ANATOMY & PHYSIOLOGY OF EAR

The auditory system is comprised of three components; the outer, middle, and inner

ear, all of which work together to transfer sounds from the environment to the brain.

EXTERNAL EAR:

The outer ear includes the portion of the ear that we see—

 the pinna/auricle

 the ear canal.

 Tympanic membrane (also called the eardrum). The tympanic membrane divides the external

ear from the middle ear.

PINNA: The pinna or auricle is a concave cartilaginous structure, which collects and directs

sound waves traveling in air into the ear canal or external auditory meatus.

EAR CANNAL: The ear canal or external auditory meatus is approximately 1.25 inches long

and .25 inch in diameter. The inner two-thirds of the ear canal is imbedded in the temporal
bone. The outer one-third of the canal is cartilage. Although the shape of each ear canal

varies, in general the canal forms an elongated "s" shape curve. The ear canal directs airborne

sound waves towards the tympanic membrane (eardrum). The ear canal resonates sound

waves and increases the loudness of the tones in the 3000-4000 Hz range.

The ear canal maintains the proper conditions of temperature and humidity necessary

to preserve the elasticity of the tympanic membrane. Glands, which produce cerumen

(earwax) and tiny hairs in the ear canal, provide added protection against insects and foreign

particles from damaging the tympanic membrane.

MIDDLE EAR

The middle ear, an air-filled cavity, includes the tympanic membrane laterally and the

otic capsule medially. The middle ear cleft lies between the two. The middle ear is connected

by the eustachian tube to the nasopharynx and is continuous with air-filled cells in the

adjacent mastoid portion of the temporal bone. The eustachian tube, which is approximately 1

mm wide and 35 mm long, connects the middle ear to the nasopharynx.

 Normally, the eustachian tube is closed, but it opens by action of the tensor veli

palatini muscle when performing a Valsalva maneuver or when yawning or swallowing. The

tube serves as a drainage channel for normal and abnormal secretions of the middle ear and

equalizes pressure in the middle ear with that of the atmosphere.

TYMPANIC MEMBERANE: The tympanic membrane (ie, eardrum), about 1 cm in

diameter and very thin, is normally pearly gray and translucent. The tympanic membrane

consists of three layers of tissue: an outer layer, continuous with the skin of the ear canal; a

fibrous middle layer; and an inner mucosal layer, continuous with the lining of the middle ear

cavity. Approximately 80% of the tympanic membrane is composed of all three layers and is

called the pars tensa.

The tympanic membrane protects the middle ear and conducts sound vibrations from

the external canal to the ossicles. The sound pressure is magnified 22 times as a result of

transmission from a larger area to a smaller one.

OSSICLES: The middle ear contains the three smallest bones (ie, ossicles) of the body:

malleus, incus, and stapes. The ossicles, which are held in place by joints, muscles, and

ligaments, assist in the transmission of sound. Two small fenestrae (ie, oval and round

windows), located in the medial wall of the middle ear, separate the middle ear from the inner

ear.

The footplate of the stapes sits in the oval window, secured by a fibrous annulus, or

ring-shaped structure. The footplate transmits sound to the inner ear. The round window,

covered by a thin membrane, provides an exit for sound vibrations

 INNER EAR

The inner ear is housed deep within the temporal bone. The organs for hearing (ie,

cochlea) and balance (ie, semicircular canals), as well as cranial nerves VII (ie, facial nerve)

and VIII (ie, vestibulocochlear nerve), are all part of this complex anatomy. The cochlea and

semicircular canals are housed in the bony labyrinth. The bony labyrinth surrounds and

protects the membranous labyrinth, which is bathed in a fluid called perilymph.

MEMBERANEOUS LABYRINTH: The membranous labyrinth is composed of the

utricle, the saccule, the cochlear duct, the semicircular canals, and the organ of Corti. The

membranous labyrinth contains a fluid called endolymph. The three semicircular canals—

posterior, superior, and lateral, which lie at 90-degree angles to one another—contain sensory

receptor organs, arranged to detect rotational movement. These receptor end organs are

stimulated by changes in the rate or direction of an individual’s movement. The utricle and

saccule are involved with linear movements.

ORGAN OF CORTI: The organ of Corti is located in the cochlea, a snail-shaped, bony

tube about 3.5 cm long with two and one-half spiral turns. Membranes separate the cochlear

duct (ie, scala media) from the scala vestibuli, and the scala tympani from the basilar

membrane. The organ of Corti is located on the basilar membrane stretching from the base to

the apex of the cochlea. As sound vibrations enter the perilymph at the oval window and

travel along the scala vestibuli, they pass through the scala tympani, enter the cochlear duct,

and cause movement of the basilar membrane.

The organ of Corti, also called the end organ for hearing, transforms mechanical

energy into neural activity and separates sounds into different frequencies. This

electrochemical impulse travels through the acoustic nerve to the temporal cortex of the brain

to be interpreted as meaningful sound. In the internal auditory canal, the cochlear (acoustic)

nerve, arising from the cochlea, joins the vestibular nerve, arising from the semicircular

canals, utricle, and saccule, to become the vestibulocochlear nerve (cranial nerve VIII). This

canal also houses the facial nerve and the blood supply from the ear to the brain.
 SOUND CONDUCTION & TRANSMISSION:

Sound enters the ear through the external auditory canal and causes the tympanic

membrane to vibrate. These vibrations transmit sound through the lever action of the ossicles

to the oval window as mechanical energy. This mechanical energy is then transmitted through

the inner ear fluids to the cochlea, stimulating the hair cells, and is subsequently converted to

electrical energy. The electrical energy travels through the vestibulocochlear nerve to the

central nervous system, where it is analyzed and interpreted in its final form as sound.

Vibrations transmitted by the tympanic membrane to the ossicles of the middle ear are

transferred to the cochlea, lodged in the labyrinth of the inner ear. The stapes rocks, causing

vibrations (ie, waves) in fluids contained in the inner ear. These fluid waves cause movement

of the basilar membrane to occur that then stimulates the hair cells of the organ of Corti in the

cochlea to move in a wavelike manner. The movements of the tympanic membrane set up

electrical currents that stimulate the various areas of the cochlea. The hair cells set up neural

impulses that are encoded and then transferred to the auditory cortex in the brain, where they

are decoded into a sound message.

 CONGENITAL ANOMALIES / EAR DEFORMITIES

Abnormal development or deformities of the ear anatomy can cause a range of

complications, from cosmetic issues to hearing and development problems. An estimated 6 to

45 percent of children are born with some sort of congenital ear deformity.

Some ear deformities are temporary. If the deformity was caused by abnormal

positioning in the uterus or during birth, it may resolve as the child grows, the ear unfolds and

takes on a more normal form.

PROTRUDING EARS (also called prominent ears): Ears that, regardless of size, stick out

more than 2 cm from the side of the head

CONSTRICTED EARS: A variety of ear deformities where the helical rim is either folded

over (also called lop ear), wrinkled, or tight

CRYPTOTIA: Ear cartilage framework that is partially buried beneath the skin on the side

of the head

MICROTIA: Underdeveloped external ear

ANOTIA: Total absence of the ear

STAHLS EAR: Ears that have a pointy shape and an extra cartilage fold (crus) in the scapha

portion of the ear

EAR TAGS: Also known as an accessory tragus or a branchial cleft remnant, ear tags consist

of skin and cartilage

EAR LOBE DEFORMITIES: These come in a variety of shapes, including earlobes with

clefts, duplicate earlobes, and earlobes with skin tags

 TRAUMATIC EAR INJURIES: Lacerations, tears and bite injuries.

SPLIT EAR LOBES: Occur gradually due to large or heavy earrings

CAULIFLOWER EAR: Abnormal cartilage forms on top of the normal cartilage, resulting

in bulky misshapen ears

EAR KELOIDS: Caused by excessive scar tissue formation after minor trauma, most

commonly after ear piercing

EAR HEMANGIOMAS: Most common benign tumor of infancy, can occur anywhere on

the body, including the external ear and the salivary gland in front of the ear.

CAUSES:

 Genetic disorders - mutation

MANAGEMENT:

 Maternal screening and supplements

 Surgical correction
 OTALGIA

DEFINITION:

Ear pain, also known as otalgia or earache, is pain in the ear. Primary ear pain is pain

that originates inside the ear. Referred ear pain is pain that originates from outside the ear.

Ear pain is not always associated with ear disease. It may be caused by several other

conditions, such as impacted teeth, sinus disease, inflamed tonsils, infections in the nose and

pharynx, throat cancer, and occasionally as a sensory aura that precedes a migraine.

CAUSES:

 Otitis media is a particularly common cause of otalgia in early childhood

 secondary to other infectious illnesses, such as colds, coughs, or conjunctivitis.

TYPES:

PRIMARY: Ear pain can be caused by disease in the external, middle, or inner ear, but the

three are indistinguishable in terms of the pain experienced. External ear pain may be:

 Mechanical: trauma, foreign bodies such as hairs, insects or cotton buds.

 Infective (otitis externa):

 Staphylococcus, Pseudomonas, Candida, herpes zoster, or viral Myringitis.

REFERRED: The neuroanatomic basis of referred earaches rests within one of five general

neural pathways. The general ear region has a sensory innervation provided by four cranial

nerves and two spinal segments.

 Via Trigeminal nerve

 Via Facial nerve

 Via Glossopharyngeal nerve

 Via Vagus nerve

 Via the second and third spinal segments, C2 and C3.

DIAGNOSTIC FEATURES:

 History collection – previous history of ENT infections if any.

 The physical examination should include an exhaustive otologic, neuro-otologic, head, and

neck examination.

 Palpation of the neck is important to look for thyroid disease, adenopathy, and

musculoskeletal disorders

 Careful rhinoscopy, nasopharyngoscopy, and indirect laryngoscopy are mandatory.

MANAGEMENT:

 Management of ear pain depends on the underlying cause

 Often migraines are caused by middle ear infections which can easily be treated with

antibiotics.

 Often using a hot washcloth can temporarily relieve ear pain.

 Age-appropriate analgesics or a warm washcloth placed over the affected ear can help relieve

pain until the infection has passed.

 Most cases of otitis media are self-limiting, resolving spontaneously without treatment within

3–5 days.

 In some cases ear pain has been treated successfully with manual therapy.
 EAR TUMORS

INTRODUCTION:

Tumors of the ear can be benign or malignant. They can occur on the external ear, or

in the ear canal, the middle ear or inner ear.

CHOLESTEATOMAS:

Cholesteatomas are NOT a form of cancer. They are benign tumors. As they grow,

they can look like an onion peel of white skin formed into a ball.

CLINICAL MANIFESTATIONS:

 Hearing loss and recurring discharge from the ear.

 Pus or unpleasant smelling fluids coming from the ear are common.

DIAGNOSTIC FEATURES:

 A surgical microscope is necessary to make a proper inspection and cleansing of the

condition, especially when there is infection.

 A history of recurring ear infections after colds, or the entrance of water into the ear from

swimming, require the ear to be examined regularly for this condition.

MANAGEMENT:

 Antibiotics, given both by mouth and drops in the ear, combined with weekly cleaning of the

ear under the surgical microscope, can clear up the infection.

 Once infection is cleared up and the ear is dry, a decision regarding surgery to remove the

cholesteatoma can be made by the physician

 TYMPANIC MEMBERANE PERFORATION

DEFINITION:

It is defined as the rupture or tare in the tympanic membrane and its layer.

CAUSES:

❖ Infection

❖ Trauma include skull fracture, explosive fracture, severe blow to the ear

❖ Perforation caused by foreign objects

❖ Injury to the ossicles

PATHO PHYSIOLOGY:

Due to the etiological factors

Pressure in the middle ear exceeds the atmospheric pressure in the external auditory canal

Rupture of tympanic memberane

CLINICAL FEATURES:

➢ Nausea.

➢ Vomiting.

➢ Various degrees of the hearing loss.

➢ Possibly tinnitus.

DIAGNOSTIC FEATURES:

✓ History collection – regarding history of occupation.

✓ Physical examination - about the hearing acuity.

✓ Hearning acuity test

✓ Otoscopic examination
MANAGEMENTS:

Medical management:

• Although most tympanic membrane perforations heal spontaneously within weeks

after rupture, some may take several months to heal.

• Some perforations persist because scar tissue grows over the edges of the perforation,

preventing extension of the epithelial cells across the margins and final healing.

• In the case of a head injury or temporal bone fracture, a patient is observed for

evidence of cerebrospinal fluid otorrhea or rhinorrhea—a clear, watery drainage

from the ear or nose, respectively.

• While healing, the ear must be protected from water.

Surgical management:

• Perforations that do not heal on their own may require surgery.

• The decision to perform a tympanoplasty (ie, surgical repair of the tympanic

membrane) is usually based on the need to prevent potential infection from water

entering the ear or the desire to improve the patient’s hearing.

• Performed on an outpatient basis, tympanoplasty may involve a variety of surgical

techniques.

• In all techniques, tissue is placed across the perforation to allow healing. Surgery is

usually successful in closing the perforation permanently and improving hearing.

 OTOSCLEROSIS

DEFINITION:

Otosclerosis involves the stapes and is thought to result from the formation of new,

abnormal spongy bone, especially around the oval window, with resulting fixation of the

stapes.

The efficient transmission of sound is prevented because the stapes cannot vibrate and

carry the sound as conducted from the malleus and incus to the inner ear.

More common in women and frequently hereditary, otosclerosis may be worsened by

pregnancy.

CLINICAL FEATURES:

 The condition can involve one or both ears and manifests as a progressive conductive

or mixed hearing loss.

 The patient may or may not complain of tinnitus.

DIAGNOSTIC FEATURES:

 History and Physical Examination

 Otoscopic examination usually reveals a normal tympanic membrane.

 Bone conduction is better than air conduction on Rinne testing.

 The audiogram confirms conductive hearing loss or mixed loss, especially in the low

frequencies.
MANAGEMENTS:

Medical management:

 There is no known nonsurgical treatment for otosclerosis.

 However, some physicians believe the use of Florical (a fluoride supplement) can

mature the abnormal spongy bone growth.

 Amplification with a hearing aid also may help.

Surgical management:

 A stapedectomy, performed through the canal, involves removing the stapes

superstructure and part of the footplate and inserting a tissue graft and a suitable

prosthesis.

 Some surgeons elect to remove only a small part of the stapes footplate (ie,

stapedotomy).

 Stapes surgery is very successful in improving hearing. Balance disturbance or true

vertigo, which rarely occurs in other middle ear surgical procedures, can occur for a

short time after stapedectomy.

 OTITIS MEDIA

DEFINITION:

It is defined as Infection of the middle ear is termed as otitis media. There are 3

types acute , chronic, serous.

ACUTE OTITIS MEDIA

Acute otitis media is an acute infection of the middle ear, usually lasting less than 6

weeks.

CAUSES:

The primary cause of acute otitis media is usually Streptococcus pneumoniae,

Haemophilus influenzae, and Moraxella catarrhalis

PATHO PHYSIOLOGY:

Due to the etiological factors

Bacteria can enter the eustachian tube caused by obstruction related to upper respiratory

infections from contaminated secretions in the nasopharynx and the middle ear from a

tympanic membrane perforation.

inflammation of surrounding structures (eg, sinusitis, adenoid hypertrophy), or allergic

reactions (eg, allergic rhinitis).

which enter the middle ear after eustachian tube dysfunction,

CLINICAL FEATURES:

 The symptoms of otitis media vary with the severity of the infection.
  The condition, usually unilateral in adults, may be accompanied by otalgia.

 Other symptoms may include drainage from the ear, fever, and hearing loss.

 The pain is relieved after spontaneous perforation or therapeutic incision of the

tympanic membrane.

DIAGNOSTIC FEATURES:

 History and Physical Examination

 On otoscopic examination, the external auditory canal appears normal. The patient

reports no pain with movement of the auricle.

 The tympanic membrane is erythematous and often bulging.

MANAGEMENTS:

Medical management:

 The outcome of acute otitis media depends on the efficacy of antibiotic therapy (ie,

the prescribed dose of an oral antibiotic and the duration of therapy), the virulence of

the bacteria, and the physical status of the patient.

 With early and appropriate broad-spectrum antibiotic therapy, otitis media may

resolve with no serious sequelae.

 If drainage occurs, an antibiotic preparation is usually prescribed.

 The condition may become subacute (lasting 3 weeks to 3 months), with persistent

purulent discharge from the ear.

 Rarely does permanent hearing loss occur.

  Secondary complications involving the mastoid and other serious intracranial

complications, such as meningitis or brain abscess, although rare, can occur.

Surgical management:

• An incision in the tympanic membrane is known as myringotomy or tympanotomy.

The tympanic membrane is numbed with a local anesthetic such as phenol or by

iontophoresis (ie, electrical current flows through a lidocaine-and-epinephrine

solution to numb the ear canal and tympanic membrane). Under microscopic

guidance, an incision is made through the tympanic membrane to relieve pressure and

to drain serous or purulent fluid from the middle ear. The incision heals within 24 to

72 hours

CHRONIC OTITIS MEDIA

Chronic otitis media is the result of repeated episodes of acute otitis media causing

irreversible tissue pathology and persistent perforation of the tympanic membrane. Chronic

infections of the middle ear damage the tympanic membrane, destroy the ossicles, and

involve the mastoid.

CLINICAL FEATURES:

 Symptoms may be minimal, with varying degrees of hearing loss and the presence

of a persistent or intermittent, foul-smelling otorrhea.

 Pain is not usually experienced, except in cases of acute mastoiditis, when the

postauricular area is tender to the touch and may be erythematous and edematous.
DIAGNOSTIC FEATURES:

 Otoscopic evaluation of the tympanic membrane may show a perforation, and

cholesteatoma can be identified as a white mass behind the tympanic membrane or

coming through to the external canal from a perforation.

 In cases of cholesteatoma, audiometric tests often show a conductive or mixed

hearing loss

MANAGEMENTS:

Medical management:

• Local treatment of chronic otitis media consists of careful suctioning of the ear under

microscopic guidance. Instillation of antibiotic drops or application of antibiotic

powder is used to treat a purulent discharge. Systemic antibiotics are usually not

prescribed except in cases of acute infection.

SURGICAL MANAGEMENT:

TYMPANOPLASTY: The most common surgical procedure for chronic otitis media is a

tympanoplasty, or surgical reconstruction of the tympanic membrane. There are five types of

tympanoplasties. The simplest surgical procedure, type I (myringoplasty), is designed to close

a perforation in the tympanic membrane. The other procedures, types II through V, involve

more extensive repair of middle ear structures. The structures and the degree of involvement

can differ, but all tympanoplasty procedures include restoring the continuity of the sound

conduction mechanism.

OSSICULOPLASTY: Many people use the term tympanoplasty to include ossiculoplasty,

or surgical reconstruction of the middle ear bones to restore hearing. Prostheses made of
materials such as Teflon, stainless steel, and hydroxyapatite are used to reconnect the

ossicles, thereby reestablishing the sound conduction mechanism.

MASTOIDECTOMY: A mastoidectomy is usually performed through a postauricular

incision. Infection is eliminated by removing the mastoid air cells. As the patient awakens

from anesthesia, any evidence of facial paresis should be reported to the physician. A second

mastoidectomy may be necessary to check for recurrent or residual cholesteatoma. The

hearing mechanism may be reconstructed at this time. Surgery is usually performed in an

outpatient setting. The patient has a mastoid pressure dressing, which can be removed 24 to

48 hours after surgery.

 LABYRINTHITIS

DEFINITION:

It is defined as the inflammation of the inner ear caused by the bacterial or viral origin

which may affect the cochlear or vestibular portion of the labyrinth.

CAUSES:

▪ Bacterial – mainly through the middle ear infection.

▪ Viral – mainly spread through the blood stream.

▪ Ramsay hunt syndrome – disorders of the facial and acoustic nerves.

TYPES:

1. Circumstance – complete erosion of the bony labryin.

2. Diffuse serous – presence of the vertigo, nausea, vomiting and absence of pus formation.

3. Diffuse suppurative – loss of vestibulocochlear nerve and nystagmus.

PATHO PHYSIOLOGY:

Due to the etiological factors

The infection can spread to the inner ear

Penetrating the membranes of the oval and round window

Affects the hearing acuity and gait disturbances

Infection enters into the blood stream and spread to the brain

Meningitis

CLINICAL FEATURES:

➢ Sudden onset of the incapacitating vertigo.

➢ Nausea.

➢ Vomiting.

➢ Various degrees of the hearing loss.

➢ Possibly tinnitus.
➢ Nystagmus ( an abnormal rhythmic, jerking movements of eye )

➢ Permanent deafness.

DIAGNOSTIC FEATURES:

✓ History collection – regarding history of vertigo or tinnitus.

✓ Physical examination - about the hearing acuity.

✓ Neurological examination – examination of the vestibulocochlear nerve.

✓ Audiometric studies – include the speech discrimination and tone decay.

MEDICAL MANAGEMENT:

Administration of the IV antibiotics therapy for the patients with bacterial labyrinthitis.

IV fluids can also be administered for maintain the hydrated level.

Administration of the anti-histamine such as meclizine and anti-emetics medications to

prevent the allergic responses.

Treatment of viral labyrinthitis is based on patient symptoms.

The patient requires physical therapy to recondition the brain to interrupt the vestibular input.

Asses the changes in the level of conscious, head ache and nuccal rigidity to prevent the

attack of the meningitis.

Maintain the decreased sodium intake level in the diet pattern.

Avoid the alcohol intake and citrus fluids.

SURGICAL MANAGEMENT:

Labyrinthotomy (opening and constructing of the labyrins ) and labyrinthectomy ( removal

of the labyrins ) is the choice of the surgical management of the patient with the labyrinthitis.

COMPLICATIONS:

Meningitis.

Chronic suppurative otitis media.

 Upper respiratory tract infections.

POSSIBLE NURSING DIAGNOSIS:

1. Impaired adjustment related to disability in the ear.

2. Anxiety related to threat of health status.

3. Self care deficit related to episode of vertigo.

4. Ineffective coping related to effects of vertigo

5. Risk for fluid volume deficit related to increased fluid output.

 MENIERES DISEASE

DEFINITION:
It is an abnormal inner ear fluid balance caused by the malabsorption in the

endolymphatic sac or a blockage in the endolymphatic duct. It is characterized by the

symptoms caused by inner ear diseases including episodic vertigo, tinnitus, fluctuating

sensoineural hearing loss and aural fullness. This disease was first discovered by a

physician menieres in 1861.

CAUSES:
• Unknown causes.

• But mainly suggested due to the hormonal imbalances.

• Decreased blood flow to the inner ear.

• Allergic reactions.

• Perilymph fluid fluid imbalances.

• Auto immune disorders and metabolic disorders.

PATHO PHYSIOLOGY:

Due to the etiological factors

There is a over production and defective absorption in the endolymph fluid

Increases pressure within the labyrinth

Fluid imbalances in the membranous labyrinth

Rupture of the membranous labyrinth

Mixing of high potassium endolymph with low potassium endolymph

May produce the sense of the fullness and decreased the hearing acuity

Hearing loss
 TYPES:

1. Classic - having sense of vertigo, tinnitus, hearing loss.

2. Cochlear - episodic vertigo, tinnitus.

3. Vestibular - tinnitus, hearing loss.

CLINICAL MANIFESTATIONS:

▪ Fluctuating, progressive sensorineural hearing loss

▪ Tinnitus or a roaring sound.

▪ A feeling of pressure or fullness in the ear.

▪ Episodic, incapacitating vertigo.

▪ Diaphoresis

▪ Feeling of imbalances.

▪ Nausea and vomiting.

DIAGNOSTIC FINDINGS:

❖ History collection – regarding a family history of menieres disease.

❖ Physical examination – about the hearing acuity.

❖ Webber’s test – hearing acuity using a tuning fork.

❖ Audiogram – reveals sensorineural hearing loss.

❖ Electronystagmogram – shows an induced vestibular response.

❖ Glycerol test – administration may increase the hearing acuity.

MANAGEMENTS:

A) Medical :

It can be successfully treated with the diet and medication.

Symptoms can be treated by the low sodium intake in the diet.

 Pharmacological therapy mainly given according to the symptomatic ones.

Administration of the anti-histamines such as meclizine to prevent the allergic reactions.

Transquilizers such as diazepam may be administered to control the vertigo.

Administration of the anti-emetics (promethazine), diuretics (hydrochlorothiazide), anti-

cholinergic (atropine) to reduce the pressure inside the ear caused by the perilymph fluid.

Vasodialators such as nicotinic acid, papaverine hydrochloride may also be given to

improves the blood circulation to the inner ear.

Take the foods which are rich in potassium such as bananas, tomatoes, oranges to prevent the

low potassium level in the perilymh fluid.

Avoid the monosodium glutamate which may increase the symptoms.

Limit the intake of the coffee, tea because of its diuretic effect.

Eat meals and snacks at regular interval to make at a hydrated level.

Don’t skip the foods because it may alter the fluid level in the inner ear.

B) Surgical:

However hearing loss, tinnitus and and aural fullness may be treated with the surgical

management.

Endolymphatic sac decompression – a shunt is inserted into the endolymphatic sac through

a postaruicular incision in order to equalize the pressure in the endolymphatic space.

Middle and inner ear perfusion – some ototoxic medications such as streptomycin and

gentamycin may be infused to the middle and inner ear to destroy the vestibular function and

reduce the vertigo.

Intraotologic catheters – insertion of the catheters into the inner ear through tympanic

memberane to delivered the medications into the inner ear.

 Vestibular nerve sectioning – it can be performed by the translabryinthine approach that can

conserve the hearing depending on the degree of the hearing loss. Cutting the nerve from the

brain from receiving input from the semicircular canals.

COMPLICATIONS:

Cerebro spinal fluid leakage.

Facial nerve damage.

Increased intra cranial pressure.

POSSIBLE NURSING DIAGNOSIS:

1. Impaired adjustment related to disability in the ear.

2. Anxiety related to threat of health status.

3. Self care deficit related to episode of vertigo.

4. Ineffective coping related to effects of vertigo

5. Risk for fluid volume deficit related to increased fluid output.

6. Risk for injury related to altered mobility caused by the gait disturbances.