Eyes & Ears Ppt

NEUROSENSORYNEUROSENSORYNEUROSENSORYNEUROSENSORY

SYSTEMSYSTEMSYSTEMSYSTEM

ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEYESEYES

ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEYESEYES

EXTERNAL STRUCTURESEXTERNAL STRUCTURES

• EYELIDSEYELIDS• CONJUNCTIVACONJUNCTIVA

– PALBEBRALPALBEBRAL– BULBARBULBAR

• LACRIMAL APPARATUSLACRIMAL APPARATUS– LACRIMAL GLAND, DUCTS & PASSAGESLACRIMAL GLAND, DUCTS & PASSAGES

• 6 EXTRAOCULAR MUSCLES6 EXTRAOCULAR MUSCLES• Levator palpebrae muscleLevator palpebrae muscle

EXTERNAL STRUCTURESEXTERNAL STRUCTURES

• EYELIDSEYELIDS• CONJUNCTIVACONJUNCTIVA

– PALBEBRALPALBEBRAL– BULBARBULBAR

• LACRIMAL APPARATUSLACRIMAL APPARATUS– LACRIMAL GLAND, DUCTS & PASSAGESLACRIMAL GLAND, DUCTS & PASSAGES

• 6 EXTRAOCULAR MUSCLES6 EXTRAOCULAR MUSCLES• Levator palpebrae muscleLevator palpebrae muscle

ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEYESEYES

• ORBITORBIT

• EYEBALL : 3 LAYERS: EYEBALL : 3 LAYERS: • OUTEROUTER

– SCLERASCLERA– CORNEACORNEA

• MIDDLE MIDDLE – CHOROIDCHOROID– CILIARY BODY CILIARY BODY – IRISIRIS

•INNERINNER–RODSRODS

–SENSITIVE TO LIGHTSENSITIVE TO LIGHT–PERIPHERAL VISIONPERIPHERAL VISION

–CONESCONES–FINE FINE DESCRIMINATIONDESCRIMINATION–COLOR VSIONCOLOR VSION

EYESEYES

ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEYESEYES

• LENS – FOCUS IMAGELENS – FOCUS IMAGE

• FLUIDS OF THE EYE:FLUIDS OF THE EYE:– AQUEOUS HUMORAQUEOUS HUMOR

• ANTERIOR & POSTERIOR CHAMBERSANTERIOR & POSTERIOR CHAMBERS• ANTERIOR EYE CAVITYANTERIOR EYE CAVITY• NUTRIENTS TO LENS & CORNEANUTRIENTS TO LENS & CORNEA• INTRAOCULAR PRESSURE MAINTENANCEINTRAOCULAR PRESSURE MAINTENANCE

– 20-25 mmHg20-25 mmHg

– VITREOUS HUMORVITREOUS HUMOR• POSTERIOR EYE CAVITYPOSTERIOR EYE CAVITY• TRANSPARENCY & FORM OF THE EYETRANSPARENCY & FORM OF THE EYE

EYESEYES

VISUAL PATHWAYSVISUAL PATHWAYSRETINARETINA

OPTIC NERVEOPTIC NERVE

OPTIC CHIASMOPTIC CHIASM

OPTIC TRACTOPTIC TRACT

OCCIPITAL LOBEOCCIPITAL LOBE

Physical Examination-EYEPhysical Examination-EYE

• VISUAL ACUITY : VISUAL ACUITY : SNELLEN’S CHARTSNELLEN’S CHART

• VISUAL FIELDS: VISUAL FIELDS: PERIMETRYPERIMETRY

• EXTERNAL STRUCTURESEXTERNAL STRUCTURES– POSITION & ALIGNMENT OF EYESPOSITION & ALIGNMENT OF EYES– PUPILS (PERRLA)PUPILS (PERRLA)

• EXTRAOCULAR MOVEMENTSEXTRAOCULAR MOVEMENTS– PARALYSISPARALYSIS– NYSTAGMUSNYSTAGMUS

• CORNEAL REFLEXCORNEAL REFLEX

Don’t look at me…

DIAGNOSTIC TESTSDIAGNOSTIC TESTS

• SNELLENSNELLEN• OPHTHALMOSCOPEOPHTHALMOSCOPE• BIOMICROSCOPE / SLITLAMPBIOMICROSCOPE / SLITLAMP

– EXAMINE THE ANTERIOR SEGMENT OF THE EYEEXAMINE THE ANTERIOR SEGMENT OF THE EYE

• TONOMETERTONOMETER– 14-20 mmHg14-20 mmHg

• BJERRUM’S TANGENT SCREENBJERRUM’S TANGENT SCREEN– CENTRAL FIELD OF VISIONCENTRAL FIELD OF VISION

• ISHIHARA COLOR PLATE TEST ISHIHARA COLOR PLATE TEST – IDENTIFY 3 PRIMARY COLORSIDENTIFY 3 PRIMARY COLORS

• GONIOSCOPYGONIOSCOPY– ANGLE OF ANTERIOR CHAMBERANGLE OF ANTERIOR CHAMBER

PLANNING FOR HEALTH PLANNING FOR HEALTH PROMOTIONPROMOTION

CARE OF THE EYESCARE OF THE EYES

• EYEDROPS, DISCOURAGEDEYEDROPS, DISCOURAGED• PRINTED MATTER: 14 INCHES AWAYPRINTED MATTER: 14 INCHES AWAY• TV: 10-12 FT AWAYTV: 10-12 FT AWAY• READ WITH ILLUMINATION: 100-150 WATTSREAD WITH ILLUMINATION: 100-150 WATTS• LIGHT FROM BEHINDLIGHT FROM BEHIND• TEACH ABOUT DANGER SIGNALS OF TEACH ABOUT DANGER SIGNALS OF

VISUAL DISORDERVISUAL DISORDER

•PERSISTENT REDNESSPERSISTENT REDNESS•CONTINUED DISCOMFORT & PAIN ESP CONTINUED DISCOMFORT & PAIN ESP

FOLLOWING INJURYFOLLOWING INJURY•CHILDREN: CROSSING OF EYESCHILDREN: CROSSING OF EYES•BLURRED VISION/ SPOTS BEFORE THE EYESBLURRED VISION/ SPOTS BEFORE THE EYES•GROWTH ON THE EYE/ OPACITIESGROWTH ON THE EYE/ OPACITIES•CONTINUAL DISCHARGE, CRUSTING ORCONTINUAL DISCHARGE, CRUSTING OR

TEARINGTEARING•PUPIL IRREGULARITIESPUPIL IRREGULARITIES

PLANNING FOR HEALTH PLANNING FOR HEALTH MAINTENANCE & RESTORATIONMAINTENANCE & RESTORATION• INSTILLATION OF EYEDROPSINSTILLATION OF EYEDROPS

– LOWER CUL-DE-SACLOWER CUL-DE-SAC– JUST CLOSE EYES, NOT SQUEEZEJUST CLOSE EYES, NOT SQUEEZE

• INSTILLATION OF EYE OINTMENTINSTILLATION OF EYE OINTMENT– FROM INNER CANTHUS, OUTWARDFROM INNER CANTHUS, OUTWARD

• HOT/ COLD COMPRESSHOT/ COLD COMPRESS• EYE IRRIGATIONSEYE IRRIGATIONS

– REMOVE CHEMICALS OR SECRETIONSREMOVE CHEMICALS OR SECRETIONS

• MASSAGE THE EYEBALLMASSAGE THE EYEBALL– IN GLAUCOMA ESP AFTER OPERATIONSIN GLAUCOMA ESP AFTER OPERATIONS

• CARE OF CONTACT LENSCARE OF CONTACT LENS– NOT TO WEAR WITH SWIMMINGNOT TO WEAR WITH SWIMMING

DISORDERS - EYEDISORDERS - EYE

• INJURIES & INJURIES & TRAUMATRAUMA

• INFECTIONSINFECTIONS

• CATARACTCATARACT

• GLAUCOMAGLAUCOMA

• DETACHMENT OF DETACHMENT OF THE RETINATHE RETINA

• REFRACTIVE REFRACTIVE ERRORSERRORS

INJURIES & TRAUMAINJURIES & TRAUMA

EMERGENCY:EMERGENCY:• TREAT THE PATIENT, LEAVE THE EYE ALONE, TREAT THE PATIENT, LEAVE THE EYE ALONE,

EXCEPT IN CHEMICAL INJURY EXCEPT IN CHEMICAL INJURY - FLUSH EYES STAT- FLUSH EYES STAT

• FOREIGN BODIES: FLUSH WITH WATER FOR 15 FOREIGN BODIES: FLUSH WITH WATER FOR 15 MIN WHILE GOING TO THE DOCTOR; DON’T MIN WHILE GOING TO THE DOCTOR; DON’T TOUCH CORNEATOUCH CORNEA

• MAY USE CARBONATED DRINKS IF WATER IS MAY USE CARBONATED DRINKS IF WATER IS NOT AVAILABLENOT AVAILABLE

INFECTIONSINFECTIONS

• HORDEOLUM/ STY -Zeis glandHORDEOLUM/ STY -Zeis gland in the follicle in the follicle

• CHALAZION –meibomian glandsCHALAZION –meibomian glands• CONJUNCTIVITIS – pink eyeCONJUNCTIVITIS – pink eye

– bacterial infection, allergy, traumabacterial infection, allergy, trauma

• UVEITIS - irisUVEITIS - iris• KERATITIS - corneaKERATITIS - cornea• PTERYGIUM – triangular foldPTERYGIUM – triangular fold

– From white of the eye to the corneaFrom white of the eye to the cornea

CATARACTCATARACT• Opacity of the lens & its capsule which interferes Opacity of the lens & its capsule which interferes

with transparencywith transparency

S/SX:S/SX:• Dimness in visual acuityDimness in visual acuity• Rapid & marked cxs of refraction errorRapid & marked cxs of refraction error

CLASSIFICATION:CLASSIFICATION:• Primary/ senilePrimary/ senile• Secondary/ traumaticSecondary/ traumatic

• CongenitalCongenital

TREATMENT:TREATMENT:•Intracapsular extraction – Intracapsular extraction – lens & capsulelens & capsule•Extracapsular extraction – Extracapsular extraction – lens onlylens only•Cryoextraction – Cryoextraction – probe cooled below 0 probe cooled below 0 ooCC•Phacoemulsification – Phacoemulsification – probe vibratesprobe vibrates•Enzymatic zonulysis – Enzymatic zonulysis – alphachemotrypsin: alphachemotrypsin: fibrinolytic & proteolytic, to anterior chamberfibrinolytic & proteolytic, to anterior chamberIntraocular lens – Intraocular lens – synthetic; distant visionsynthetic; distant vision

for aphasic patientfor aphasic patient

EYE SURGERYEYE SURGERY

NURSING CARE PRE-OPNURSING CARE PRE-OP

• Orient to new environmentOrient to new environment• Teach deep breathing & how to Teach deep breathing & how to

close eyes without squeezingclose eyes without squeezing• Eye antibiotics preopEye antibiotics preop• Mydiatrics if orderedMydiatrics if ordered

EYE SURGERYEYE SURGERY

NURSING CARE POST-OPNURSING CARE POST-OP

• Reorient patient to his Reorient patient to his surroundingssurroundings

• Prevent increase in IOP & stress on Prevent increase in IOP & stress on the suture linethe suture line

ACTIVITIES THAT INCREASE IOP:ACTIVITIES THAT INCREASE IOP:

•CoughingCoughing•Brushing Brushing •Shaving Shaving •Vomiting Vomiting •Bending Bending •Stooping Stooping

•Promote comfort of the patient: Promote comfort of the patient: mild analgesic to control painmild analgesic to control pain

EYE SURGERYEYE SURGERY

NURSING CARE POST-OPNURSING CARE POST-OP

• Observe & treat complicationsObserve & treat complicationsCOMPLICATIONS:COMPLICATIONS:•NAUSEA & VOMITINGNAUSEA & VOMITING

•AntiemeticsAntiemetics•Cold compressCold compress

•HEMORRHAGEHEMORRHAGE•Sudden pain of the eyeSudden pain of the eye

•PROLAPSE OF THE IRISPROLAPSE OF THE IRIS•Most common postop complicationMost common postop complication•Can precipitate glaucomaCan precipitate glaucoma

• Promote the rehab of the patientPromote the rehab of the patient•Encourage the patient to become Encourage the patient to become

independent- walk with him when he first independent- walk with him when he first become ambulatorybecome ambulatory•Health teachingsHealth teachings

EYE SURGERYEYE SURGERY

HEALTH TEACHINGS:HEALTH TEACHINGS:

• 1-4 wks : dark glasses; temporary corrective 1-4 wks : dark glasses; temporary corrective lenseslenses

• 6-8 wks: permanent lenses6-8 wks: permanent lenses• It will take time to learn distances & climb It will take time to learn distances & climb

stairsstairs• Color slightly changedColor slightly changed• Use one eye at a time unless with contact lensUse one eye at a time unless with contact lens• Decreased peripheral visionDecreased peripheral vision

GLAUCOMAGLAUCOMA• INCREASED IOPINCREASED IOP• PROGRESSIVE LOSS OF PERIPHERAL VISIONPROGRESSIVE LOSS OF PERIPHERAL VISION

CAUSE: CAUSE: OBSTRUCTION TO CIRCULATION OF AQUEOUS OBSTRUCTION TO CIRCULATION OF AQUEOUS HUMORHUMOR

TYPES:TYPES:1.1. CHRONIC/ SIMPLE/ OPEN-ANGLECHRONIC/ SIMPLE/ OPEN-ANGLE2.2. ACUTE ANGLE CLOSUREACUTE ANGLE CLOSURE3.3. CongenitalCongenital4.4. Secondary – trauma, uveitis, postopSecondary – trauma, uveitis, postop5.5. Absolute – uncontrolled- enucleationAbsolute – uncontrolled- enucleation

EYESEYES

CORNEACORNEA

IRISIRIS

CILIARY BODYCILIARY BODYANTERIORANTERIORCHAMBERCHAMBER

LENSLENS

CANAL OF SCHLEMMCANAL OF SCHLEMM

ZONULESZONULES

OPEN-ANGLE GLAUCOMAOPEN-ANGLE GLAUCOMA

EYESEYES

CORNEACORNEA

IRISIRIS

CILIARY BODYCILIARY BODYANTERIORANTERIORCHAMBERCHAMBER

LENSLENS

CANAL OF SCHLEMMCANAL OF SCHLEMM

ZONULESZONULES

ACUTE-ANGLE CLOSURE GLAUCOMAACUTE-ANGLE CLOSURE GLAUCOMA

OPEN ANGLE GLAUCOMAOPEN ANGLE GLAUCOMA

S/SX:S/SX:

• Loss of peripheral vision (tunnel)Loss of peripheral vision (tunnel)• Difficulty in adjusting to darknessDifficulty in adjusting to darkness• Failure to detect changes in colorFailure to detect changes in color• Headache, pain behind the eyeballHeadache, pain behind the eyeball• HalosHalos• Nausea & vomitingNausea & vomiting

OPEN ANGLE GLAUCOMAOPEN ANGLE GLAUCOMA

MANAGEMENT:MANAGEMENT:

Conservative :Conservative :• Miotics : pupillary constrictionMiotics : pupillary constriction

draw iris smooth muscle away draw iris smooth muscle away from the canalfrom the canal

Given early amGiven early am• Acetazolamide : decrease aqueous Acetazolamide : decrease aqueous

productionproduction• Fluid restrictionFluid restriction

Aggressive: Aggressive:

Principle: improve drainage of aqueousPrinciple: improve drainage of aqueous

•Iridocleisis-Iridocleisis-anterior chamber & subconjunctival spaceanterior chamber & subconjunctival space

•Corneoscleral trephening – Corneoscleral trephening – junction of cornea & sclerajunction of cornea & sclera

•Trabeculotomy Trabeculotomy •Laser therapy to meshworkLaser therapy to meshwork

Acute Angle GlaucomaAcute Angle Glaucoma

CAUSE:CAUSE:• Pupillary dilation by mydiatricsPupillary dilation by mydiatrics• Abnormal anterior displacement of irisAbnormal anterior displacement of iris

S/SX:S/SX:• Severe eye painSevere eye pain• Nausea & vomitingNausea & vomiting• Blurred visionBlurred vision• Colored halos around lightsColored halos around lights• Dilated pupilsDilated pupils• Increased IOPIncreased IOP

MANAGEMENT:MANAGEMENT:

•MioticsMiotics•DiamoxDiamox•Osmotic agents – glycerolOsmotic agents – glycerol•Surgery - iridectomySurgery - iridectomy

GLAUCOMAGLAUCOMA

NURSING CARE – SURGERYNURSING CARE – SURGERY

PRE-OPPRE-OP• Explain that vision lost cannot be restored, Explain that vision lost cannot be restored,

but further loss can be preventedbut further loss can be preventedPOST-OPPOST-OP• Flat 24H- prevent iris prolapseFlat 24H- prevent iris prolapse• Narotics or sedativesNarotics or sedatives• Liquid diet until 1Liquid diet until 1stst dressing dressing• Turn to unoperative siteTurn to unoperative site

LONG TERM CARE:LONG TERM CARE:

•No restriction on the use of the eyesNo restriction on the use of the eyes•No fluid restriction; exercise permittedNo fluid restriction; exercise permitted•Medical follow up needed for lifeMedical follow up needed for life

RETINARETINA CHOROIDCHOROID

SCLERASCLERA

OPTIC NERVEOPTIC NERVE

RETINAL DETACHMENTRETINAL DETACHMENT

RETINAL DETACHMENTRETINAL DETACHMENT

• Fluid accumulationFluid accumulation• TumorTumor

CAUSE:CAUSE:• Myopic Myopic

degenerationdegeneration• TraumaTrauma• Aphakia Aphakia

S/SX:S/SX:• Floating spots or Floating spots or

opacities before the opacities before the eyeeye

• Casts shadows on Casts shadows on the retinathe retina

• BrightFlashes of BrightFlashes of lightlight

• Progressive Progressive constriction of constriction of vision in 1 eyevision in 1 eye

MANAGEMENT:MANAGEMENT:

Conservative :Conservative :•Quiet in bed with eyes coveredQuiet in bed with eyes covered•Head: positioned so that retinal holes lowerHead: positioned so that retinal holes lower•Photocoagulation – Photocoagulation – small burn to retinasmall burn to retina•Cryotherapy – Cryotherapy – cold probe to freeze retinacold probe to freeze retina

Surgical: Surgical: •Scleral buckling- Scleral buckling- sealing break & reattachingsealing break & reattaching

retinaretina

RETINAL DETACHMENTRETINAL DETACHMENT

POST-OP NURSING CARE:POST-OP NURSING CARE:• Cover eyesCover eyes• Area of detachment, dependentArea of detachment, dependent• MydiatricsMydiatrics• Discharge instructions:Discharge instructions:

– No strenuous exercises & acivity x No strenuous exercises & acivity x 6mos6mos

– Contact sports restrictedContact sports restricted– No sudden jarring head motionNo sudden jarring head motion– No restriction with use of eyesNo restriction with use of eyes

REFRACTIVE ERRORSREFRACTIVE ERRORS

REFRACTION – bending of light raysREFRACTION – bending of light raysACCOMMODATION – ability to adjust from near to ACCOMMODATION – ability to adjust from near to

far visionfar visionADAPTATION – ability to see light from darknessADAPTATION – ability to see light from darkness

COMMON ERRORS:COMMON ERRORS:• MyopiaMyopia• HyperopiaHyperopia• PresbyopiaPresbyopia

•AstigmatismAstigmatism•Blindness Blindness

myopiamyopia

NEAR-SIGHTEDNEAR-SIGHTED

• Long A-P dimension of the eyeballLong A-P dimension of the eyeball• Light rays focus infront of the Light rays focus infront of the

retinaretina• Good vision for near distancesGood vision for near distances• Concave lensesConcave lenses

hyperopiahyperopia

FAR-SIGHTEDFAR-SIGHTED

• Eyeball A-P dimension too shortEyeball A-P dimension too short• Light rays focus behind the retinaLight rays focus behind the retina• Good vision for far distancesGood vision for far distances• Convex lensesConvex lenses

presbyopiapresbyopia

FARSIGHTEDNESS OF OLD AGEFARSIGHTEDNESS OF OLD AGE

• Gradual loss of accommodationGradual loss of accommodation• Loss of lens elasticityLoss of lens elasticity• Inability to rad without holding the Inability to rad without holding the

material more than 13 ft from the material more than 13 ft from the eyeeye

• Bifocal lensesBifocal lenses

ASTIGMATISMASTIGMATISM

• Asymmetry or irregular curvature Asymmetry or irregular curvature of the corneaof the cornea

• Cylindrical lensesCylindrical lenses

BLINDNESSBLINDNESS

• Vision: 20/200Vision: 20/200

• Severus, 42y.o, is receiving Severus, 42y.o, is receiving cryotherapy for repair of a cryotherapy for repair of a detached retina. When taking detached retina. When taking history from him, which symptom history from him, which symptom would the nurse expect him to would the nurse expect him to have?have?

a.a. DiplopiaDiplopiab.b. Severe eye painSevere eye painc.c. Sudden blindnessSudden blindnessd.d. Bright flashes of lightBright flashes of light

ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEARSEARS

EXTERNAL EAREXTERNAL EAR• AURICLEAURICLE• PINNAPINNA• TYMPANIC MEMBRANETYMPANIC MEMBRANE

MIDDLE EARMIDDLE EAR• OSSICLES: MALLEOUS, INCUS, STAPESOSSICLES: MALLEOUS, INCUS, STAPES• EUSTACHIAN TUBEEUSTACHIAN TUBE

EAREAR

ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEARSEARS

INNER EARINNER EAR• ORGAN OF CORTI ORGAN OF CORTI

– HEARINGHEARING

• VESTIBULAR APPARATUSVESTIBULAR APPARATUS– BALANCEBALANCE– 3 SEMICIRCULAR CANALS3 SEMICIRCULAR CANALS– UTRICLEUTRICLE

EAREAR

ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEARSEARS

SOUND WAVES TO TYMPANIC MEMBRANESOUND WAVES TO TYMPANIC MEMBRANE

OSSICLES IN MOTIONOSSICLES IN MOTION

VIBRATION FROM STAPES TO OVAL WINDOWVIBRATION FROM STAPES TO OVAL WINDOW

COCHLEA : ORGAN OF CORTICOCHLEA : ORGAN OF CORTI

CRANIAL NERVE 8 TO TEMPORAL LOBECRANIAL NERVE 8 TO TEMPORAL LOBE

HEARINGHEARING

AUDITORY ASSESSMENTAUDITORY ASSESSMENT

EXTERNAL EAR EXAMINATIONEXTERNAL EAR EXAMINATION

• Inspection & palpation of auricleInspection & palpation of auricle• Visualization: straighten the auditory canal: Visualization: straighten the auditory canal:

– PULL AURICLE UP, & BACKPULL AURICLE UP, & BACK

• NORMAL EARDRUM: NORMAL EARDRUM: – slightly conicalslightly conical– ShinyShiny– pearly gray in colorpearly gray in color

AUDITORY ASSESSMENTAUDITORY ASSESSMENT

HEARING TEST:HEARING TEST:

Tests for acuteness of hearing or Tests for acuteness of hearing or degree of deafness:degree of deafness:

• Whisper or spoken voice testWhisper or spoken voice test• Audiometer :Audiometer :

– Pure tone – mx loudness in decibelPure tone – mx loudness in decibel– Speech – ability to understand & descriminateSpeech – ability to understand & descriminate

• Watch tick testWatch tick test• Tuning fork testTuning fork test

AUDITORY ASSESSMENTAUDITORY ASSESSMENT

HEARING TEST:HEARING TEST:

Test to localize cause of deafness:Test to localize cause of deafness:

• Schwabach’sSchwabach’s• Rinne’sRinne’s• Weber’sWeber’s

SCHWABACH’SSCHWABACH’S

•Bone conduction vs normal hearingBone conduction vs normal hearing•Tuning fork @ px’s mastoid until the patientTuning fork @ px’s mastoid until the patient

hears no sound.hears no sound.•TF transferred to examiner’s earTF transferred to examiner’s ear•N = no sound heardN = no sound heard•ABN = ABN = sensorineural hearing losssensorineural hearing loss

RINNE’S TESTRINNE’S TEST

•Sound heard better: air vs boneSound heard better: air vs bone

•N = positive; air conduction is betterN = positive; air conduction is better•ABN: negative: bone conduction betterABN: negative: bone conduction better

conductive hearing lossconductive hearing loss

WEBER’SWEBER’S

•TF top midline of the headTF top midline of the head•Sound heard: normal ear vs affected earSound heard: normal ear vs affected ear•Better in affected ear: Better in affected ear: conductiveconductive•Better in normal ear : Better in normal ear : sensorineuralsensorineural

AUDITORY ASSESSMENTAUDITORY ASSESSMENT

TEST FOR VESTIBULAR FUNCTONTEST FOR VESTIBULAR FUNCTON

• CALORIC TESTCALORIC TEST– Check direction of nystagmusCheck direction of nystagmus– COWS ( cold-opposite; warm-same side of COWS ( cold-opposite; warm-same side of

stimulated ear)stimulated ear)

• ROTATION (BARANY) TESTROTATION (BARANY) TEST– Rotating chairRotating chair– Nystagmus is opposite to the direction of Nystagmus is opposite to the direction of

rotationrotation

HEALTH PROMOTIONHEALTH PROMOTION

EAR PROTECTIONEAR PROTECTION

• Noise over 70 decibels is Noise over 70 decibels is potentially damaging to hearingpotentially damaging to hearing

• Most common & impt type of Most common & impt type of occupational hearing is caused by occupational hearing is caused by LOUD NOISELOUD NOISE

GENERAL EAR CAREGENERAL EAR CARE

• Ear is self-cleaningEar is self-cleaning• Cerumen-lubricant; traps dirtCerumen-lubricant; traps dirt• Keep eyes, mouth & both nostrils Keep eyes, mouth & both nostrils

while blowing the nosewhile blowing the nose• Cleanse the external ear reached Cleanse the external ear reached

by vision by vision

NURSING INTERVENTIONSNURSING INTERVENTIONS

EAR DROPSEAR DROPS• WarmWarm• After adm’n, head should remain tiltedAfter adm’n, head should remain tilted

SOFTENING & REMOVING IMPACTED SOFTENING & REMOVING IMPACTED CERUMENCERUMEN

• Few drops of hydrogen peroxide/ warm Few drops of hydrogen peroxide/ warm glycerineglycerine

• Irrigate the earIrrigate the ear

NURSING INTERVENTIONSNURSING INTERVENTIONS

EAR IRRIGATIONEAR IRRIGATION

• To clean the external canalTo clean the external canal• Remove impated cerumenRemove impated cerumen• Caloric testCaloric test• Apply antiseptic solutionsApply antiseptic solutions• Remove foreign bodiesRemove foreign bodies

COMMON EAR PROBLEMSCOMMON EAR PROBLEMS

1.1. OTOSCLEROSISOTOSCLEROSIS

2.2. MENIERE’S DSEMENIERE’S DSE

3.3. HEARING IMPAIRMENTHEARING IMPAIRMENT

OTOSCLEROSISOTOSCLEROSIS

• Normal bone is replaced by spongy Normal bone is replaced by spongy bonebone

• Ankylosis of the footplate of the Ankylosis of the footplate of the stapesstapes

• Impaired vibration systemImpaired vibration system

OTOSCLEROSISOTOSCLEROSIS

ASSESSMENTASSESSMENT

• Gradual hearing loss Gradual hearing loss • Difficulty hearing a whisperDifficulty hearing a whisper• Own voice is loudOwn voice is loud• Paracusis : hear better in loud Paracusis : hear better in loud

environmentenvironment• Rinne’s test: bone conduction betterRinne’s test: bone conduction better

OTOSCLEROSISOTOSCLEROSIS

PLANNING & IMPLEMENTATIONPLANNING & IMPLEMENTATION

• Hearing aidHearing aid• Surgery – primary form of txSurgery – primary form of tx

– StapedectomyStapedectomy– Stapes mobilization operationStapes mobilization operation– Fenestration operation : new window Fenestration operation : new window

is createdis created

EAR SURGERYEAR SURGERY

PRE-OP CARE;PRE-OP CARE;

• Hair shampooHair shampoo• Inform client:Inform client:

– Head still during surgeryHead still during surgery– Post op: get out of bed with assistancePost op: get out of bed with assistance

avoid nose blowing until 1 weekavoid nose blowing until 1 week

EAR SURGERYEAR SURGERY

POST OP POST OP

• Promote comfort & safetyPromote comfort & safety• Promote psychological well-beingPromote psychological well-being• Prevent complicationsPrevent complications

COMFORT & SAFETYCOMFORT & SAFETY

•24h bed rest24h bed rest•No TVNo TV•Pain relieverPain reliever•Gradual ambulation with assistanceGradual ambulation with assistance

PSYCHOLOGICAL WELL-BEINGPSYCHOLOGICAL WELL-BEING

•Reassurance about decreased hearing from Reassurance about decreased hearing from swelling & dressingswelling & dressing

•Slushing within the ear- report to physicianSlushing within the ear- report to physician

COMPLICATIONS;COMPLICATIONS;

•Facial nerve involvementFacial nerve involvement•Facial paralysis, facial weaknessFacial paralysis, facial weakness•Inability to show teeth, wrinkle forehead,Inability to show teeth, wrinkle forehead,

raise eyebrows or close eyesraise eyebrows or close eyes•Meningitis – bacterialMeningitis – bacterial

•Report signs & symptomsReport signs & symptoms•Bleeding Bleeding

EAR SURGERYEAR SURGERY

DISCHARGE PLANNINGDISCHARGE PLANNING

• Discharged with dressingDischarged with dressing• Sudden head movement, avoidedSudden head movement, avoided• No elevatorsNo elevators• No hair washing at least 2 weeksNo hair washing at least 2 weeks• Avoid people with URTIAvoid people with URTI

MENIERE’S DSEMENIERE’S DSE

• Chronic Chronic • Increase in endolymphatic pressureIncrease in endolymphatic pressure

ASSESSMENT:ASSESSMENT:• TinnitusTinnitus• Unilateral hearing lossUnilateral hearing loss• Vertigo Vertigo

MENIERE’S DSEMENIERE’S DSE

PLANNING & IMPLEMENTATIONPLANNING & IMPLEMENTATION

• CONSERVATIVE: palliativeCONSERVATIVE: palliative– Bed restBed rest– MedsMeds

• Sedative :PhenobarbitalSedative :Phenobarbital• Antihistamine Antihistamine • AntiemeticsAntiemetics

– Low salt dietLow salt diet

MENIERE’S DSEMENIERE’S DSE

PLANNING & IMPLEMENTATIONPLANNING & IMPLEMENTATION

• SURGERY- delayed until client’s SURGERY- delayed until client’s hearing below the serviceable levelhearing below the serviceable level– Destruction of the labyrinthDestruction of the labyrinth– Decompression of endolymphatic sacDecompression of endolymphatic sac– Sectioning of the vestibular nerveSectioning of the vestibular nerve– Cryosurgery of the labyrinthCryosurgery of the labyrinth

HEARING IMPAIRMENTHEARING IMPAIRMENT

TYPES OF HEARING LOSSTYPES OF HEARING LOSS

• CONDUCTIVE CONDUCTIVE – Damage to the conducting systemDamage to the conducting system– Hearing aid is usefulHearing aid is useful

• SENSORINEURALSENSORINEURAL– Damage to the:Damage to the:1.1. Organ of CortiOrgan of Corti2.2. Cochlear nerveCochlear nerve3.3. Acoustic branch of the auditory nerveAcoustic branch of the auditory nerve

COMMUNICATING WITH COMMUNICATING WITH HEARING-IMPAIRED CLIENTSHEARING-IMPAIRED CLIENTS

• Avoid use of gestures without speechAvoid use of gestures without speech• Do not shoutDo not shout• Speak distinctly & as close to the clientSpeak distinctly & as close to the client• Use short phrasesUse short phrases• Do not communicate with someone else Do not communicate with someone else

in front of a hearing-impaired clientin front of a hearing-impaired client• Hearing impairment goes with visual Hearing impairment goes with visual

problems in elderlyproblems in elderly

SOUND AMPLIFICATIONSOUND AMPLIFICATION

TYPES OF HEARING AIDS;TYPES OF HEARING AIDS;

• Post-auricularPost-auricular• Body-typeBody-type• In-the ear modelIn-the ear model

Select hearing aid that has cotrollable Select hearing aid that has cotrollable volume & is properly fittedvolume & is properly fitted

• Albus, 62 yo, has a Albus, 62 yo, has a stapedectomy. Which of the stapedectomy. Which of the following is the most important following is the most important for the nurse to include in the for the nurse to include in the post-op care plan?post-op care plan?

a.a. Checking the gag reflexChecking the gag reflex

b.b. Encouraging independenceEncouraging independence

c.c. Instruct not to blow noseInstruct not to blow nose

d.d. Position on the operative sidePosition on the operative side

““that’s that’s allallfolks”folks”

““that’s that’s allallfolks”folks”