4. OTOSCLEROSIS (HARDENING OF THE
EAR):-
IT IS DEFINED AS THE FORMATION OF AN ABNORMAL
SPONGE LIKE BONE GROWTH ALONG WITH THE STAPES
BONE IN MIDDLE EAR.
DUE TO THIS ABNORMAL BONE GROWTH STAPES
BECOMES IMMOBILIZE TO TRANSMIT VIBRATION INTO
EAR.
THIS WILL LEADS TO CONDUCTIVE HEARING LOSS. ITS
COMMONLY DEVELOP IN AGE OF 15-35, COMMONLY IN
WOMEN
8. DIAGNOSTIC EVALUATION:-
H.C. & P.E.
AUDIOMETRIC TESTING
CT-SCAN
WHISPER VOICE TEST
MANAGEMENT:- HEARING AID USED TO TREAT HEARING
LOSS
SURGICAL MANAGEMNT:-
STAPEDECTOMY- A SURGICAL REMOVING PORTION OF
SPONGY BONE AND IMPLANT PROSTHESIS.
STAPEDOTOMY- DRILLING HOLE IN THE STAPES WITH
MICRODRILL & THE INSERTION OF A PROSTHESIS.
9.
10.
11. NURSING MANAGEMENT:-
• MAINTAIN POSITION AFTER SURGERY
• ASSESS THE LEVEL OF PAIN AFTER SURGERY
• ADMINISTER DRUGS AS PRESCRIBED
• MONITOR EAR DRAINAGE AFTER SURGERY
• ASSESS SURGICAL SITE INTERVALY
12. OTITIS MEDIA:- OTITIS- INFLAMMATION OF EAR, MEDIA- MIDDLE
IT IS DEFINED AS INFECTION & INFLAMMATION OF THE
MIDDLE EAR.
ETIOLOGY & RISK FACTORS:-
BACTERIAL INFECTION (H.INFLUENZA, PNEUMOCOCCUS,
MORAXELLA)
VIRAL INFECTION (RHINOVIRUS)
SORE THROAT
COLDS/ FEVER
PHARYNGITIS & SECONDARY TO RESPIRATORY DISORDER
ALTERED IMMUNITY
TYMPANIC MEMBRANE PERFORATION
HISORY OF SEASONAL ALLERGIES
POOR PERSONAL HYGIENE
13. CLASSIFICATION:-
OTITIS MEDIA HAS MANY DEGREES OF SEVERITY.
ACUTE OTITIS MEDIA
OTITIS MEDIA WITH EFFUSION
CHRONIC SUPPURATIVE OTITIS MEDIA
♦ACUTE OTITIS MEDIA (AOM):- ITS ALSO CALLED ACUTE
SUPPURATIVE OTITS MEDIA. AOM IS AN ACUTE
INFLAMMATION & INFECTION OF THE MIDDLE EAR
MUCOSA.
ACUTE OTITS MEDIA IS RAPID ONSET & SHORT DURATION
14. ♦OTITIS MEDIA WITH EFFUSION (EOM) / GLUE EAR:-
ITS ALSO CALLED SECRETORY OTITIS MEDIA. IN THIS
COLLECTION OF FLUID IN MIDDLE EAR. THIS CAN
MOSTLY FROM VIRUS URI INFECTION.
OVER WEEKS & MONTHS, MIDDLE EAR FLUID CAN
BECOME VERY THICK & GLUE LIKE. THUS MAY CAUSE
CONDUCTIVE HEARING IMPAIRMENT.
15. PATHOPHYSIOLOGY:-
URTI/INFLAMMATORY OR ALLERGIC CONDITION
OBSTRUCTION OF EUSTACHIAN TUBE
AIR NOT PASSING FROM E.TUBE TO MIDDLE EAR
NEGATIVE PRESSURE IS GENERATED IN MIDDLE EAR
NEGATIVE PRESSURE PULLS INTERSTITIAL FLUID INTO
TUBE
CREATES SEROUS EFFUSION
THIS EFFUSION PROVIDES MEDIA FOR MICROBIAL
GROWTH
16. CHRONIC SUPPURATIVE OTITIS MEDIA:-
CSOM MAY DEVELOP AFTER A PROLONGED PERIOD OF
TIME WITH EFFUSION OR NEGATIVE PRESSURE BEHIND
TYMPANIC MEMBRANE. CSOM CAUSE HOLE IN THE EAR
DRUM & THERE MAY BE CONTINUING DRAINAGE FROM
THE EAR.
CLASSIFICATION:-
•TUBOTYNPANIC TYPE
•ATTICOANTRAL DISEASE
17. C/M. :-
EARPAIN (OTALGIA)
TINNITUS
SENSE OF FULLNESS IN EAR
MASTOID TENDERNESS
FEVER
DEEP EAR PAIN WITH HEADACHE(CSOM)
HEARING LOSS
EAR DRAINAGE
REDNESS & SWELLING OF EAR
18. DIAGNOSTIC EVALUATION:-
H.C. & P.E.
CT-SCAN & MRI
TYMPANOCENTESIS:- STERILIZATION OF THE EAR CANAL
WITH ISOPROPYL ALCOHOL OR POVIDINE
IODINESOLUTION. INSERT A NEEDLE THROUGH
ANTERIOR PORTION OF TYMPANIC MEMBRANE AND
ASPIRATE THE CONTENTS.
AUDIOMETRY
LABORATORY STUDIES
20. SURGICAL MANAGEMENT:-
MYRINGOTOMY:- PERFORMING HOLE IN THE TYPMANIC
MEMBRANE BY MICROALLIGATOR FORCEPS &
SUCTIONING THE MIDDLE EAR & INSTILLING ANTIBIOTIC
DROPS.
TYMPANOPLASTY/MYRINGOPLASTY
OSSICULOPLASTY – SURGICAL RECONSTRUCTION OF THE
MIDDLE EAR BONE & REPLACING WITH PROSTHESIS.
OTOLAM- A NEW PROCEDURE INVOLVES MAKING HOLE
IN THE EARDRUM WITH A LASER. AND OPENS MIDDLE
EAR FOR SEVERAL WEEKS.
23. P/P:-
BACTERIA SPREAD FROM MIDDLE EAR TO MASTOID AIR
CELLS
INFLAMMATION BEGINS
DAMAGE TO MASTOID CELLS
ABSCESS FORMATION
ABSCESS EXTENSION TO SURROUNDING STRUCTURE
LIKE CRANIAL FOSSA,MIDDLE EAR FOSSA
28. LABYRINTHITIS IS AN INFLAMMTION & INFECTION OF
THE INNER EAR.
THIS CONDITION PRODUCES DISTURBANCES OF BALANCE
& HEARING. VERTIGO IS A HALLMARK SYMPTOM OF
LABYRINTHITIS.
ETIOLOGY/ RISK FACTORS:-
•SECONDARY TO OTITIS MEDIA & MENINGITIS
• HEAD INJURY
•EXTREME STRESS
•DRINKING LARGE AMOUNT OF ALCOHOL
•IDIOPATHIC
29. P/P.:-
DUE TO ETIOLOGY
INFLAMMATION OF INNER EAR STRUCTURE
DISTURBANCES IN FUNCTION OF SEMICIRCULAR CANAL
& COCHLEA
DIFFICULTY IN HEARING & MAINTAING BALANCE
30. CLINICAL MANIFESTATIONS OR SIGNS & SYMPTOMS:-
→EXTREME VERTIGO
→DIZZINESS (SENSATION OF FAINTNESS)
→SENSORINEURAL HEARING LOSS
→AURAL FULLNESS/ EAR FULLNESS
→TINNITUS
→OTALGIA
→NAUSEA/ VOMITING
32. MANAGEMENT:-
VERTIGO TREATED BY MECLIZINE, SCOPALAMINE
ANTIBIOTICS- BROAD SPECTRUM ANTIBIOTICS
ANTIVIRAL
ANTIEMETICS
BENZODIAZEPINES (DIAZEPAM)
CORTICOSTEROIDS (PREDNISOLONE)
OTHER:-
PROVIDE REST
DRINK MORE WATER
AVOID HEAVY EXERCISES
AVOID DRIVING
AVOID SUDDEN POSITION CHANGES & JUMPING
ACTIVITIES
33.
34. MENIER’S DISEASE IS A DISORDER OF THE INNER EAR
THAT CAN AFFECT AUDITORY(HARING) SYSTEM &
VESTIBULAR (BALANCE) SYSTEM.
ITS CHARACTERIZED BY SUDDEN & RECURRENT
EPISODES OF DIZZINESS, TINNITUS & PROGRESSIVE
HEARING LOSS, USUALLY IN ONE EAR.
ITS NAMED AFTER FRENCH PHYSICIAN PROSPER
MENIERE IN 1861.
35. ETIOLOGY/ RISK FACTORS:-
EXACT CAUSE IS IDIOPATHIC
SWELLING OF ENDOLYMPHATIC SAC
HEAD INJURY
MIDDLE EAR INFECTION
ALLERGIES
ALCOHOL USE
STRESS
SMOKING
39. Management:-
There is no cure for Meniere’s disease.
The goal of treatment is to reduce pressure in the inner ear
& relieve symptoms.
→ Antihistamine
→ anticholinergics
→ steroids
→ diuretics
→ meclizine or scopalamine (vertigo)
→ benzodiazepines
→ antiemetics
40. HEARING AID FOR HEARING LOSS
LOW SALT DIET TO REDUCE FLUID RETENSION
SMOKING CESSATION
ELIMINATE CAFFINE IN COFFEE, TEA, COLAS &
CHOCOLATE IN DIET
SURGICAL MANGEMENT:-
ENDOLYMPHATIC SAC DECOMPRESSION
LABYRINTHECTOMY
VESTIBULAR NEURECTOMY(90-95% SUCCESSFUL IIN
CURE VERTIGO)
CRYOSURGICAL METHOD
41. OTOTOXICITY:-
OTOTOXICITY IS DEFINED AS FUNCTIONAL IMPAIRMENT
OR CELLULAR DAMAGE OF THE INNER EAR & EIGHTH
CRANIAL NERVE DUE TO DRUGS OR CHEMICALS.
OTOTOXICITY CAN RESULT IN TEMPORARY OR
PERMANNET DISTURBANCES OF HEARING, BALANCE OR
BOTH.
OTOTOXIC DRUGS:-
• AMINOGLYCOSIDES ANTIBIOTICS (GENTAMYCIN,
STREPTOMYCIN, NEOMYCIN,)
• ANTI-NEOPLASTICS DRUGS (CISPLATIN, CARBOPLATIN)
• LOOP DIURETICS (LASIX, BUMETANIDE)
• ENVIRONMENTAL CHEMICALS LIKE MERCURY, CARBON
DISULFIDE, HEXANE, CARBON MONOXIDE, TOLUENE,
XYLENE, MANGANESE
42. C/M.:-
HEARING LOSS, TINNITUS, VERTIGO, DIZZINESS
MANAGEMNT:-
→ CAREFUL MONOTORING OF SERUM DRUG LEVEL
→MONOTORING DRUG DOSES
→ADMINISTER PROPER DOSES
→ASSESS CLIENT FOR DRUG SIDE EFFECT
43. ACOUSTIC NEUROMA/ VESTIBULAR SCHWANNOMA :-
NEUROMA- NERVE TUMOR
ACOUSTIC- COCHLEAR
ITS DEFINED AS BENIGN PRIMARY INTACRANIAL TUMOR
OF THE MYELIN-FORMING CELLS OF THE
VESTIBULOCOCHLEAR NERVE (CN-8).
CAUSE:-
IDOPATHIC
EXPOSURE TO RADIATION
45. DEAFNESS
DEAFNESS IS DEFINED AS PARTIAL OR COMPLETE
HEARING LOSS.
HEARING IMPAIRMENT RANGES FROM A MILD DIFFICULTY
IN UNDERSTANDING WORDS OR SOUND TO A TOTAL LOSS
OF HEARING.
QUANTIFICATION OF HEARING LOSS:-
SEVERITY OF HEARING IMPAIRMENT IS RANKED
ACCORDING TO THE LOUDNESS (MEASURED IN DECIBLES
dB)
1. MILD: BETWEEN 25-40 dB
2. MODERATE:- BETWEEN 41-55 dB
3. MODERATELY SEVERE:- BETWEEN 56-70 dB
4. SEVERE: BETWEEN 71-90 dB
5. PROFOUND: BETWEEN 91 dB-GREATER
46. CLASSIFICATION:-
CONDUCTIVE HEARING LOSS IS ANY IMPAIRMENT
RESULTING FROM DYSFUNCTION IN ANY OF THE
MECHANISMS THAT NORMALLY CONDUCT SOUND WAVES
THROUGH THE OUTER EAR, EAR DRUM OR THE BONES OF
THE MIDDLE EAR.
CAUSES:- EAR WAX, OTITIS EXTERNA, FOREIGN BODY IN
THE EAR, CONGENITAL ATRESIA, EAR DRUM
PERFORATION, OTITIS MEDIA, OTOSCLEROSIS.
SENSORINEURAL HEARING LOSS IS RESULTING FROM
DYSFUNCTION IN THE INNER EAR OR VESTIBULAR
COCHLEAR NERVE.
MENIERS DISEASE, COCHLEAR DAMAGE, CRANIAL
NERVE-8 DAMAGE
MIXED HEARING LOSS
47. MANAGEMENT:-
REMOVING WAX BLOCKAGE
REMOVING FOREIGN BODY
TREATING EAR INFECTION BY MEDICATION
EAR IRRIGATION
AURAL TOILETING
HEARING AIDS
SURGICAL MANAGEMNT:-
TYMPANOPLASTY
STAPEDECTOMY
MYRINGOTOMY
48. HEARING AIDS:-
HEARING AID IS AN ELECTROACOUSTIC DEVICE FITS IN
OR BEHIND THE EAR & IS DESIGN TO IMPROVE HEARING
ABILITY OF WEARER’S.
A HEARING AID HAS FOUR BASIC PARTS
1. MICROPHONE:- TO RECEIVE SOUND WAVES & CHANGE
INTO ELECTRICAL SIGNALS
2. AMPLIFIER:- TO INCREASE STRENGTH OF ELECTRICAL
SIGNALS
3. RECIEVER:- EARPHONES TO CHANGE THE ELECTRICAL
SIGNALS INTO SOUND WAVES.
4. BATTERY:- SOURCE OF ENERGY
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71. FOREIGN OBJECTS IN EXTERNAL AUDITORY
CANAL:-
FOREIGN BODY MAY BE STUCK IN THE EAR CANAL
INTENTIONALLY OR ACCIDENTLY. ITS COMMON &
EMERGENCY MEDICAL CONDITION.
SOMETIMES PERSON MAY BE UNAWARE AS IN INSECT
OBSTRUCTION(COCKRACHES,MOSQUITOES, FLIES, ANTS,
ETC).
SYMPTOMS:- FEELING OF SOMETHING IN EAR
-PAIN
- EAR IRRITATION
-EAR ITCHING
-SOMETIMES BLEEDING OR DISCHARGE
-BUZZING IN THE EAR (LIVE INSECTS IN EAR CANAL)
72. MANAGEMENT
-FIRST AID:-THE OBJECTS IF ITS CLEARLY VISIBLE
GRASPED & REMOVE GENTLY.
-TILT HEAD TO AFFECTED SIDE BY USING GRAVITY.
-TRY USING OIL(BABY OIL, MINERAL OIL, OLIVE OIL) FOR
AN INSECT IN EAR CANAL.
OTHERS:-
-EAR IRRIGATION
-SUCTIONING
-MEDICATION (EAR DROPS)
-MECHANICAL EXTRACTION (BY ALLIGATOR FORCEPS OR
BAYONET FORCEPS)
73. IMPACTED WAX IN THE EAR CANAL:-
[EAR WAX- CERUMEN]
ITS CONDITION IN WHICH CERUMEN IMPACTION OR
CERUMEN ACCUMULATION IN THE EXTERNAL EAR
CANAL. THIS WILL BLOCK THE EAR DRUM.
SYMPTOMS:-
-PARTIAL LOSS OF HEARING
-ITCHING IN EAR
-PAIN
-SENSATION OF FULLNESS IN THE EAR
-DISCOMFORT IN THE EAR
