The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [318]
Inner ear
The inner ear is very small and includes the organ of Corti, which is situated inside the snail-shaped cochlea, the three semi-circular canals and vestibular apparatus (see Figure 9.6).
The organ of Corti is the organ for hearing. It is fluid-filled and has a membranous layer that connects to the end of the auditory nerve; the membrane is covered in tiny cells with hair-like projections (Alexander et al. 2007). Sound waves travel through the fluid and are distributed to the hair cells. At this point the sound waves change to impulses which pass along the auditory nerve to the brainstem and cortex, where they are interpreted as sound.
The semi-circular canals and vestibular apparatus maintain balance. These canals are highly sensitive; they contain fluid and hair cells that recognize when the head moves and send signals to the brain to maintain equilibrium. The brain interprets these messages along with visual input from the eyes (Nigam and Knight 2008). Adjustments to the muscles and joints are made in response to the information received (Tortora and Derrickson 2009).
If the inner ear structures are damaged, the patient may develop permanent vertigo or hearing loss (Pullen 2006).
Ear wax impaction
Ear wax (cerumen) is a waxy secretion of glands within the auditory canal, combined with skin scales and hair. Ear wax impaction is the biggest cause of ear problems; thousands of people in the UK have ear wax removed every week (Aung and Mulley 2002) (Box 9.6).
Box 9.6 Individuals prone to ear wax impaction
Older people.
Those with learning disabilities.
Narrow ear canals.
Hearing aid users.
Those with a hereditary history.
Those who use cotton buds to clean the ear as this causes the wax to be pushed further down the canal and can cause injury to the surface of the canal.
(Aung and Mulley 2002, Harkin 2008, Kraszewski 2008)
The symptoms of ear wax impaction are:
dull hearing
tinnitus
disturbed balance (Alexander et al. 2007).
Related theory
Hearing is important for effective communication and balance and these can be affected by poor ear hygiene; for example, using cotton buds to clean the ears can result in ear wax impaction.
Hearing loss can develop over time and become less noticeable to the individual and those close to them, as they find alternative ways to cope. It is imperative that nurses notice poor communications, such as patients not recalling being spoken to or feeling frustrated when communicating with others, and that they then investigate this (Harkin 2005). Nurses need to be aware of how ear problems occur so they are able to explore these with patients and their relatives, to identify problems early and provide appropriate patient education. All findings should be documented and handed over to the patient’s doctor for further investigation such as hearing assessment.
Evidence-based approaches
After bathing or showering, the outer ear should be dried with tissue or alcohol-free wipes; nothing should be put into the ear to dry it (Harkin 2008). The ear canal is self-cleaning through jaw movement and epithelial migration action which moves wax and debris up to the outer ear skin (Harkin 2008).
Rationale
Indications
Ear care may be necessary under the following circumstances.
To relieve pain and discomfort, including tinnitus.
To prevent or treat infection.
To prevent loss of hearing.
To prevent vertigo.
To prevent or treat injury.
To detect disease at an early stage.
Ear care also includes patient education and health and safety advice.
(Harkin 2008)
Contraindications
Ear care can cause:
otitis media
trauma to the external meatus
tinnitus
deafness
perforation of the tympanic membrane.
Special care should be