Pharmacology · chapter 39 · Otic Drugs
Introduction to the Ears
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
The most common hearing loss
Sensorineural hearing loss (SNHL) is the most common type of hearing loss and accounts for the majority of all hearing loss.
Ear wax usually self-cleans
This canal accumulates ear wax that typically self-cleans through daily chewing, grinding, and yawning motions (Sevy et al., 2023).
What ruptures the eardrum
The tympanic membrane can rupture from infection, barotrauma, or the use of cotton swabs.
Hearing complaints can signal CNS disease
The inner ear is part of the central nervous system (CNS). Therefore, clients’ complaints about hearing can also be a sign of a more serious CNS disease process.
Listen and report hearing concerns
The nurse should listen carefully to the client’s description of hearing issues and communicate concerns with the provider.
Medications that cause tinnitus
Some medications can cause tinnitus, and hearing may not always fully return after stopping the medication. Medications associated with tinnitus include nonsteroidal anti-inflammatory drugs (NSAIDs), some antibiotics, anticancer medications, and antidepressants (Kim et al., 2021).
Signs of Ménière's disease
This condition is characterized by hearing loss, vertigo, increased sweating, nausea, and vomiting.
Fall precautions in Ménière's disease
The nurse must implement fall precautions when caring for a client with Ménière’s disease because vertigo can predispose them to falls, including falls with injuries.
Report itchy, painful ears
The nurse should report client complaints of itchy, painful ear(s) to the provider because an untreated infection can spread to the bones and deep tissues of the ear canal and lead to skull osteomyelitis (Bruschini et al., 2019).
Why children get otitis media
Children are more likely to develop otitis media because of their horizontal Eustachian tube architecture, which increases the likelihood of fluid being trapped, causing an infection.
No antibiotics for effusion alone
Often decongestants or nasal steroids are prescribed to treat these symptoms. Antibiotics are not appropriate at this stage when no infection persists.
Adults versus children and antibiotics
Acute otitis media in adults can cause significant complications; therefore, adults are treated with antibiotic therapy (Limb et al., 2023). In general, antibiotic therapy is used more judiciously in children to avoid antibiotic resistance and side effects.
BPPV and fall risk
Episodes can last for a few minutes and are disconcerting to the client, who is at risk of falling.
Talking with a hearing-impaired client
Do not shout; rather, speak slowly, clearly, and distinctly. Pause between concepts to ensure you are understood before continuing.
Terms to know
- Tinnitus
- Tinnitus is an ear disorder characterized by ringing or other annoying sounds in the ear.
- Otitis externa
- Otitis externa (also known as swimmer’s ear) is an inflammation and/or infection of the external ear canal characterized by itchiness, pain, and a red ear canal.
- Otitis media
- Otitis media is an inflammation or infection of the middle ear.
- Benign paroxysmal positional vertigo
- Benign paroxysmal positional vertigo (BPPV) is a condition of the inner ear where otoliths—crystals of calcium carbonate—migrate into the inner ear fluid and cause a false sense of spinning.
- Ménière’s disease
- Ménière’s disease occurs when there is excess fluid in the inner ear.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
A client admitted with Ménière's disease reports episodes of vertigo with nausea. Which nursing action is the priority?
- Irrigate the ear canal.
- Place the client on a low-fiber diet.
- Implement fall precautions.
- Encourage the client to walk alone to regain balance.
Answer: Implement fall precautions.
Vertigo in Ménière's disease predisposes the client to falls, including falls with injuries, so fall precautions are required. Irrigation, walking alone and diet changes are not described and would not protect the client.
An older adult with poorly controlled diabetes reports an itchy, painful ear. What should the nurse do?
- Tell the client to clean the canal with cotton swabs.
- Reassure the client that ear itching is harmless.
- Report the complaint to the provider.
- Advise the client to wear earbuds to protect the canal.
Answer: Report the complaint to the provider.
Itchy, painful ears should be reported because untreated otitis externa can spread to bone and deep tissue and cause skull osteomyelitis. Cotton swabs can rupture the eardrum, and earbuds can make otitis externa worse.
A parent asks why their toddler gets ear infections so much more often than the adults in the family. What is the best explanation?
- Children have a thicker eardrum.
- Children produce less ear wax.
- Children's Eustachian tubes are more horizontal, so fluid is more likely to be trapped.
- Children's inner ear is not part of the nervous system.
Answer: Children's Eustachian tubes are more horizontal, so fluid is more likely to be trapped.
Children are more likely to develop otitis media because their horizontal Eustachian tube makes fluid more likely to be trapped. The other statements are not supported by the section.
A client reports new ringing in the ears. Which of the client's medication classes are associated with tinnitus? Select all that apply.
- Artificial tears
- Antidepressants
- Some antibiotics
- NSAIDs
- Anticancer medications
Answer: Antidepressants, Some antibiotics, NSAIDs, Anticancer medications
Medications associated with tinnitus include NSAIDs, some antibiotics, anticancer medications and antidepressants, and hearing may not fully return after stopping them. Artificial tears are not listed.
The nurse is teaching a client whose hearing is impaired by an ear infection. Which communication techniques are appropriate? Select all that apply.
- Give written directions and ask the client to repeat the specifics.
- Shout from the doorway so the client can hear.
- Face the client directly when speaking.
- Speak slowly, clearly and distinctly.
- Rephrase a message the client does not understand.
Answer: Give written directions and ask the client to repeat the specifics., Face the client directly when speaking., Speak slowly, clearly and distinctly., Rephrase a message the client does not understand.
The nurse faces the client, speaks slowly and clearly, rephrases when needed and provides written information with teach-back. Shouting and talking from another area are specifically discouraged.
A child has fullness in the ear after an otitis media infection has cleared, with no signs of ongoing infection. Which treatment does the nurse expect?
- Decongestants or nasal steroids
- A second course of antibiotics
- Immediate surgery
- Echinocandin antifungals
Answer: Decongestants or nasal steroids
Otitis media with effusion is often treated with decongestants or nasal steroids, and antibiotics are not appropriate when no infection persists. Surgery and antifungals are not described for this stage.
Where every quote comes from
Section 39.1 Introduction to the Ears of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.