1.5 Disorders of the Ear

Hearing Loss

Conductive Hearing Loss. Hearing loss due to an impairment of the external ear, middle ear or both.

Perceptive Hearing Loss. (Sensorineural hearing loss). Hearing loss due to disease of the inner ear or nerve pathways. Sensitivity to sound and discrimination of sound are both impaired.

Mixed Hearing Loss. Hearing loss due to a combination of conductive and perceptive loss.

Psychogenic Hearing Loss. Hearing loss with no physical basis. Usually a manifestation of an emotional disturbance.

Impacted Cerumen (Earwax)

a. Cerumen is a waxlike secretion found within the external auditory canal. Its presence is normal.

b. Cerumen does not need to be removed unless it is impacted or it interferes with hearing.

c. Impacted cerumen is removed by the physician (or a trained technician) using one of the following techniques:

(1) Irrigation.

(2) Instillation of drops designed to break down the cerumen.

(3) Removal with a blunt instrument such as a curet or loop.

Foreign Body in the Ear

Foreign bodies in the ear are most commonly seen in children, as children will frequently stick small objects into their ears. Other types of foreign bodies include:

(1) Insects (crawl or fly into the ear).

(2) Airborne matter (maybe blown into the ear).


NOTE: NEVER attempt to remove a foreign body from the ear unless you are skilled at the techniques used. The external ear canal could be damaged or the tympanic membrane ruptured. This procedure is normally performed by the physician.

 b. Assist the physician to remove insects.

(1) Instill mineral oil drops to smother the insect.

(2) Turn the patient's head toward the affected side to facilitate the drainage of the oil with the insect.

(3) Use a blunt loop or forceps to remove the insect if it does not drain out.

c. Assist the physician to remove foreign bodies of non-vegetable matter:

(1) Irrigate the ear.

(2) Remove the object with a blunt instrument such as a curet or loop.

d. Assist the physician to remove foreign bodies of vegetable matter (peas, for example):

(1) Use a blunt instrument to remove the object.

(2) DO NOT irrigate the ear, as vegetable matter has a tendency to absorb water and swell. This will cause the object to become further impacted and more difficult to remove.

Otitis Media

Otitis media is inflammation of the middle ear, caused by entrance of pathogenic organisms. Pathogens may enter through the eustachian tube or the external ear canal, through a perforated tympanic membrane.


Signs and Symptoms of Otitis media

Pain (earache, headache).
Difficulty hearing.
Noises in the ear or head.
Distended tympanic membrane.
Closed eustachian tube (secondary to swelling).


Treatment of Otitis media

Local heat.
Myringotomy, if indicated.

Nursing Implications. The mucous membrane that lines the middle ear, eustachian tube, and pharynx is a continuous one.  For this reason, infection may spread quickly and easily from one area to another. Nursing personnel should be alert for signs of spreading infection. Nursing personnel should be alert for signs that the tympanic membrane may rupture, namely increased pain or swollen tympanic membrane (bulging).

e. Myringotomy.

(1) A myringotomy is a small incision into the bottom of the tympanic membrane.

(2) Myringotomy is performed to:

(a) Relieve pressure.

(b) Allow drainage of pus or fluid.

(c) Prevent spontaneous rupture of the tympanic membrane. (3) After a myringotomy, the tympanic membrane heals rapidly and hearing is not adversely affected.