pinna or auricle

(earlobe)

Where is the Malleus located?

Describe the Malleus.

Middle ear

shaped like a hammer and attached

to the tympanic membrane

1. Malleus
2. Incus
3. Stapes 

Middle ear

shaped like an anvil and attached to the malleus

Stapes

Middle ear

Shaped like a saddle and attached to the oval window

Name 2 functions of the Eustachian Tube

1. Connects the middle ear cavity with the throat (pharynx)
2. Allows pressure to equalize on the 2 sides of the TM (tympanic membrane)

Labyrinth contains

3 areas of the inner ear

1. vestibule 
2. Semicircular canals
3. cochlea 

inner ear inside the labyrinth

2 bony chambers that contain some of the receptors for equilibrium

inner ear inside the labyrinth

3 bony tubes containing receptors for equilibrium

inner ear inside labyrinth

snail shaped structure containing receptors for hearing

whisper test

whispered word at 12", Weber Rinne, audiometry

tuning forks 

different sizes produce different frequencies of vibrations that are used to establish the range of hearing for the client

Stem or handle is placed at various points allong the midline of the skull and face

the client is asked to identify which ear hears the sound created by the vibrations

how it the caloric test performed

the ear is irrigated with either hot or cold water, normally stimulating the vestibular apparatus, resulting in nystagmus

• punctured eardrum
• acute attack of Meniere's Disease

test the acoustic nerve

CN VIII

what is a screening technique used to detect early damage to hearing resulting from exposure to loud noise

sound is inadequately conducted throught the external or middle ear

• cerumiosis
• otosclerosis
• impaired or ruptured TM (eardrum) 

what part of the ear is associated with Sensorineural hearing loss

inner ear 

• nerve damage from loud noise
• drugs  

• Asprin
• Aminoglycosides

• Gentamicin
• Vancomicin
• Lasix 

incision of the tympanic membrane to reduce pressure and release middle ear exudate

*Position operative side down to enhance drainage

*Apply cotton in ears to absorb drainage and change frequently

*Administer analgesics and antibiotics

myringotomy is the only procedure that the pt will be placed op side down

what procedure will you place a pt operative side down instead of operative side up?

1. have pt lie down immediately
2. immobile
3. head held in one position

removal of the sapes in the middle ear and insertion of a graft and prosthesis

• 1st 24 hours - position the client flat with operative side up - then supine with HOB elevated with operative side up to reduce vertigo
• will have external packing for 5-6 days (may impair hearing)
• change packing daily 

Nursing considerations for tympanosplasty

name 8

tympanoplasty - procedure on the TM or Ossicles to restore or improve hearing

1. position pt supine with HOB elevated - to reduce edema and vertigo
2. Operatvive side up - to reduce edema
3. Temporary hearing loss is normal
4. Open mouth when sneezing or coughing to reduce inner ear pressure
5. Instruct pt not to fly in an airplane for at least 6 months
6. Do not blow nose, if necessary blow nose one nostril at a time
7. Keep ear dry and avoid loud noises
8. NO swimming

Chronic disease of the inner ear due to an increase in endolymph

s/s of meriere's disease

name 5

1. recurrent vertigo
2. progressive unilateral nerve deafness
3. tinnitus
4. nausea
5. vomiting

treatment of Meniere's Disease

name 6 things that can be done 4 are drugs

1. Diuretics, between attacks
2. low sodium diet
3. dramamine
4. antivert
5. compaxine
6. benadryl

Ear Surgeries

5 nursing considerations

1. Keep dressing packs in place as ordered
2. avoid activities that increase innner ear pressure or place pressure on sutrue lines NO: rapid movement, straining, sneezing, coughing, blowing nose, bending, vomiting
3. lay operative side up (exception: myringotomy)
4. report bleeding, pressure, pain, fever, headache and vertigo
5. do not allow water to enter into the operative ear 

what activties should be avoided after ear surgery

name 7

any activities that increase the inner ear pressure or suture lines

1. rapid movement
2. straining
3. sneezing
4. coughing
5. blowing nose
6. bending
7. vomiting

what position do you place a pt after ear surgery

except what procedure

operative side up

myringotomy

what s/s are important to report following ear surgery

name 6

Report:

1. bleeding
2. pressure
3. pain
4. fever
5. headache
6. vertigo

• Outer and middle ear
• Temporary - due to ruptured TM, ear infection, wax build up, ossicles
• Tx: ear lavage, sugery, anitbiotics, hearing aides

• Inner Ear
• Hx of exposure to loud noise
• Permanent
• Damage to CN VIII
• Also caused by drugs - ototoxicity 1)Lasix 2)gentamicin 3)ASPRIN - TINNITUS 4) vancomycin
• Tx: NONE

What s/s do you look for in an infant that may be a sign of ear pain

pulling, grabbing, or tugging  

AdUlt

  P

and back

ChilD

     O

      W

     N

and back

what do you do to the otic medication before administration

warm the otic preparation in the hand for a few minutes

*cold drops will cause pt to vomit!

What may happen to pt if you instill cold or warm drops to the ear?

when instilling otic medication do you stick the dropper or applicator tip inside the ear canal?

How long do you have pt lay on the untreated side after administration of otic medication?

what can be ordered to prevent leakage of otic medications

a prescription drug used to treat ceruminosis

(impacted ear wax)

No more than 30 minutes

15-30 is normal and then the ear is flushed

*do not use longer than 4 days

Instillation of Otic Meds technique

10 steps

1. Wash Hands thoroughly before cleansing the area around the ear and instilling drops or ointments 
2. warm solution to room temp
3. shake suspenisions for 10 seconds before use
4. tilt heat with affected ear up
5. pull pinna up and back for adults, down and back for children <3year.
6. DO NOT allow applicator or dropper to touch ear
7. instill prescribed number of drops and replace cap or dropper
8. apply soft cotton plug if ordered
9. keep the head tilted or lie on the untreated side for ~3-5 minutes
10. wipe off excess solution with a tissue

Important pt teaching with otic medications

name 4

1. Complete the full course of treatment
2. do not use any other nonprescription ear products during or after treatment unless approved by primary care provider (pcp)
3. temporary changes in hearing or feeling of fullness may occure
4. notify pcp if symptoms do not improve or worsen

Corticosteroids > inflammation

Antibiotic > infection

Combo solutions

name 2 drugs

1. Cortisporin Otic
2. Ciproflaxacin and hydrocortisone = Cipro HC Otic

1 – skull
2 – ear canal
3 – pinna
4 – tympanum
5 – fenestra ovalis
6 – malleus
7 – incus
8 – stapes
9 – labyrinth
10 – cochlea
11 – auditory nerve
12 – eustachian tube

1=auricle (external ear)

2=auditory canal

3=hammer (malleus)

4=anvil (incus)

5=semicircular canal

6=inner ear drum

7=acoustic nerve - CN VIII

8=cochlea

9=stirrup (stapes)

10=tympanic membrane