Chapter 59 Assessment and Management of Patients with Hearing and Balance Disorders
Slide 1: Anatomy of the Ear
 External, middle, and inner ear
 Extra detail: bone conduction vs air conduction
 Eardrum looks pearly gray
Slide 2: Assessment of Hearing and Balance
 External inspection, otoscopy
 Gross auditory acuity: whisper, Weber, Rinne
tests
Slide 3: Weber and Rinne Tests
 Weber test: bone conduction
 Rinne test: compares air vs bone conduction
 Whisper Test
 Otoscopic Examination
 Gross Auditory Acuity
Slide 4: Question #1
What does the Weber test assess?
 A. Air conduction
 B. Bone conduction
 C. Air and bone conduction
 D. Neither
Answer: B. Bone conduction
Rationale: Weber = bone conduction; Rinne = air vs bone
conduction.
Slide 5: Diagnostic Evaluation
 Audiometry – detecting hearing loss most important diagonotic instrument
 Pure Tone – Sound Simulation of music tones
 Speech Audimetry – spoken word
 Tympanogram
 Auditory brainstem response
 Electronystagmography
EAR WAX buildup and Removal
 Platform posturography
 Sinusoidal harmonic acceleration
 Middle ear endoscopy
Are YOU spinning or is the ROOM
spinning?
Slide 6: Hearing Loss
Ears
other things
 ↑ with age; 50% over 70 yrs (presbycusis)
 Excessive Noise levels
 Types:
o Conductive: external/middle ear Otitis Media/Otosclerosis
o Sensorineural: cochlea/vestibulocochlear nerve
o Mixed
o Functional (psychogenic)
Slide 7: Manifestations of Hearing Loss
 Tinnitus (ringing) – permanent
 Difficulty hearing in groups

Turning up TV volume
 Gradual impairment not recognized
 Progression → speech deterioration, fatigue, withdrawal, isolation
Slide 8: Communication Guidelines (Hearing Impaired)
 Ask preferred communication method
 Low-tone, normal voice
 Speak slowly, distinctly
 Reduce noise
 Face patient, get attention, speak into better ear
 Use gestures, expressions
 Write info or use interpreter if needed
Slide 9: External Ear Disorders #1
 Cerumen impaction: irrigation, suction, instrumentation (soften with oil, peroxide)
o Ear wax build up
 Foreign bodies: irrigation/suction unless swelling risk; may need OR removal
Slide 10: External Ear Disorders #2
 External otitis: bacterial (Staph, Pseudomonas) or fungal (Aspergillus)
o Pain, discharge, edema, erythema, itching, hearing loss, fullness
o Tx: comfort, edema reduction, treat infection; wick may deliver meds
 Malignant otitis externa: rare, progressive, skull involvement
Slide 11: Question #2
True/False: Otalgia = fullness or pain in ear.
Answer: True
Rationale: Otalgia = ear fullness/pain. In otitis externa → persistent, nocturnal pain. In otitis media →
pain may lessen if tympanic membrane ruptures.
Slide 12: Middle Ear Disorders #1
 Tympanic membrane perforation
 Acute otitis media: children; bacterial/viral; pain, fever, hearing loss. Tx: antibiotics,
myringotomy/tympanotomy
Slide 13: Middle Ear Disorders #2
 Serous otitis media: fluid without infection
 Chronic otitis media: recurrent; damages TM, ossicles, mastoid
 Tx: prevent recurrence, tympanoplasty, ossiculoplasty, mastoidectomy
Slide 14: Middle Ear Surgery
 Tympanoplasty: TM reconstruction
 Ossiculoplasty: ossicle reconstruction with prosthesis
 Mastoidectomy: remove diseased bone/mastoid/cholesteatoma
Slide 15: Stapedectomy
 For otosclerosis
Slide 16: Mastoid Surgery Assessment
 Hx: hearing loss, pain, drainage, vertigo, duration, meds
 PE: erythema, edema, lesions, discharge (color/odor)
 Review audiogram
Slide 17: Mastoid Surgery Goals

Reduce anxiety
 Relieve pain
 Prevent infection
 Stable/improved hearing
 Absence of vertigo/injury
 Increased knowledge (disease, surgery, postop care)
Slide 18: Nursing Interventions Post-Mastoid Surgery #1
 Reduce anxiety: reinforce teaching, support
 Relieve pain: analgesics for discomfort; sharp pain = eustachian opening; throbbing+fever =
infection
 Prevent injury: assist ambulation, antiemetics/antivertigo
Slide 19: Nursing Interventions Post-Mastoid Surgery #2
 Improve communication/hearing:
o
edema/blood/dressings may impair initially; use strategies from “communicating with
hearing impaired”
 Prevent infection:
o monitor signs, administer antibiotics, prevent water entry (showers/hair wash)
o HAND Hygiene
 Constant Throbbing pain and fever => Infection
Slide 20: Patient Education Post-Mastoid Surgery
 Analgesics, antivertigo meds
 Activity restrictions: avoid nose blowing both sides, lifting, straining (↑pressure)
 Infection signs/reporting
 Safety: call for ambulation help (vertigo)
 Follow-up care
Slide 21: Question #3
Which teaching is incorrect post-mastoid surgery?
 A. Avoid water in ear
 B. Constant throbbing pain = infection
 C. Call for ambulation help
 D. No activity restrictions
Answer: D. No activity restrictions
Rationale: Patients must avoid pressure changes, water exposure, monitor infection, and restrict
activities.
Slide 22: Inner Ear Disorders #1
 Vestibular disorders → fall risk
 Dizziness: altered orientation sense
 Vertigo: illusion of motion/spinning
 Nystagmus: rhythmic eye movement, vestibular dysfunction
Slide 23: Inner Ear Disorders #2
 Tinnitus
 Labyrinthitis
 Benign positional vertigo (BPPV)
 Ototoxicity
 Acoustic neuroma (CN VIII tumor)
************Slide 24: Ménière Disease ********
 Abnormal inner ear fluid balance cause by malabsorption of the endolymphatic sac or
blockage of the endolymphatic duct
 Manifestations include triad of symptoms: episodic vertigo, tinnitus, and fluctuating
sensorineural hearing loss. Feeling of pressure, nausea and vomiting
 Treatment
 Low-sodium diet; 1000 to 1500 mg/day
 Meclizine (Antivert); tranquilizers—valium, antiemetics—promethazine, and diuretics
may also be used
 Surgical management to eliminate attacks of vertigo; endolymphatic sac
decompression, middle and inner ear perfusion, and vestibular nerve sectioning

Abnormal endolymph balance: sac malabsorption/duct blockage
 Triad: episodic vertigo, tinnitus, fluctuating sensorineural loss
 Also: pressure, N/V
 Tx: low-sodium diet (1000–1500 mg/day), meds (meclizine, valium, promethazine,
diuretics)
 Surgical: sac decompression, inner ear perfusion, vestibular nerve section
Slide 25: Question #4
True/False: Cochlear implant = auditory prosthesis for bilateral profound sensorineural loss,
unhelped by hearing aids.
Answer: True
Rationale: Cochlear implant restores hearing in profound sensorineural loss not improved with
conventional aids.