EAR DISORDERS

Anatomic and physiologic over view

The ear is divided in to three distinct parts
Outer ear consists
Auricle
The external acousticmeatus
Middle ear (tympanic cavity) Consists
Tympanic membrane
Ossicles (three small bones)
Inner ear consists
Membranous labyrinth
Organ of corti

Function of the ears

Hearing
Sound conduction and transmission
Balance and equilibrium
Assessments of the ear
Inspection of the external ear
Otoscopic examination
Whisper test
Weber test
Rinne test
Audiometry
Tympanogram
Hearing loss
Early manifestation of hearing impairments and loss may include
Tinnitus
Increasing inability to hear in groups
Triggers changes in attitude, the ability to communicate, awareness of
Surroundings
Cause
Conductive
Sensorineural

Conductive hearing loss occur when sound cannot reach cochlea

Conduction of sound wave through the air and through the middle
ear to the
Inner ear, maybe blocked by

Obstruction of the external canal

TM perforation
Serous OM

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 Middle ear bone drainage from infection
Otoscearosis
Sensorineural hearing loss occur when the 8th cranial nerve damaged due to
Noise( induced hearing loss )
Drug ototocicity
Menieres disease
Tumor- neuroma of the 8th nerve
Congenital deafness
Aging of the nerve cell in the cochlea
Risk factors
Family history of sensorineural impairments
Low birth weight
Use of toxic medication
Recurrent ear infection
Bacterial meningitis
Chronic exposure to loud noise
Perforation of TM
Symptoms of hearing loss
Speech deterioration
Fatigue
Indifference
Social withdrawal
Insecurity
Indecision
Suspiciousness
False pride
Loneliness and unhappiness
Ass and dx
Evaluation gross auditory acuity
Weber test
Rinne test
Management
Medical management
Aural rehabilitation includes
Auditory training
Speech reading
Uses of hearing aid

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External ear problem
Giving nursing care for a pt with CERUMEN impaction
Large amounts of waxy accumulate and cause hearing loss and otalgia
Cause
It is self-induced through ill-advised attempts at cleaning the ear

S/S
Ear pain
Impacted wax
Hearing loss
Assessment
Inspection with otoscope
Management
Installing of ear drops or glycerin, mineral oils
Irrigation
Suction
Instrumentation

otitis external
External otitis: - is an inflammation of the external auditory canal
Cause
Water in the ear canal
Trauma to the skin of the ear canal
Systemic condition (vitamin deficiency and endocrine disorder
Bacterial or fugal infection
Clinical manifestations
Pain
Discharge from the external auditory canal
Aural tenderness
Sign of infection
Yellow or green discharge with foul smelling
Assessment
Otoscopic examination
Medical and nursing management
Anti pain
Antibiotic (systemic and local)
The nurse should teach the pt not to clean external auditory canal with
cotton tiped
applicators
Avoid swimming
Advice to protect the ear when shampooing or showering

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 Prevent infection by using antiseptic otic preparation after swimming

foreign body in the ear

Some objects inserted intentionally in to the ear by adults or children
such as
Insects
Beans
Pebbles
Toys

Clinical manifestations
Pt present with pain
Decreased hearing
Management
Removing of the foreign body form EAC
Using three standard methods

Middle ear problems

Tympanic membrane perforation
TMP is the perforation of the tympanic membrane
Cause
Infection and trauma
Sources of trauma
Skull fracture
Explosive injury
Sever blow to the ear
Foreign objects
S/S
Progressing hearing loss
Slight to moderate purulent ear drainage
Foul smelling
Management
Treat the cause and
If perforation does not heal, perform tympanoplasty
TP is done to prevent potential infection from water entering to the ear

otitis media

Types of otitis media

Acute OM
Serous OM
Chronic OM
An acute infection of the middle ear usually lasting less than 6 weeks

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Cause
Streptococcus pneumonia
H- Influenza
Clinical manifestations
Otalgia
The pain relieved after spontaneous perforation or therapeutic incision
TM
Drainage from the ear
Hearing loss

Assessment
Otoscope examination
Management
Medical management
Antibiotic
Antibiotic otic preparation

Surgical management
An incision in the TM (Myringotomy or Tympanotomy)
Serous OM
Is a collection of middle ear secretion that does not drain through the
Eustachian tube in to the nose
Cause
Negative pressure in the middle ear caused by Eustachian
Clinical manifestations
Hearing loss
Fullness in the ear
Sensation of congestion
Popping and crackling noise
Bubbles maybe visualized in the middle ear
Management
Myrngotomy of the drum can be performed
Corticosteroids to decrease edema of Eustachian tube
Chronic OM
Is the result of acute OM causing irreversible tissue pathology and
persistant perforation of TM
Clinical manifestations
Hearing loss
Moderate purulent ear discharge and foul smelling
Otorhea
Pain may not manifested
Perforation of TM

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 Cholesteatoma can be identified

Management
Medical
Careful suctioning of the ear
Antibiotic drop
Systemic antibiotic
Wicking

Surgical
Tympanoplasty -surgical reconstruction of the TM
Mastoidectomy - removing of the mastoid air cells
Ossiculloplasty- surgical reconstruction of the middle ear bones
to hearing

Nose and throat Disorder

General objectives: - at the end of this instruction, the trainee will be able
to give nursing care for a pt with nose and throat disorder

sinusitis
Sinusitis is an infection of Para nasal sinus
Cause
URTI infection
Allergic rhinitis
Streptococcus pneumoniae
H-influenza
Pathophysiology
Inflammation and congestion due to infection

Thickened mucous secretion

Occludes sinus cavity

Occludes the openings

Prevent drainage
Clinical manifestation
Facial pain or pressure over affected sinus area
Nasal obstruction
Fatigue
Purulent nasal discharge
Sign of infection
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 Decreased sense of smell
Sore throat
Eyelid edema

Assessment and Dx
Careful history and physical examination
Percussed using the index finger
Sinus x-ray
Management
Nasal irrigation with saline
Steam inhalation
Anti pain
Antibiotic

Complications
If left un treated life threatening complications such as
Meningitis
Brain abscess
Osteomyelitis

Chronic sinusitis
Is an inflammation of the sinus that persists more than 3 weeks in
adults and 2 weeks in child
Clinical manifestations
Impaired mucociliary clearance and ventilation
Cough
Chronic hoarseness
Chronic head ache
Partial pain
Nasal stiffness
Decrease in smell and tests
Fullness in the ear
Medical management
Antibiotic including
Augmentine
Clarthromycin
Cephalosporins
Decongestant agents
Antihistamines

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Epistaxis
Epistaxis is hemorrhage from the nose
Most common site is anterior lower septum
Cause
Rupture of tinny, distended vessels in the MM
Injury or disease
Some of the diseases that cause epistaxis include
Rheumatic fever
Acute sinusitis
Hypertension
Hemorrhagic disease
Management
Medical and nursing management
Appling direct pressure (the pt sit up pinch the lower half of the nose wall
against the mid line septum five to ten minutes
If the bleeding does not stop
Use adrenalin pack
The pt should avoid blowing his nose for one to two days
If bleeding continues
A physician may have to try cauterizing the sites of bleeding

nasal Polyps
Nasal polyps are edematous mucosally covered masses commonly seen in
pt with
Allergic rhinitis
Cause
Allergic rhinitis
Clinical manifestations
Obstruction of the air way
Diminished sense of smell
Management
Surgery
Giving nursing care for a pt with deviated septum
It is a common cause of nasal obstruction in older children and adults
Nasal symptom is normally thin and straight and allows air to pass through
easily
But when it is defected as a result of injury, it impairs the air way
Management
Sub mucous resection

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Eye disorder
General objectives: - at the instruction the trainee will able to give nursing
care for a patient with eye disorder
Anatomic and physiologic over view
There are three layers of tissue in the wall of the eye
The outer fibrous layer
Sclera cornea
The middle vascular layer or uveal tract
Choroids-ciliary body and iris
The inner nervous tissue
Retina
External ocular disease
Belpharitis
Belpharitis is any generalized infection and inflammation of the eyelid
margin
Cause
Seborrheic
Staphylococcal
Clinical manifestations
Irritation
Burning and itching sensation
The eyes are red rimmed
The lid margins are hyperemic
Meibomian are inflamed
Abnormal secretion
Management
Lid hygiene
Cleaning the scalp and eye lids frequently
Antibiotic if piogenic infection

Conjunctival diseases
conjunctivitis
Conjunctivitis is inflammation of the conjunctiva
It is the most widely spread ocular disease worldwide
Classifications and causes of conjunctivitis
Bacterial conjunctivitis
Viral conjunctivitis
Trachoma
Allergic

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Clinical manifestations
Foreign body sensation
Red eye
Edema of the conjunctiva
Increased secretion
Photophobia
Assessment and Dx
Physical examination
The four main features are important to evaluate type of discharge
(Watery, mucoid, muco purulent)
Management
Bacterial conjunctivitis
Local antibiotic (TTC, Genta eye drops)
Clean the eye 2-4 times per day
Viral conjunctivitis
Symptomatic management
Allergic conjunctivitis
Steroid eye drops

trachoma
Trachoma is a chronic contagious disease of the conjunctiva
Cause
Chlamydia thrchomatis

Predisposing factors
The disease spreads among people who are careless in cleanliness due to
flies
Direct contact with excretion from infected eyes
Indirectly by infected towels and handkerchief
Clinical manifestations
Burning sensation
Photophobia
Itching sensation
Feeling of foreign body
Presence of follicles in the tarsal conjunctiva
Trachomatous
Assessment and Dx
Physical examinations
Management
TTC eye ointment 3-4 times daily for 6 weeks
TTC FOR 3 WEEKS
Prevention
Proper health education

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 Personal hygiene
Family hygiene
Teaching children in schools is excellent method of preventing trachoma

Diseases of the cornea

Giving nursing care for a pt with keraitis
Keraitis is inflammation of the cornea
Keraitis may be localized, generalizes or deep
Cause
Bacteria
Fungi
External trauma (dry air and dust)
Clinical manifestations
Pain
Blurred vision
Photophobia and watering
Vessels around the limbus are dilated and increased
The anterior chamber of the eye may show exudates
Management
Because different cause of keraitis treatment is not easy
If bacterial, local antibiotic every 1-2 hrs
Systemic antibiotic
If the cause if viral antiviral drug

cataract
Cataract is opacity or cloudiness of the lens
Classification of cataract
Immature or early cataract
Mature cataract (the lens is completely opaque)
Hyper mature
Cause
Congenital cataract
Aging the most common cause
Trauma
Secondary cataract from other intra ocular diseases like uveitis
Excess corticosteroid drugs usage
Clinical manifestations
Painless blurry vision
The pt perceive that the surrounding is dimmer
Light scattering is common
Myopic shift
Loss of visual acuity
Diplopia (double vision)

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Assessment and Dx
The snellen visual acuity test
Ophthalmoscopy

Management
Medical management
There is no known medicine
Surgical management
Intra capsular cataract extraction
The entire lens removed
Extra capsular cataract extraction
Intraocular lens may be in planted
Nursing management
After cataract extraction
The pt needs to have antibiotic ointment
Atropine ointment
Some times cortisone is added
Avoid giving of aspirin
Prevent bleeding
The pt wears eye patch for 24 hrs after surgery
Sunglass should be worn while out doors
The eye patch should be removed after the first appointment
Post op complications
Retinal detachments
Blindness

glaucoma
Glaucoma is rise in intra ocular pressure, which damages various structures
in the eye
Risk factors
Eye trauma
Family history of glaucoma
Diabetes
Cardiovascular disease

Clinical manifestations
Glaucoma is often called the silent thief of sight
Loss of peripheral vision
Fixed dilated pupil with no reaction to light
Cornea may hazy
The lens is clear or opaque
Management
Medical management

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 Treatment should be started early
Medical treatment is mostly by use of pilocarpine drops to narrow the pupil
Aseteazolamid tablet may be added to decrease aqueous humor production
Surgical treatment is recommended
Surgical management
Drainage operation
Laser

refractive error
In refractive error, vision is impaired because shortened or elongated
eyeball prevents light rays from focusing sharply from the retina
The most common types of refractive errors are
Presbyopia
Myopia (short sight)
Hypermetropia (long sight)
Presbyopia
The lens in the eye become harder with age and less able to change its shape
Near objects do not focused exactly on the retina
Distant objects appear sharp
Management
Spectacles with convex lens
Adding one or two dioptre strength lens in front of the eye
Myopia (short sight)
Means the refractive power is too great
Parallel rays of the lights are focused in front of the retina
Distant objects appear blurred
Myopic people can see near objects clearly
The shape of the eye ball put the retina too far away from the lens

Management
Negative (concave) spectacle lens will help to focus parallel rays of
light on the retina
Hypermetropia
The opposite of myopia
The refractive power of the lens can not focus near objects on the retina ]
Parallel rays of light focused behind the retina
The eyeball may be too close to the lens
Hypermetropia patent can see far objects
Management
Positive dioptre concave spectacles lens

Aphakia
The pts on lens has been removed and the light ray from far distance and near
distance, do not focus clearly on the retina

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Some visions are present but not clear
Management
Strong spectacle lens of +10 dioptre to compensate loss of his own lens

Pre and postoperative nursing care for pts undergoing eye

surgery
Pre op care
Wash the whole body and the hair
Trim the eyelash the day before surgery
Put an antibiotic in the eye ready for surgery
NPO after mid night
Some pre medication just before going to the OR
Except in children, eye surgery is usually done under local anesthesia
Post op care
Giving eye ointment according to orders
The eye will be kept patched for a few days
Activity should allow a day after surgery
Pt should avoid coughing and staining every surgery
If the pt complain of pain in from for the physician
If both eye are patched the pt can need help for all activity

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