CH 45 EAR, Auditory, & Balance Disorders

Name Pathophysiology Treatment

Impaired Hearing Teach Clients to avoid noisy
environments and wear ear protection
when exposed to loud noises, to reduce
rate of hearing impairment. Two Types
conductive & sensorineural. Both can
occur at birth, develop later in life, be
genetic, or caused by injury or trauma.
CONDUCTIVE: inability of sound waves
to reach inner ear. Caused by cerumen
build up, blockage, perforated tympanic
membrane, or fixation of one or all the
ossicles. SENSORINEURAL: inner ear or
cochlear portion of cranial nerve VIII is
abnormal or diseased. Caused by
exposure to loud noises, tumor,
infection, or trauma.
** Hearing loss associated with age is
called Presbycusis.
Hearing aids, lip-reading.
** Alarm clock strobe lights.
Surgical: cochlear implant is possible
treatment for people with profounded
deafness.


Menieres Disease State of hearing loss chacterized by
tinnitus or vertigo. Etiology unknown.
Major symptoms: VERTIGO, TINNITUS,
& UNILATERAL HEARINGLOSS.
Constant low pitched roaring noise.
Symptoms worse first attack which can
last minutes to 6 hours. Nystagmus-
repetive involuntary movement of
eyeball & diaphoresis may occur during
an attack. Attacks can cause permanent
bilateral hearing loss.
Avoid caffeine, alcohol, & salt. (Beer,
wine, soda, chocolate, coffee, tea, salty
foods or snacks). Do Not Smoke.
**Disability occurs often.
Antihistamines, diuretics, antiemetics,
tranquilizers, oral niacin.

**Lasix, Gentamycin, Aspirin: careful
with 8
th
cranial nerve can cause hearing
loss and ototoxicity.

CH 45 EAR, Auditory, & Balance Disorders

Advise against reading and using glaring
lights. Avoid sudden position changes.

Otosclerosis Most common conductive hearing loss.
Cause unknown. Softening of ossicles
bone over time or without warning.
More common in adults, and even more
common in women. **Young white
females. Difficult to hear a whisper or in
a loud crowded place. **Stapes most
commonly affected.
Stapedectomy is preferred surgical
technique for improving hearing loss.
Done under local or general anesthesia.
Artificial stapes inserted.
**No shampoo up to 6 weeks, no shower
water. Do not blow nose for 10 days
post op (Avoid people with colds).
Sneeze with mouth open. Hearing will
be decreased for 3-4 weeks until gel
foam packing dissolves.
Acoustic Neuroma Slow growing usually benign tumor of
inner ear. Facial weakness caused by
compression of tumor on 7
th
cranial
nerve. Dizziness, tinnitus, hearing loss,
unbalanced.
Treatment is almost always surgical
excision of tumor.
Antihistamines to reduce dizziness.
Otitis Media Inflammation of the middle ear.
**Common cause of conduction hearing
loss. Symptoms ear pain, fever, redness
of auricle, and ear canal, sometimes
enlarged lymph nodes over mastoid
process, parotids, or neck. **Occurs
more frequently in children than adults.
Fluid accumulates behind eardrum
because of blockage of the Eustachian
tube. *Secondary to upper respiratory
infection, allergies, or acute bacterial
infections.
Tropical heat & analgesics may be used
to control pain. Myringotomy-incision in
eardrum, fluid aspirated.
Tympanoplasty if tympanic membrane
ruptures. Decongestants Sudafed,
antihistamines Benadryl, antibiotics
omnipen. Sterile cotton loosely placed
external ear to absorb drainage. Warn
client against blowing nose or getting
ear wet.
CH 45 EAR, Auditory, & Balance Disorders

Otitis Externa Swimmer Ear. Bacterial infection of
external ear. Canal red & swollen.
Alcohol, ear wick with medicated gauze.
Liquid Colace in ear loosens earwax.
Mastoiditis Inflammation of mastoid. Results from
bacterial otitis media. Infection finds its
way to the bone. If left untreated cause
severe damage, deafness, facial
weakness, brain abscess and
MENINGITIS.
Antibiotics for trial period. If it doesnt
resolve then surgery to remove mastoid
bone may be necessary.


OTOLARYNGOLOGIST: ear, nose, & throat physician.
AUDIOLOGIST: evaluates hearing, determines extent & type of hearing loss.

External Ear: auricle (pinna), cartilage, external ear canal (meatus).
-Responsible for collecting & conducting sound waves.
-Cerumen (earwax) yellowish brown discharge guards ear against bacteria.

Middle Ear: malleus (hammer), Incus (anvil), Stapes (stirrup).
-Resemble blacksmiths tools
-Equalizes pressure on both sides of eardrum, amplification of sound, and move fluids threw inner ear.

Inner Ear: semicircular canals, vestibule, & cochlea.
-Provides balance, hearing, vibration of stapes creates pressure & causes nerves to respond to different sounds.
-Sounds are sent to the brain threw auditory nerve (8
th
cranial nerve).

***AC (air conduction) > BC (Bone Conduction)
**Most common hearing loss is Sensorineural (can be helped with hearing aid)
*Down Syndrome causes lower ear set.

CH 45 EAR, Auditory, & Balance Disorders

Caloric test: Normal: cold water causes nystagmus, when warm water injected eyes move toward injected ear and then slowly
back toward midline. (Vestibular function test). Diagnosis acoustic neuroma & Menieres disease.

Otoscopic exam: Tympanic membrane is intact and pearly grey.
Rinne Test: Tunning fork on mastoid & front of ear canal
Weber Test: Tunning fork on head.
Whisper Test: whispered 1-2 feet behind client. If client is unable to repeat the word there is high frequency range hearing
loss.

Administer Ear Drops:
ADULTS: Up & Back
CHILDREN: Down & Back
Tilt head for 15 minutes use cotton ball to prevent leak.

CH 45 EAR, Auditory, & Balance Disorders


CH 45 EAR, Auditory, & Balance Disorders