1. Care of Patients with Ear and Hearing Problems
Chapter 51
Care of Patients with Ear and Hearing Problems

2. Conditions Affecting the External and Middle Ear
External otitis
Furuncle
Perichondritis
Cerumen or foreign bodies
Otitis media
Mastoiditis
Trauma
Neoplasms

3. Types of Interventions
Infection control (equipment)
Medications
Surgical
Compare/contrast with surgical interventions for other types of operative procedures
Patient teaching

4. Earwick
Earwick used for instillation of antibiotics into the external canal. When edema occludes the external auditory canal, it is difficult for antibiotic solutions to enter the canal adequately. An earwick is placed through the meatus. Solutions placed on the external portion of the earwick are absorbed through the canal.

5. Irrigation of the External Ear
Cerumen and debris can be removed from the ear by irrigation with warm water. The stream of water is aimed above or below the impaction to allow back-pressure to push it out rather than push it further down the canal.

6. Otitis Media Three types: Acute Chronic Serous
Left: Otoscopic view of otitis media. Right: Otoscopic view of a perforated tympanic membrane.

7. Conditions Affecting the Inner Ear
Tinnitus
Vertigo and dizziness
Labyrinthitis
Ménière's disease
Acoustic neuroma
Hearing loss

8. Acoustic Neuroma
T1-weighted axial MR image after administration of contrast agent. A large acoustic neuroma widens the left internal auditory canal (solid arrow) and compresses the brain stem (hollow arrow).

9. Anatomy of Hearing Loss
Hearing loss can be divided into three types: (1) conductive (difficulty in the external ear or the middle ear); (2) sensorineural (difficulty in the inner ear or the acoustic nerve); and (3) mixed conductive-sensorineural (a combination of the two).

10. Types of Interventions
Medical
Early detection
Safety measures (due to hearing loss)
Dietary (nutrition, hydration)
Medication
Surgical
Hearing aids
Implants (e.g., cochlear devices)

11. Types of Interventions (cont’d)
Communication
Hearing aids
Lip-reading, sign language
Speech therapy
Community resources
Support groups

12. “You are right; there is nothing wrong with you.”
An 80-year-old patient presents for his annual check-up. His son reports that his hearing has significantly diminished over the past few years. The patient tells the nurse that he believes that his hearing is “just fine” and that “nothing is wrong” with him.
When the patient states that he feels fine and nothing is wrong with his hearing, what is the appropriate nursing response?
“You are right; there is nothing wrong with you.”
“Why don’t you believe what your children are saying about your hearing?”
“Don’t be scared of losing your hearing.”
“It must feel frightening to think about losing your hearing.”
ANS: D
The nurse should acknowledge the potential fear that the patient may be having without being patronizing or confrontational. Telling the patient there is nothing wrong with him exhibits false reassurance. Asking the patient why he doesn’t believe his children’s statements exhibits confrontation by demanding an answer. Telling the patient not to be frightened of losing his hearing minimizes the patient’s situation.

13. (cont’d)
The patient is diagnosed with suspected hearing loss. Which precautions would you teach the patient and his family about ear care before discharge? (Select all that apply.)
Use cotton swabs to clean your ear canal after every shower.
Avoid exposure to loud music or other noises.
Nothing smaller than a fingertip should be inserted into the ear canal.
Use an ear irrigation syringe to remove built up ear wax (cerumen).
Ear plugs should be used when engaging in all water sports to avoid infection.
ANS: B, C, D, E
It is important to teach about the dangers of using foreign objects to clean the ear canal (e.g. toothpicks, cotton swabs, bobby pins). Stress that nothing smaller than a person’s fingertip should ever be inserted into the ear canal.

14. (cont’d)
The patient’s son asks what he can do to better communicate with his father.
Which teaching is most appropriate?
Refer him and the patient to a sign language class.
Encourage the patient to learn to read lips.
Direct him to community support groups.
Promote family dialogue about hearing aids.
ANS: D
Promoting family dialogue about hearing aids opens the door for more understanding about a reasonable approach to better communication. Sign language classes and learning to read lips do not take into consideration that the patient is 80 years old and that he could have a difficult time learning these skills. Community support groups do not provide an immediate avenue to communication between the patient and his family.

15. (cont’d)
A week later, the patient’s hearing is tested by audiometry and it is determined that he needs a hearing aid.
Which statement indicates the need for additional teaching about hearing aid care?
“I can wear my hearing aid at all times, even when bathing.”
“I should check and replace the battery whenever needed.”
“I can clean the hole in the hearing aid of debris with a toothpick.”
“I should adjust the hearing aid’s volume to the lowest setting that lets me hear to avoid feedback squeaking”
ANS: A
The patient should keep the hearing aid dry. The ear mold can be cleaned with mild soap and water, but excessive wetness should be avoided. All of the other responses are correct teaching points for hearing aid care.

16. Audience Response System Questions
Chapter 51
Audience Response System Questions 16

17. Question 1
A priority nursing intervention for a patient with tinnitus is:
Evaluate medications for ototoxicity.
Encourage music or soft white noise during sleeping hours.
Acknowledge the psychological stressors of the disorder.
Provide education on loudness levels to prevent hearing loss.
Answer: B
Rationale: Tinnitus is a challenging hearing condition that lacks exact diagnostic testing. Tinnitus can disturb sleep patterns. Offering soft music or white noise can help the patient sleep. Other interventions include reviewing medications that may exacerbate the condition or alter hearing, exploring the patient’s coping and stress related to the condition, and discussing noise levels that may muffle the ringing sensation without damaging hearing.
(Source: Accessed November 28, 2011, from

18. Question 2
A patient is reporting ear pressure, dizziness, and decreased hearing. What should the nurse do?
Examine the ear for excessive ear wax (cerumen).
Ask the patient if he or she is experiencing headaches, malaise, or pain.
Establish a timeline for the patient’s symptoms.
Examine the patient’s hearing acuity.
Answer: B
Rationale: Acute and/or chronic otitis media will have multi-symptom presentation that includes conductive hearing loss, pain, headaches, malaise, fever, dizziness, nausea, and vomiting. Excessive ear wax can obscure hearing acuity and is a common condition in older adults. Patients may develop chronic otitis media, and frequency/pattern of symptoms is important for treatment.

19. Question 3
Which is a nursing intervention for maximizing communication with a patient with hearing loss while he or she is under Airborne Precautions?
Speak loudly.
Turn the TV volume down or off.
Speak clearly and slowly.
Ensure that you have the patient’s attention before speaking.
Answer: C
Rationale: Airborne Precautions requires wearing a mask while in close contact with the patient, thereby removing the patient’s ability to read lips. When communicating with patients that have difficulty hearing, speaking clearly, slowly, and closer to the patient is most helpful. Other strategies to assist with communication include reducing noise in the room, ensuring the patient is engaged with you, and projecting the voice but in a lower tone.