External ear-collects and directs sound waves toward ear drum.
auricle, or pinna that projects from the head
external auditory canal-leads from the outside to the ear drum
cerumen-produced by glands which coat the canal (ear wax)
Ear drum or tympanic membrane-{connects the external ear canal to the middle ear.
vibrations of the membrane send sound waves to the inner ear
Middle ear-transfer of sound to the inner ear through specialized bony structures.
hammer, anvil and stirrup vibrate and transfer the sound to the inner ear.
Eustachian tube-{connects the nasopharynx and the middle ear. Equalizes air pressure.
Inner ear or labyrinth-boney and membranous structures transmit sounds to the brain through the auditory nerve.
specialized hearing cells.
vestibule and semicircular canals-sense movement in three planes, balance, position, equilibrium.
cochlea-sensory receptor for hearing.
Auditory (or acoustic) nerve-transmits the sound impulses to the brain.
Mechanisms of hearing
Sound is conducted by air vibrations collected and directed through the structures of the ear.
Vibrations of the ear drum transfer sound to boney and membranous structures of the inner ear.
Sensory cells transfer to impulses directed through the auditory nerve to the brain.
Perception of sound is interpreted by the brain.
Possible effects of aging on the auditory structures Refer to your textbook pg 224
Presbycusis....Diminished ability to distinguish sounds. This lessening of hearing may be affected by heredity or environmental factors. Persistent exposure to loud noises can damage organs of hearing. Usually the higher pitched sounds are lost first which impacts the resident's ability to hear speech. Lower pitches may diminish over time. Other factors may include underlying disease processes, accidents, reduced flexibility of the boney structures, reduced hydration producing drier cerumen and membranes.
Inner ear – decreased ability to hear high pitched sounds, tinnitus, alteration in balance.
Ear disorders
Refer to your textbook pg 225
Tinnitus-perception of sound in the absence of an acoustic stimulation. Associated with numerous causes including side effects of medications.
Earache-pain located in the general area of the ear due to inflammation or infection.
Headache-May be caused by nerve inflammation, localized infection and inflammation of the ears.
Difficulty hearing-may be due to mechanical, neurological, or inflammation.
Vertigo-perception of rotary movement associated with imbalance and dizziness.
Drainage-may indicate severe infection, ruptured ear drum, or other disease process.
Swelling-usually can be distinguished by visually comparing ears. Painful when touched--external ear or surrounding area, especially in front of or behind ear.
Congestion-because the Eustachian tube connects to the nasal passages, congestion may be communicated to the ear and result in infection and inflammation of the ear.
Terms and diseases
DermatitisBinflammation of the skin of the outer ear or external ear canal.
EczemaBcharacterized by itching, redness, peeling or scaly skin. Discharge may be present.
Frequently recurs.
May be associated with middle ear infection.
ObstructionBaccumulated earwax because of excess production or dry consistency associated with aging.
Insects and foreign objects may be inserted in the ear, causing intense annoyance, itching, pain, and impairing hearing.
Tumors may arise which obstruct the ear canal.
Cysts or boils.
Otitis externa, or external otitis
Infection of the external ear canal.
"Swimmer’s ear”
Associated with swimming in contaminated water or persistent retention of water in the ear (creating environment for bacterial or fungal growth).
Related medications and treatments:
Refer to your textbook pg 227
Antibiotics-used to reduce bacterial growth and inflammation. May be given orally. Topical antibiotic solutions alone may not be effective when inflammation, wax, or infection debris is in the ear canal. Topical solutions are ineffective for middle-ear infections. Refer to your textbook p 225-226
Anti-inflammatory-used to reduce swelling, inflammation.
Hydrocortisone.
Anti-inflammatory medications are not used for fungal infections. Nystatin is used for fungal infections.
Combination therapies-medications that combine actions of more than one type of drug.
Polymyxin, Neomycin and hydrocortisone, acetic acid and hydrocortisone.
Vasoconstrictive-used to open the eustachian tube.
Ephedrine, pseudoephedrine.
Antihistamines-reduces allergic response.
Analgesics-reduce pain, provide comfort. Ineffective as a treatment of the source of the pain and should never be used alone in persistent ear pain.
Symptoms of serious complications may be covered up by analgesics.
Topical antipyrine, benzocaine, glycerin (Auralgan), Tylenol, Tylenol with Codeine.
Wax-softeners-help keep ear wax from building up. Should not be used when there are signs of infection.
Triethanolamine (Cerumenex).
carbamide peroxide (Debrox)
General considerations in administering ear medication
Medications may be in a variety of forms. It is important to have the correct form of the medication as ordered.
Topical medications may be ointments for outer ear or drops instilled in the ear.
Preventing Hearing Problems- Refer to your textbook pg 226
Pay close attention to your textbook pg 228 regarding Representative Drugs for the Ear.
Also read the in your textbook pg 230 the practice procedure for instilling ear drops.
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Unit 16
collected and directed through the structures of the ear.