Ears - Otosclerosis and Meniere’s disease

Otosclerosis

Overview:

• Fixation of the stapes caused by the growth of bone, preventing transmission of vibrations

• Cause unknown, but incidence higher in females; heredity a factor

Otosclerosis

Clinical findings:

• Loss of hearing; ringing or buzzing in the ears

• Use of a tuning fork shows bone conduction better than air conduction (Rinne test); presence of spongy bone in the labyrinth

Otosclerosis

Therapeutic Interventions:

• Hearing aids to amplify sound

• Stapedectomy: removal of the diseased portion of the stapes, and replacement with a prosthetic implant to conduct vibrations from the middle to inner ear

Otosclerosis

Nursing Care:

• Assessment:

• History of onset and progression of symptoms

• Extent of hearing loss via audiometry

• Rinne test to evaluate loss of air conduction

Otosclerosis

Nursing Care:

• Nursing Diagnoses:

• Impaired verbal communication related to hearing loss

• Risk for injury related to hearing loss, vertigo, presence of a graft

Otosclerosis

Nursing Care:

• Planning/Implementation:

• Position postoperatively according to orders: lying on the operated side facilitates drainage: lying on the nonoperated side helps prevent displacement of graft

• Instruct the client to alter position gradually to prevent vertigo

Otosclerosis

Nursing Care:

• Planning/Implementation:

• Question about pain, headache, vertigo, or unusual sensations in ear

• Instruct avoidance of sneezing, blowing nose, swimming, showering, and flying until permitted by physician; if the client must sneeze, instruct to keep mouth open to equalize pressure in ear

Otosclerosis

Nursing Care:

• Planning/Implementation:

• Explain that because of edema from surgery and the presence of packing, hearing will be diminished but will improve

Otosclerosis

Nursing Care:

• Evaluation/ Outcomes:

• Reports improved hearing ability

• Remains free from injury

• Establishes effective communication

Meniere’s disease (Endolymphatic hydrops)

Meniere’s disease

Overview:

• Chronic inner ear disease that incapacitates because of sudden, severe attacks of vertigo

• Cause unknown, but may follow infections of middle ear or trauma

• Incidence highest in males between 40 and 60 years of age

Meniere’s disease

Clinical findings:

• Vertigo; nausea; headache; tinnitus; sensitivity to loud sounds; sensory hearing loss, usually unilateral

• Vomiting; diaphoresis; nystagmus during attacks; Weber test and auditory testing document unilateral hearing loss

Meniere’s disease

Therapeutic interventions:

• Pharmacologic therapy: diuretics; antihistamines; diazepam (Valium)

• Surgical destruction of the labyrinth or vestibular nerve, which causes deafness

• Surgical insertion of endolymphatic drainage shunt may relieve symptoms without loss of hearing

• Salt-free diet

Meniere’s disease

Nursing Care:

• Assessment:

• Description of onset and progression of symptoms; situations that seem to precipitate an attack

• History of allergies or infections that may have contributed to the disorder

• Extent of hearing loss via audiometry

• Weber test to determine auditory loss

Meniere’s disease

Nursing Care:

• Nursing Diagnoses:

• Risk for injury related to vertigo

• Impaired communication related to hearing loss

Meniere’s disease

Nursing Care:

• Planning/Implementation:

• Support emotionally

• Encourage avoidance of rapid movements to limit the onset of symptoms

• Teach self-protection from injury during attack (e.g., pull off the road if driving, lie down)

Meniere’s disease

Nursing Care:

• Planning/Implementation:

• Care of the client after a total labyrynthectomy:

• (a) Mainain bed rest in the presence of severe vertigo

• (b) Instruct to avoid sudden movements

• (c) Explain that Bell’s palsy may occur postoperatively but usually subsides

Meniere’s disease

Nursing Care:

• Planning/Implementation:

• Teach avoidance of foods high in salt such as salted meats, and fish; cheese, condensed milk, carrots and spinach

Meniere’s disease

Nursing Care:

• Evaluation/Outcomes:

• Reports a reduction in frequency and intensity of vertigo

• Remains free from injury

• Establishes effective communication