MEDICAL SURGICAL NURSING – EENT Disorders_______________________

4) Trauma
HEARING LOSS
Cardinal Sign
1) Sensorineural Hearing Loss ▪ Meniere’s Triad “VTS”
▪ Nerve damage / Malfunction o Vertigo
▪ CN 8: Vestibulocochlear Nerve ▪ Priority: Safety
o Purpose: For balance and o Tinnitus
hearing o Sensorineural hearing loss
o A.k.a. Auditory nerve
▪ Vestibulo: Balance Other Clinical Manifestations
▪ Cochlear: Hearing ▪ Dizziness
2) Conductive Hearing Loss ▪ Nausea and Vomiting
▪ Bone Malfunction or Bone Disorder ▪ Retching
3) Mixed Hearing Loss ▪ Sense of “fullness” of the ears
▪ Both Conducitve and Sensorineural ▪ Ear Pain
o Rare!
SENSORINEURAL CONDUCTIVE MIXED ▪ (+) Rinne’s Test
Nerve Damage Bone Damage Both
All inner ear Outer and middle ear All areas of the ear
conditions Vertigo vs. Dizziness
Air conduction Bone conduction Both air and bone - Vertigo: Vision is spinning
problem problem
✓ Absence or not
o Longer duration and can be
vibrating progressive
enough - Dizziness: “Just like riding a boat” / Motion
Ex: Ex: -
✓ Meniere’s ✓ Otosclerosis
sickness
Disease o Sudden or Short term
✓ Acoustic ✓ Otitis media
neuroma ✓ Otitis externa
✓ Presbycusis
Diagnostic Tests
1) CT scan & MRI
Bones in the ears “MIS” 2) Otoscopy
✓ Maleaus 3) Audiometry
✓ Incus ▪ Measures hearing
✓ Stapes ▪ Normal hearing capacity: 20 – 20,000
o Smallest bone in the body HTZ
▪ Normal: 0 – 85 Decibel
MENIERE’S DISEASE 4) Whisper test
▪ Whisper in a certain distance
- A.k.a. Endolymphatic Hydrops 5) Romberg Test
- Endo: Inner ear ▪ Balance
- Lymphatic: Lymphatic network or vessels ▪ Checks for:
- Hydrops: Water o Ear: Vestibulo
o Brain: Cerebellum
Basic Definition 6) Rinne’s Test & Weber’s Test ‼️
- Over accumulation or over production of ▪ Tool: Tuning Fork
excessive fluids in the inner ear and lymphatic o Emits low frequency sound in
vessels
an average of 512 HTZ
o Fluid is from the lymphatic vessels ▪ Rinne’s Test (Quantitative)
- Causes excess pressure towards the Cranial 1) Tap tuning fork in any hard
Nerve 8 surface
o CN 8 malfunction or damage 2) Place tuning fork directly to
the mastoid bone
Causes 3) Listen and measure the length
✓ Idiopathic of the sound
▪ Primary reason 4) As the sound disappears, place
tuning fork 1 – 2 cm beside
Predisposing Factors the ear
1) Chemical exposure 5) Listen and measure the length
2) Autoimmune of sound
3) Genetics
______________________________________________________________________________________________________________________________ 1
Patricia Marie A. Braulio, BSN – Velez College - SLRC
 MEDICAL SURGICAL NURSING – EENT Disorders_______________________
▪ Webber’s Test (Qualitative) Ramsey Hunt Syndrome
1. Tap tuning fork to any hard - Autoimmune disorder that affects CN 7 & 8
surface
2. Place tuning fork directly in Diagnostic Test
the middle of the head 1. MRI & CT scan
3. Listen and assess the equality ▪ Confirmatory
of sound 2. Biopsy
▪ Optional only
3. Rinne’s & Webbers
Results of Rinne’s Test 4. Audiometry
If air conduction > bone Normal
conduction and minimum 5. Otoscopy
length of sound is 2x 6. Whisper test
If bone conduction > air Conductive hearing loss 7. Romberg’s test
conduction ✓ (-) Rinne’s Test
If bone conduction = air Conductive hearing loss 8. Nerve conduction velocity test
conduction ▪ Rationale: To check for facial
If air conduction > bone Sensorineural hearing loss paralysis
conduction but length of sound ✓ (+) Rinne’s Test
is less than 2x
If no sound Mixed type Management for Acoustic Neuroma
▪ Antineoplastic
Results of Webber’s Test ▪ Radiation
Bilateral hearing, symmetrical Normal
sound ▪ Surgery
If with chief complaint of ✓ Sensorineural Hearing Loss o Last option
hearing “SUCA” ✓ Unaffected ear (if sound is
louder)
o SOC: Craniotomy or Burr holes
✓ Conductive hearing loss ▪ Infratentorial Craniotomy
✓ Affected ear (if sound is o Flat on bed after procedure
louder)
If no sound hear on both ears Mixed

PRESBYCUSIS

Management for Meniere’s Diseasde

- Degenerative loss of hearing
1) Diet
- Due to aging
▪ Low sodium and limit fludis
2) Ambulation assistance
“Pres”
3) Instruct the patient to turn with the body
slowly, not with the head - Meaning degenerative
4) Diuretics
Management for Presbycusis
5) Analgesics for pain
▪ No cure
6) Surgery
▪ Hearing aid only
▪ Tympanostomy
o For ear drainage
o Takes an average 4 – 6 weeks
OTOSCLEROSIS
for hearing gradually goes back
▪ Myringotomy - A.k.a. Otospongiosis
o For ear drainage - Overproduction of spongy bones in the middle
o Takes an average 4 – 6 weeks ear
for hearing gradually goes back - Fixation of bone in the middle ear
o Losing the ability of the bones to
ACOUSTIC NEUROMA
vibrate >> Conductive hearing loss
- Due to benign or a non-malignant tumor at the
Common bone affected
CN 8
✓ Stapes
o Affects the Schwann cells
- Causes sensorineural hearing loss
Sclerosis
- Can also affect balance
o A.k.a. Ataxia - Damage and hardening
In severe casess
Causes
- CN 7 can be involved or affected
▪ Hereditary
- May possibly lead to Bells Palsy
▪ Autosomal Dominant
______________________________________________________________________________________________________________________________ 2
Patricia Marie A. Braulio, BSN – Velez College - SLRC
 MEDICAL SURGICAL NURSING – EENT Disorders_______________________
Cardinal sign
✓ Schwartz Sign GLAUCOMA
o A.k.a. Flamingo Pink Sign 🦩
o Mixture of bone and blood vessels - Due to high levels of IOP
o White bone & red vessels = pink
o Area is highly vascularized Normal IOP
- 10 – 21 mmHg
Other Clinical Manifestations - Uses Tonometer thru Tonometry
▪ Sense of fullness
▪ Ear pain CLOSE ANGLE GLAUCOMA OPEN ANGLE GLAUCOMA
Higher IOP IOP not too high, not too low
Initially symptomatic Initially not too low IOP
Diagnostic tests ✓ Asymptomatic
1) MRI & CT Emergency condition Poor prognosis
✓ If not treated, can
2) Cranial X-ray lead to permanent
3) Otoscopy blindness
4) All hearing tests A.k.a. Acute Angle A.k.a. Chronic Angle
Early detection Late detection
Lesser chance of blindness Higher chance of blindness
Management of otosclerosis Earliest symptom: Earliest symptom:
▪ Sodium Fluoride otic drops ✓ Pain ✓ Blurred vision
#1 causative factor: #1 causative factor:
o To control the bone growth ✓ (+) Obstruction of the Canal ✓ Overproduction of Aqueous
▪ Surgery of Schlemm Humor
o Stapedectomy ✓ Produced by ciliary body
✓ Accumulates at Anterior
▪ Removes excess stapes chamber
▪ Position post-op: unaffected
side Predisposing factors for both
▪ Takes about 4 – 6 weeks to 1. Genetics
gradually improve or 2. Age
normalize hearing 3. Trauma
4. Eye Surgery
5. Medication
OTITIS MEDIA & EXTERNA
▪ Steroids
▪ Mydriatics
- A.k.a. Swimmer’s Ear
o Ex: Atropine & Scopolamine
- Due to dirty water staying and contaminating
6. Infection
the outer ear
▪ Conjunctivitis
▪ Keratitis
Common in the ff:
✓ Swimmers/Divers
Mydriatics
✓ Infants
- Dilates the pupil
o V. Humor mixes with A. Humor,
Complications
adding more pressure to anterior
✓ Meningitis
chamber
- Constricts the canal and blood vessels at back
Clinical Manifestations
of the eye
▪ Ear discharges
o Harder to drain >> retention of fluid to
▪ Pain
anterior chamber >> increases IOP
▪ High-grade fever
▪ Conductive hearing loss
Conjunctivitis
▪ Sensation of “fullness” of ears
- Inflammation of conjunctiva
▪ Pedia: Constant tugging of ears
- Adds pressure to canal of schlemm
- Can be bacterial or viral
Management for Otitis Media & Externa
o Viral: More contagious
▪ Antibiotic Otic drops
o Bacterial: More dangerous
o Proper pulling of ears
Keratitis
▪ Rationale: To straighten the
- Infection and inflammation of the cornea
ear canal
o Drop at the walls of the ear canal,
NOT directly to the ear canal
______________________________________________________________________________________________________________________________ 3
Patricia Marie A. Braulio, BSN – Velez College - SLRC
 MEDICAL SURGICAL NURSING – EENT Disorders_______________________
Hordealum ▪ Constricts pupil to control
- A.k.a. Stye mixture of V.humor to
- Acute infection of the eyelids with the A.humor
presence of a cyst with pus ▪ Given as optic drops
- Causative agent: S. Aureus ▪ Press lacrimal duct for 1 – 2
- Cause: Constant rubbing of eyes minutes after eye drops
administration to prevent
Blepharitis systemic absorption
- Chronic infection of the eyelids without cyst, ▪ Ex: Pilocarpin, Timolol,
but have many crusts Betaxolol
▪ Systemic a/e: Drops BP
Clinical Manifestations of Glaucoma ▪ Surgery
▪ Tunneled Vision o Iridotomy
o CARDINAL SIGN o Trabeculectomy, Trabeculotomy,
o Loss of peripheral vision Trabeculoplasty
o Mngmnt: Place things in front or at
center *What happens to the pupil, happens to your
▪ Halos around lights bronchus*
▪ Nausea and vomiting
▪ Headache RETINAL DETACHMENT

Macular degeneration Leading Factor

- Loss of central vision - Direct physical trauma
- Due to aging
- Mngmnt: place things on side Predisposing factors
- No cure ✓ Genetics
o Ex: Marfan’s Syndrome
Astigmatism ▪ Connective Tissue Disorder
- Starbursts-light vision ▪ Thin connective
- Cause: Unequal lens ✓ Aging

Management for Glaucoma Ultimate complication

▪ Position: Low to Semi 30 – 45 degrees ✓ Permanent Blindness
▪ Position post-op: Lie on unaffected side
▪ If both eyes, post-op position: Low to Semi Cardinal signs
fowlers ▪ Curtain Veil Vision
▪ Mydriatics given BEFORE surgery ▪ Floaters or burst of black spots
▪ Miotics given AFTER surgery o Ex: “Can you see the circles?”
▪ Avoid any form of exertion o Indicates bleeding
o How much weight patient can carry:
5lbs Other Clinical Manifestations
▪ Diet ▪ Blurred vision
o High fiber diet ▪ Periorbital swelling
o Low sodium ▪ Eye pain
o Soft diet ▪ Headache
o Limit fluids
▪ Medications Diagnostic tests
o Diuretics 1. Ophthalmoscopy
▪ Ex: Carbonic Anyhydrase 2. Slit-lamp test
Inhibitors 3. CT scan & MRI
• Targets the Ciliary ▪ For severe cases
Body
• Decreases production Cardinal eye gaze
of A. Humor - Controlled by CN 3, 4, 6
o Analgesics for pain and the headache
o Miotic
▪ DRUG OF CHOICE

______________________________________________________________________________________________________________________________ 4
Patricia Marie A. Braulio, BSN – Velez College - SLRC
 MEDICAL SURGICAL NURSING – EENT Disorders_______________________
Management of Retinal Detachment Diagnostic tests
1) If acute phase of detachment 1. Ophthalmoscopy
▪ Eye patch BOTH eyes 2. Slit-lamp test
o Rationale: To prevent rapid 3. Snellen chart
eye movement >> contributes ▪ Does not confirm
further detachment ▪ Checks only blurred vision
▪ Lie down on the AFFECTED side ▪ 20ft away from chart
▪ Rationale: To prevent further bleeding ▪ At 3 months old: First clear vision of
& trauma baby is achieved
2) Post-surgery ▪ 3 colors: Baby can only see R, W, B
▪ Postion the patient on the unaffected ▪ 6 -12 years old: 20/20 vision is
side achieved
▪ Dim light room 4. Ishihara chart
3) Surgery of choice ▪ For color blindness
▪ Scleral Buckling o A.k.a. Achromatopsia or
o Rationale: To repair Dantenopia
o Cones are affected
o Cannot distinguish colors
CATARACT
Management for Cataract
- A.k.a. Senile lens ▪ Treat underlying cause
- Opacity of crystalline lens secondary to ▪ Laser surgery
overgrowth tissues ▪ Phacoemulsification
- Senility: Aging o Less invasive
▪ Extra Capsular Cataract Extraction
Leading factor o Dangerous
✓ Aging ▪ Artificial lens implant

Other risk factors

SUMMARY
▪ Diabetes
▪ Medications
o Steroids EYE DISORDER CARDINAL SIGN
▪ Increases blood sugar Glaucoma ✓ Tunneled Vision
o Statins ✓ Halos around lights
Macular Degeneration Loss of central vision
▪ Genetics or Congenital Astigmatism Starbursts-light vision
o Smoking during pregnancy Retinal Detachment ✓ Curtain veil vision
▪ Smoking ✓ Floaters or bursts of
black spots
▪ Recurrent eye infections Cataract ▪ White cloudy vision or
▪ Constant Trauma seeing white spots
▪ Over exposure to sunlight or UV rays ▪ Milky appearance of
lens

Ultimate complication
✓ Blindness

Cardinal signs
▪ White cloudy vision
o Seeing white spots
▪ Milky appearance of the lens

Other signs and symptoms

▪ Blurred vision
▪ Decrease visual acuity
▪ Absence of red eye reflex
o Can be checked using slit-lamp test
▪ Photosensitivity

______________________________________________________________________________________________________________________________ 5
Patricia Marie A. Braulio, BSN – Velez College - SLRC