CHAPTER 45 / Nursing Care of Clients with Eye and Ear Disorders 1497

NURSING CARE OF THE CLIENT HAVING EAR SURGERY

PREOPERATIVE CARE ures such as written messages as needed for effective com-
• Review Chapter 7 for routine preoperative care. munication with the hearing-impaired client. Reassure the
• Assess the client’s hearing or verify documentation of preoper- client that decreased hearing acuity immediately after sur-
ative hearing assessment. These data are important in evaluat- gery is expected. Hearing improvement, if an expected result of
ing the results of the surgical procedure. the ear surgery, typically does not occur until ear plugs are re-
• Agree on a means of communication to be used after surgery. moved, and edema and drainage at the operative site have re-
Hearing may be impaired after surgery. solved. If no reconstruction of the middle ear is done or the
• Explain that blowing of the nose, coughing, and sneezing are cochlea is involved, permanent hearing loss in the affected ear
restricted to prevent pressure changes in the middle ear and may be an expected result.
potential disruption of the surgical site. If the client needs to • Remind client to avoid coughing, sneezing, or blowing the
cough or sneeze, leaving the mouth open minimizes pressure nose. These increase pressure in the middle ear.
changes in the middle ear. Providing teaching and the opportu-
Client and Family Teaching
nity to practice before surgery promotes the client’s cooperation in
• Provide instructions for home care.
the postoperative period.
a. To prevent contamination of the ear canal, avoid showers,
shampooing, and immersing the head until the physician
POSTOPERATIVE CARE
says you can do so.
• Review Chapter 7 for routine postoperative care. b. Keep the outer ear plug clean and dry, changing it as
• Assess the client for bleeding or drainage from the affected ear. needed. Do not remove inner ear dressing until the physi-
Infection and hemorrhage are possible complications. cian so orders.
• Administer antiemetics as ordered to prevent vomiting. c. Avoid blowing the nose; if you need to cough or sneeze,
Vomiting may increase the pressure in the middle ear, disrupting keep the mouth open.
the surgical site. d. Do not swim or dive without physician [Link] with
• Elevate the head of bed and have the client lie on the unaf- the physician regarding air travel.
fected [Link] position minimizes the pressure in the middle ear. e. Meclizine hydrochloride (Antivert) or other antiemetic/
• Assess for vertigo or dizziness, especially with ambulation or antihistamine medication may be necessary for up to 1
movement in bed. Avoid unnecessary movements such as month following surgery.
[Link] measures to ensure safety when the client gets up f. Fever, bleeding, increased drainage, increased dizziness, or
and ambulates. Surgery on the ear may disrupt the client’s equi- decreased hearing after discharge may indicate a complica-
librium, increasing the risk of falling. tion. Notify the physician if any of these occur.
• Assess the client’s hearing postoperatively. Stand on the
client’s unaffected side to communicate and use other meas-

blood supply to the stapes, causing its destruction and conduc- If surgical treatment of chronic otitis media will affect the
tive hearing loss. Cholesteatomas are benign and slow-growing client’s hearing, include this information in preoperative teach-
tumors, which can enlarge to fill the entire middle ear. Un- ing. Teach the client and family how to use alternative means
treated, the cholesteatoma can progressively destroy the ossi- of communication if this will be necessary postoperatively.
cles and erode into the inner ear, causing profound hearing loss. When an assistive device is ordered, teach the client and a fam-
Systemic antibiotics are prescribed for exacerbations of ily member about its use.
purulent otitis media. Tympanic membrane perforation is re-
paired with a tympanoplasty to restore sound conduction and
the integrity of the middle ear. A cholesteatoma may require THE CLIENT WITH OTOSCLEROSIS
radical mastoidectomy to remove the tympanic membrane,
ossicles, and tumor. The mastoid air cells and middle ear are
converted into an open cavity, which can be inspected and Otosclerosis is a common cause of conductive hearing loss.
cleaned as necessary. Abnormal bone formation in the osseous labyrinth of the tem-
As with other complications of acute otitis media, a priority poral bone causes the footplate of the stapes to become fixed
of nursing care is prevention of chronic otitis media and or immobile in the oval window. The result is a conductive
cholesteatoma. Clients with chronic otitis media need to un- hearing loss.
derstand various treatment options and their risks and benefits, Otosclerosis is a hereditary disorder with an autosomal
as well as the long-term risk of not treating a perforated tym- dominant pattern of inheritance. It occurs most commonly in
panic membrane. They are also taught how to instill ear drops, Caucasians and in females. The progressive hearing loss typi-
to clean the external auditory meatus, and to not irrigate the ear cally begins in adolescence or early adulthood and seems to be
when the tympanic membrane is perforated or if they think it accelerated by pregnancy. Although both ears are affected, the
might be. rate of hearing loss is asymmetric. Because bone conduction of