Nursing 109

N109: Foundations in Nursing Practice Study Guide

5.5 Problems Causing Hearing Impairment • External otitis : This is also known as swimmer’s ear, and is a bacterial infection of the outer ear. Ways to help prevent external otitis include using good fitting ear plugs and keeping the ears clean and dry. Antibiotics are used to treat the infection. • Cerumen impaction: This is an obstruction of the ear canal with wax (cerumen). Ear wax is a normal production of the ear that protects the ear from foreign objects. Typically, cerumen will fall out without intervention; however, in some people there is an over-production of wax or the ear wax gets pushed down into the canal, causing impaction. This impaction can cause earache or hearing loss and may require removal. The individual may be able to use glycerin or mineral oil to soften the wax for removal. If that is not successful, irrigation or manual removal with an instrument may be required. • Tympanic perforation: This is a hole, or tear, in the eardrum. This can be caused from infection, a blow to the ear, overpressure (atmospheric or underwater), or improper ear cleaning. Tympanic perforation is not painful without infection, but the individual may complain of a whistling sound and decreased hearing. A hole in the eardrum puts the middle ear at risk for injury or infection. It will usually heal on its own within a few weeks but may require surgery to repair. • Otitis media (OM) : This is commonly called an ear infection, and is an inflammation of the middle ear, usually caused by bacteria, that occurs when fluid builds up behind the eardrum. Anyone can get an ear infection, but children get them more often than adults. Eustachian tubes are smaller and more level in children than they are in adults. This makes it difficult for fluid to drain out of the ear, even under normal conditions. If the Eustachian tubes are swollen or blocked with mucus due to a cold or other respiratory illness, fluid may not be able to drain. In addition, a child’s immune system is not as effective as an adult’s because it is still developing. This makes it harder for children to fight infections. Symptoms of OMmay include earache, fever, tugging at ears, fussiness, drainage from one or both ears, trouble hearing, and trouble with balance. If a definitive diagnosis of OM can be made, many providers will prescribe an antibiotic to be taken over 7-10 days. The provider also may recommend over- the-counter pain relievers, such as acetaminophen or ibuprofen, or eardrops to helpwith fever and pain. Because aspirin is considered a major preventable risk factor for Reye’s syndrome, a child who has a fever or other flu-like symptoms should not be given aspirin unless instructedto by the provider. If the provider cannot make a definite diagnosis of OM and the child does not have severe ear pain or a fever, the provider may instruct the individual to wait a day to see if the earache goes away. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics. • Otosclerosis: This is an abnormal bone growth in the middle ear that causes hearing loss. Although the exact cause is not known, it is suspected that it may be hereditary. In young adults, otosclerosis is the most common cause of hearing loss. Symptoms include hearing loss, ringing in the ears, and vertigo. A hearing aid may be helpful but is not a cure for the disease. Surgery to remove the stapes and replace it with a prosthesis may help restore some hearing. Without treatment, the hearing loss is typically progressive. • Meniere’s disease: This is an inner ear disorder that affects balance and hearing and occurs when a part of the canal, called the endolymphatic sac, becomes swollen. This sac helps filter and remove fluid in the semicircular canals. Severe vertigo or dizziness is the symptom that causes the most problems. This vertigo may lead to nausea and vomiting. Tinnitus, a unilateral feeling of fullness in the ear, and fluctuating hearing loss (which often only affects one ear) are

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