistant –Auditory screening –Administer ear medications –Perform ear irrigations –Assist with diagnostic tests

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge What are the functions of a medical assistant related to otology? ANSWER: The medical assistant may  Perform auditory screening  Administer ear medications  Perform ear irrigations  Assist with diagnostic tests HEAR!

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Ear Diseases and Disorders Common Disorders of the Outer Ear Cerumen impaction –Eardrops to soften wax –Irrigation to remove it Otitis externa –Swimmer’s ear –Medicated drops Pruritus –Less wax with aging –Mineral oil drops

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Common Disorders of the Middle Ear Otitis Media –Fluid buildup –Ear infection Mastoiditis Otosclerosis –Abnormal bone tissue growth –Hearing loss and tinnitus Ruptured ear drum

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Common Disorders of the Inner Ear Labyrinthitis –Infection of labyrinth –Vertigo Ménière’s disease –Increased fluid in labyrinth –Vertigo, nausea, and vomiting

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Common Disorders of the Inner Ear Presbycusis –Deterioration of sensory receptors in the cochlea –Aging Tinnitus –Ringing in the ears –Damage to hearing receptors

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Hearing Loss Not a normal aging process Types –Conductive hearing loss ~ sound waves do not reach the inner ear –Sensorineural hearing loss~ damage to the inner ear, nerve, or brain Noise pollution

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Working with Patients with a Hearing Impairment Speak at a reasonable volume Speak clearly, in low-pitched tones Stand facing the patient Do not over-emphasize lip movements

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Working with Patients with a Hearing Impairment Avoid hand gestures Re-state message in short, simple sentences Treat patients with patience and respect

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge Arrange disorders properly: Inner Ear Middle Ear Outer Ear Cerumen impaction Ruptured eardrum Mastoiditis Pruritus Otitis externa Otitis media Tinnitus Presbycusis Otosclerosis Labyrinthitis Nice Job! Ménière’s Disease 1.Ménière’s Disease 2.Otitis externa 3.Otitis media 4.Ruptured eardrum 5.Tinnitus 6.Mastoiditis 7.Cerumen impaction 8. Otosclerosis 9.Labyrinthitis 10. Pruritus 11. Presbycusis

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Hearing and Other Diagnostic Ear Tests Medical assistant –Assist with testing –Educate patients Tuning fork

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Hearing and Other Diagnostic Ear Tests (cont.) Audiometer –Measures hearing acuity –Varies frequency and decibels Tympanometry –Measures eardrum’s ability to move –Gauges pressure in the middle ear

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Ear Treatments and Procedures Medical assistant –Patient education ~ preventive ear care –Administer ear medications –Perform ear irrigations –Assist with earwax removal

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Ear Treatments and Procedures (cont.) Administering medications –Local effect –Warm before administering Earwax removal –Ear curette –Irrigation

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Ear Treatments and Procedures (cont.) Ear irrigation –Relieve inflammation or irritation –Loosen and remove impacted cerumen –Remove foreign body Microscopic earwax and foreign body removal

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Hearing Aids Parts –Microphone –Amplifier –Speaker Obtaining a hearing aid –Otologist –Audiologist Care and use

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Other Devices and Strategies If hearing not helped by hearing aid –Devices that light up as well as ring –Amplifiers for phone, TV, and radio –Closed-captioning Cochlear implant –Does not amplify sound –Stimulates the auditory nerve

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge What is the differences in technique for administering eardrops to a child or an adult? ANSWER: To administer eardrops you need to straighten the ear canal by pulling the auricle upward and outward for adults, down and back for infants and children.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part In Summary 43.1 The medical assistant may perform some of the procedures that involve measuring various aspects and functions of the eye, such as visual acuity, color vision, and intraocular pressure Disorders of the eye include: those of the external eye structures, disorders of the anterior eye structures, and refractive disorders.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part In Summary 43.3 Ophthalmic exams performed in the physician’s office include: inspecting internal eye structures; testing visual fields; glaucoma testing; inspecting external eye structures; and refraction exams Ophthalmologic procedures and treatments include administering eye medications like eyedrops and ointments, and performing eye irrigation.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part In Summary 43.5 Medical assistants in an otology office may assist with or perform auditory screening, administer ear medications, perform ear irrigations, and help with diagnostic tests such as tympanometry Ear diseases and disorders include: those of the outer ear, middle ear disorders, and those of the inner ear.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part In Summary 43.7 Hearing and other diagnostic ear tests include audiometry and tympanometry Ear treatments and procedures include administration of ear medications, ear irrigation, microscope-aided earwax or foreign body removal, hearing aid fitting, and cochlear implants.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part End of Chapter 43 There is no such thing as an empty space or an empty time. There is always something to see, something to hear. In fact, try as we may to make a silence, we cannot - John Cage