EAR Self Study Worksheet

Review the provided Ear Self Study PowerPoint. Be able to differentiate

between conditions discussed in the PowerPoint and appropriate
interventions for each.
Use your Medical-Surgical Nursing 7th Edition (Volume 2) pages 1077-1105 in
addition to the provided PowerPoint for reference, if needed.

KNOW THE DEFINITIONS OF THE FOLLOWING TERMS:

(YOU DO NOT HAVE TO WRITE THESE OUT, BUT YOU ARE RESPONSIBLE FOR KNOWING THE
DEFINITION OF EACH OF THESE TERMS)
Atresia

Incus

Perichondrium

Audiometry
Barotrauma
Bony ossicles
Cauliflower
(boxers) ear
Cerumen
Cerumen
Cholesteatoma

Intensity
Labyrinthitis
Light reflex

Pinna
Presbycusis
Semicircular canals
Sensorineural
hearing loss
Spondee
stapedectomy
Stapes

Cochlea
Conductive Hearing
Loss
Diffuse
Dizziness
Epitympanum
External otitis
Frequency
Furuncle
Hyperacusis

Malleus
Mastoid process
Mastoiditis
Menieres disease
Mixed conductive-sensorineural
hearing loss

Swimmers ear

Myringoplasty

Threshold

Myringotomy
Necrotizing (malignant) otitis
Organ of Corti
Ossiculoplasty
Otosclerosis
Otoscope
Ototoxic

Tinnitus
Tophi
Tympanic membrane
Vertigo
Vestibule

SAFE AND EFFECTIVE CARE ENVIRONMENT

LIST

THREE ABNORMALITIES OF THE PINNA AND THE POSSIBLE SOURCES OF THE

ABNORMALITIES:

1. HARD, IRREGULAR, PAINLESS

CHRONIC GOUT.
2.

NODULES CALLED TOPHI ON PINNA- FROM

SMALL, CRUSTED, ULCERATED LESIONS THAT FAIL TO HEAL- FROM SQUAMOUS

CELL CARCINOMA.

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EAR Self Study Worksheet

HARD NODULES ON PINNA- FROM BASAL CELL CARCINOMA/ RHEUMATOID

ARTHRITIS.

WHAT

IS THE PROCESS FOR INSPECTING THE MASTOID PROCESS FOR INFLAMMATION?

TO ASSESS TENDERNESS- GENTLY TAP OVER MASTOID PROCESS WITH ONE FINGER,
COMPRESS THE TRAGUS AND GENTLY MOVE THE PINNA FORWARD AND BACKWARDANY TENDERNESS SUGGESTS INFLAMMATION.

DESCRIBE

THE PROCESS FROM POSITIONING THE PATIENT FOR AN OTOSCOPIC EXAMINATION

AND SELECTING THE SPECULUM THROUGH VISUALIZATION OF THE EARDRUM: TILT PATIENTS
HEAD SLIGHTLY AWAY AND HOLD THE OTOSCOPE UPSIDE DOWN, LIKE A LARGE PENTHIS ALLOWS YOUR HAND TO REST ON THE PATIENTS HEAD FOR SUPPORT AND IF
THE PATIENT MOVES, SO DOES YOUR HAND WHICH PREVENTS DAMAGE TO THE
EXTERNAL CANAL OR EARDRUM. HOLD OTOSCOPE WITH YOUR DOMINANT HAND
AND GENTLY PULL THE PINNA UP AND BACK WITH YOUR NONDOMINANT HANDTO
STRAIGHTEN THE CANAL.

WHEN

DOING AN OTOSCOPIC EXAMINATION OF THE EAR, HOW WOULD YOU EXPECT THE

EARDRUM TO APPEAR?
THE NORMAL EXTERNAL CANAL IS SKIN COLORED, INTACT, AND WITHOUT LESIONS.
IT CONTAINS VARIOUS AMOUNTS OF SOFT CERUMEN AND SMALL, FINE HAIRS.

WHAT

IS A CONTRAINDICATION TO PERFORMING AN OTOSCOPIC EXAMINATION?

ANY PATIENT WHO CANNOT HOLD HIS OR HER HEAD STILL DURING THE
EXAMINATION.

LIST

THREE METHODS OF PREVENTING THE SPREAD OF INFECTION WHEN EXAMINING AN EAR

WITH DRAINAGE:

1.

EXAMINE THE UNAFFECTED EAR FIRST

2.

USE A SEPARATE SPECULUM COVER FOR EACH EAR IN AN EXAMINATION

3.

WASH YOUR HANDS

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LIST

EAR Self Study Worksheet

THREE INTERVENTIONS THAT CAN ASSIST IN PREVENTING FALLS IN PATIENTS

EXPERIENCING VERTIGO OR DIZZINESS:

1.
2.
3.

RESTRIC HEAD MOTION AND CHANGE POSITION SLOWLY

MAINTAIN ADEQUATE HYDRATION, ESPECIALLY AFTER VOMITING
TAKE DRUGS TO REDUCE VERTIGO

LIST

OTC

SUCH AS; DRAMAMINE AND GRAVOL.

THE ELEVEN STEPS TO SAFELY INSTILL EARDROPS:

1.
2.
3.
4.
5.

GATHER THE SOLUTIONS TO BE ADMINISTERED

CHECK THE LABLES TO ENSURE CORRECT DOSAGE AND TIME
WEAR GLOVES TO REMOVE AND DISCARD ANY EAR PACKING
WASH YOUR HANDS
PERFORM A GENTLE OTOSCOPIC EXAMINATION TO DETERMINE WHETHER THE
EARDRUM IS INTACT
6. IRRIGATE THE EAR IF THE EARDRUM IS INTACT
7. PLACE THE BOTTLE OF EARDROPS IN A BOWL OF WARM WATER FOR 5 MIN
8. TILT THE PATIENTS HAD IN THE OPPOSITE DIRECTION OF THE AFFECTED EAR,
AND PLACE THE DROPS IN EAR
9. WITH HIS OR HER HEAD TILTED, ASK THE PATIENT TO GENTLY MOVE THE HEAD
BACK AND FORTH 5 TIMES
10. INSERT A COTTON BALL INTO THE OPENING OF THE EAR CANAL TO ACT AS
PACKING
11. WASH YOUR HANDS AGAIN

HEALTH PROMOTION AND MAINTENANCE

Briefly explain the dangers of using a foreign object to clean the ear canal:
They can scrape the skin of the canal, push cerumen up against the ear
drum, and even puncture the eardrum.

Using Chart 50-3 on page 1081 as a guide, using your own words, explain how you
would educate someone with a third grade education how to safely preform self-ear
irrigation for cerumen removal:
If you remember having special tubes put into your ears when you were
little or if you feel something draining out of your ear- you should not try
to remove earwax (ask for an adults help.) You will use a little syringe
(that does not have a needle) and will have a curved tip- fill with warm
water and gently place into ear with the curve pointing up. Tilt your head
a little bit so the liquid can drain out after the water is inserted. Use one
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hand to hold the syringe and the other to push the water in- gently push
the water into your ear- not too fast! You will feel your ear fill full of
water- like if you get water in your ear in the swimming pool- and water
and wax should drain out. If this procedure starts to hurt STOP
immediately. Afterward tilt your head all the way over- like youre lying
down and let everything drain out of your ear.

List three strategies that you can educate patients to prevent hearing loss:
1. Stay away from extremely high frequency sounds
2. Do not place foreign objects into the ear
3. Teach patient about ototoxicity

Using Chart 51-6 on page 1101 as a guide, briefly explain, in laymans terms, the
care of a hearing aid to a patient receiving his first hearing aid: Always keep your
hearing aid dry- remove it before showering or swimming. You may clean
the ear mold (outside area) with mild soap and water; just avoid it getting
too wet. You may clean the debris from the hole in the middle with a
toothpick- to get out wax etc. Keep your hearing aid off when you are not
using it to save battery life and replace the battery frequently. Keep
hearing aid in a safe place where you always know where it is. Avoid
dropping it and keep it out of extreme temperatures. The volume setting
can be adjusted as needed and this can prevent it from squeaking. Try not
to get any hairsprays, make up, oils, shaving cream and things like that on
the receiver- area with the hole. If you find your hearing aid is not working
check all of these things before taking it to the service center; change
battery, check connection between mold and the receiver, check on/off
switch, clean out the hole with a toothpick, adjust the volume. If none of
these work take it to the hearing aid repair center.

PSYCHOSOCIAL INTEGRITY
Explain the process of tympanometry using laymans terms and what patient
education is required prior to the test:
This test is monitoring if the progression or resolution of serious otitis
media has occurred by assessing the structures of the eardrum and its
motility by the changing air pressure in the external auditory canal. This
test also helps in discovering if there are other issues in the middle ear
such as otosclerosis, ossicular disarticulation, otitis media, and
perforation of the eardrum. Preparation teaching includes; tell the patient
to avoid aspirin containing products for 1 week before testing, shower and
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wash your hair the night before testing, do not eat or drink within 4 hours
before testing, and do not smoke for 24 hours before the testing.

Explain the process of auditory brainstem-evoked response (ABR) using laymans

terms and what patient education is required prior to and after the assessment:
This assesses hearing in patients who are unable to hear sound during a
standard hearing test. This will help diagnose both conductive and
sensorineural hearing losses. The patient will have electrodes placed on
their scalp during the test and after the patients hair will have to be
cleaned to remove the gel. Teaching before the procedure includes; no
fasting or sedation is needed, carefully explain procedure (listed above)
and its purpose, and inform the patient that it usually takes about 30
minutes to complete the procedure.

Explain what electronystagmography (ENG) testing involves using laymans terms

and what patient education is required prior to and after the test:
This test can detect central and peripheral diseases in the vestibular part
in the ear. This will detect nystagmus in patients (involuntary eye
movements) because the eyes and ears depend on each other for balance.
The patient will have electrodes taped onto the skin near their eyes while
one or more procedures are done to stimulate nystagmus such as; caloric
testing, changing gaze position, or changing head position.) If Nystagmus
does not occur with the stimulation, that suggests there is an abnormality
somewhere in the ear that is connected to the brainstem. Preparation for
this procedure includes teaching the patient; explain the procedure fully
and the purpose of it. Explain to the patient that the examiners will be
asking them to name names or do simple math problems during the test
to ensure they are staying alert, teach the patient they must fast for
several hours before the test and to avoid caffeine beverages 24-48 hours
before the test, and teach the patient if they have a pacemaker that they
should not have this test because pacemaker signals interfere with the
sensitivity of ENG.

Explain what caloric testing involves using laymans terms and what patient
education is required prior to and after the test:
This test looks at the inner ear portion of the auditory nerve (a nerve
connected to the brain that helps with hearing and balance.) The test
includes warm water or warm air infused into the patients ear. A normal
response during this would be vertigo (spinning feeling) or nystagmus
(involuntary eye movements) within 20- 30 seconds. Preparation for this
procedure includes; carefully explaining the procedure and the reason for
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it (listed above), teach the patient they must fast for several hours before
the test, teach the patient the affected side (ear that is bothering them)
will be tested first, explain to the patient that they will be on bed rest
after the procedure with careful introduction of oral fluids to prevent
nausea and vomiting, tell the patient to avoid aspirin containing products
for 1 week before testing, shower and wash your hair the night before
testing, do not eat or drink within 4 hours before testing, and do not
smoke for 24 hours before the testing.

Explain what Dix-Hallpike testing for vertigo involves using laymans terms and
what patient education is required prior to and after the test:
This test involves assisting the patient to a sitting position on an
examination table. Stand to the side of the patient and quickly reposition
him or her from sitting to supine with the head extending beyond the end
of the table. This change of position is first done to one side and then to
the other. If a patient has bening positional vertigo they will have
nystagmus after 5-10 seconds. Preparation teaching for this procedure
includes; carefully excplain the procedure and its purpose, tell the patient
to keep their eyes open and try to not blink, and explain that double vision
may occur during the test.

What would be a priority nursing diagnosis for someone who has experienced
hearing loss and why? List three interventions that would assist a person with this
diagnosis in meeting goals that are set:

Sensory Perception Disturbance r/t inablitly to hear

1. Speak to the patient in a slow manner

2. Encourage use of hearing aids
3. Obtain patients attention through touch

List a local resource that you would refer a person newly-diagnosed with a hearing
impairment to and why?

Beltone in Bowling Green. They are a large hearing aid company that
specializes in all types of hearing aids. Their website is easy to use and for
older adults who do not use the internet their phone number is listed in
the phone book or online for easy access. They also have hearing care
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programs that help teach those new to hearing aids how to use and care
for them.

PHYSIOLOGICAL INTEGRITY
Using a family member, assess and document any risks for hearing problems and
possible solutions for prevent hearing loss (focus on drug therapy, genetic
predisposition, and exposure to environmental hazards): Patient has exposure to
loud noises in a factory setting, so that puts them at risk for hearing loss.
Child has fluid on the ears and that puts them at risk for hearing loss.
Solutions to prevent hearing loss would be to wear ear protection in noisy
environment. For patient with fluid on the ears solution would be a
myringotomy with tube placement to drain the fluid from the ears.

List at least five components in the assessment of a patient with possible hearing
impairment:
1. Patient history
2. Otoscopic assessment
3. Auditory assessment
4. Family history
5. Current health problems

Describe at least five adaptations needed when caring for patients who have agerelated changes in the structure of the ear and hearing:
1. Speak clearly and slowly
2. Move closer to the better hearing ear
3. Dont shout
4. Use hand motions
5. Have the patient repeat your statements back to you

Identify 10 common drugs that affect hearing and what they are used to treat:
1. gentamycin-antibiotic

6.furosemide-diuretic

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2. erythromycin-antibiotic

7. naproxen-pain

3. tobramycin-antibiotic

8. toradol-pain

4. neomycin-antibiotic

9. aspirin- pain

5. ibuprofen-NSAID

10. streptomycin-antibiotic

Compare the clinical manifestations and interventions for external otitis with those
of otitis media:

External otitis is imflammation and/or infection of the external ear and ear
canal. Swimmers ear is an example. Patient is typically given topical
antibiotics and steroid therapy. If the ear canal is swollen shut an earwick
is placed in the canal so that drops can get to affected area. Otitis media
affects the middle ear. This is where fluid is in the middle ear. In can
become inflamed and infected. If ear is infected patient is given oral
antibiotics. Advil or Tylenol can be given for pain. Antihistamines and
decongestants are prescribed to decrease fluid that is in the middle ear.

Describe the safe removal of impacted cerumen from the ear canal of an older
patient: Use ear irrigation and make sure the water is about 98 degrees.
Use no more than 5-10mL of water. If nausea or vomiting occurs stop the
irrigation. Teach the patient how to irrigate their own ears and wipe the
outer ear.

What are the three components of Menieres disease?

1. Tinnitus
2. Unilateral Sensorineural hearing loss
3. Vertigo

Explain, in laymans terms, the pathology of Menieres disease:

It is an excessive amount of fluid in the inner ear that causes dilation of
the cochlear duct, which causes Vertigo and damage to the cochlea.
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Briefly describe what nonsurgical management of Menieres disease would involve
when educating a person newly diagnosed with the disorder (pay special attention
to nutrition):
Move the head slowly to avoid vertigo, avoid foods high in salt, avoid
caffeine, limit alcohol consumption, avoid foods that contain MSG, and
different drugs can be given to help alleviate symptoms such as Meclazine
or Zofran.

Briefly describe, in laymans terms, two surgical interventions for Menieres disease
and what determines which procedure is used:
The selection of which surgery is used depends on the degree of useful
hearing. One procedure is the Labryinthectomy which the Labyrinth is
removed through the oval window. Another provedure is the
Endolymphatic Decompression with drainage and a shunt. The
endolymphatic sac is drained and a shunt is placed to improve fluid
drainage.

A patient has been scheduled for a tympanoplasty. Briefly explain, in laymans

terms, indications for the procedure, what the procedure involves, preoperative and
postoperative care, and expected outcomes:
A tympanoplasty is repair of the ear drum. One can be after a
myringotomy when the hole doesn't heal. Another is more extensive when
there would have to be repair of the ossicles in the middle ear. Before
surgery instruct patient to irrigate ear with vinegar and water solution.
Also tell patient that its normal to have hearing loss immediately
following surgery. After surgery you will have gauze packed into your ear.
Keep dressing clean and dry. Keep patient flat and head turned to the side
for at least 12 hours after surgery. Give prescribed antibiotics.

A patient has been scheduled for a stapedectomy. Briefly explain, in laymans

terms, indications for the procedure, what the procedure involves, preoperative and
postoperative care, and expected outcomes:
This procedure helps to correct hearing loss that is mostly associated with
otosclerosis. It's performed through the external ear canal. The head and
neck of stapes are removed and a prothesis is placed in the ear. Before
surgery review the expected outcomes with the patient. After surgery
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inform patient that hearing improvement might not be noted until 6 weeks
after surgery

Using Chart 51-8 on page 1103 as a guide, identify appropriate methods for
communicating with a patient who has recently become hearing impaired:
Always face the patient when talking to them. Use appropriate hand
gestures. Write the information down for the patient and speak slowly.

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