Med Surg Week 3

• Two functions of ears: hearing and balance
• 4 types of hearing loss: conductive, sensorineural, mixed, and functional.
• Conductive: caused by external of middle ear problems.
• Sensorineural: caused by damage to the cochlea or vestibulocochlear nerve.
• Mixed: both conductive and sensorineural.
• Functional: (psychogenic) caused by emotional problem.
• Audiometry: noninvasive, tests frequency, pitch and intensity of hearing ability.
• Tympanogram: measures mobility of the TM and middle ear structures relative to sound.
• Weber and Rhine Tests: tuning forks used to see if hearing loss is present.
• Otoscopy: visualized external, TM and malleus bone through the TM; adjust auricle if needed, assess pearly gray TM and light reflex.
• Electronystagmography: detects nystagmus to see if vestibular disease is present.
• Meclizine: Antihistamine and anticholinergics, treats vertigo. Education- Observe for sedation, avoid driving.
• Antiemetics: Ondansetron- Treatments for nausea and vomiting for vertigo. Education- Do not give if cardia rhythm disorder, report dizziness.
• Diphenhydramine: antihistamine. Treatment- vertigo and nausea. Education- Observe for urinary retention, sedation, dry mouth.
• Scopolamine: Anticholinergic- Treatment nausea, motion sickness/ transdermal. Education- Urinary retention, sedation, do not give with angle-closure glaucoma.
• Diazepam: Benzodiazepine, decreases stimuli to the cerebellum. Education- sedation, do not give with angle-close glaucoma, can be addictive.
• Therapies: Vertigo-reduction activities- Position changes slowly, Avoid caffeine and alcohol, Dark environment for when vertigo present, Assistive devices, Diuretic PRN, Space intake of fluids evenly during the day, Decreased intake of salt.
• Cochlear implant (Surgery) for sensorineural hearing loss: Microphone picks up sounds and converts to auditory nerve.
• Labyrinthectomy: removal of labyrinthine portion of the inner ear to treat vertigo.
• Pressure point treatment: Insertion of tympanostomy tube that pulses to relieves vertigo by displacement of fluid in the inner ear.
• Myringotomy: Incision in the TM to drain fluid from the middle ear for OM. Stays in place 6-18 months.
• Education follows middle ear surgery: No air travel for 2-3 weeks, Avoid coughing and other straining for 2-3 weeks. Avoid washing hair or showering for several days to 1 week, Temporary hearing loss is expected due to fluid/packing. Report any drainage.