Nursing care of
ENT
Patients
Consortium eLearning Network Private Limited A-118, 1st Floor, Sector 63, Noida, U.P., 201301
Published in India in 2020 by NOLEGEIN A-118, 1st Floor, Sector 63, Noida, U.P., 201301 NOLEGEIN is an imprint of Consortium eLearning Network Private Limited Printed at LAXMAN PRINT O GRAPHICS C-293, Sector-10, Noida-201301 All rights reserved. No part of this book may be reprinted or reproduced or utilized in any from or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system without permission in writing from the publisher.
ISBN: ...............................
Table of Contents Editor Biography Preface Acknowledgement Chapter 1
Introduction: Review of Anatomy and Physiology of Ear, Nose and Throat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Chapter 2
Assessment of the Ear, Nose and Throat. . . . . . . . . . . . . . . . . . . 45 Chapter 3
Common Disorders of Ear, Nose and Throat. . . . . . . . . . . . . . . 75 Chapter 4
Nursing Management of ENT Disorders . . . . . . . . . . . . . . . . . 197 Chapter 5
Rehabilitation and Follow-Up for ENT Disorders. . . . . . . . . . 307 Chapter 6
Research Studies Related to ENT Disorders. . . . . . . . . . . . . . . 357
CHAPTER
01
Introduction: Review of Anatomy and Physiology of Ear, Nose and Throat
Nursing Care of ENT Patients
ANATOMY AND PHYSIOLOGY OF EAR, NOSE AND THROAT • Anatomy and Physiology of Ear
Outer, inner and middle ear
Hearing and equilibrium Coordination and balance
· Physiology of Ear
• Anatomy and Physiology of the Nose Position and structure Nose and nasal cavity Lining of the nasal cavity Openings into the nasal cavity
• Physiology of the Nose
Respiratory function of the nose The sense of smell
• Anatomy and Physiology of the Throat
Position and structure of pharynx, larynx, tonsil, uvula and adenoids Functions of pharynx, larynx, tonsil, uvula and adenoids
ANATOMY AND PHYSIOLOGY OF THE EAR Learning Outcomes
After studying this section, you should be able to Describe the structure of the outer, middle and inner ear parts of the ear Explain the physiology of hearing
INTRODUCTION Overview of the Ear
The ear is the sense organ that enables us to hear. Hearing is the perception of sound energy through the brain and the central nervous system. The human ear consists of the outer ear (pinna or concha, outer ear canal, tympanic membrane), 3
Introduction: Review of Anatomy and Physiology of Ear, Nose and Throat the middle ear (middle ear cavity with the three ossicles: malleus, incus and stapes) and the inner ear (cochlea which is connected to the three semicircular canals by the vestibule, which provides the sense of balance). The cochlea is connected to the brain stem via the eighth brain nerve, that is the vestibular cochlear nerve or nervous statoacoustics. The acoustical information is processed by the brain at various levels of the auditory system. An overview about the anatomy of the ear is shown in Figure 1.1.
Figure 1.1. Overview about the Anatomy of the Ear.
THE HUMAN EAR The cranium encloses and protects the brain and surrounding structures, providing attachment for various muscles that control head and jaw movements. Eight bones form the cranium: the occipital bone, the frontal bone, two parietal bones, two temporal bones, the sphenoid bone and the ethmoid bone. Some of these bones contain sinuses, which are cavities lined with mucous membranes and connected to the nasal cavity. The ears are located on either side of the cranium at approximately eye level. The ear is a sensory organ with dual functions of hearing and balance. The 4
CHAPTER
02
Assessment of the Ear, Nose and Throat
Nursing Care of ENT Patients
LEARNING OBJECTIVES 1. Collect proper history from the patient in relation to the ears, nose, mouth and throat. 2. Identify and learn about the history of the ears, nose, mouth and throat.
HEALTH ASSESSMENT — HISTORY COLLECTION Assessment of the Ears, Nose, Throat and Mouth Demographic Data Name: Age: Sex: Marital Status: Religion: Education: Occupation: Income: Address: Date of Admission: Hospital No.: Name of the Ward:
Chief Complaints at Admission
The complaints should be recorded in a chronological order Presenting complaints and /or reasons for consultation should be recorded
History of Present Illness
It includes the details of main symptoms, nature and duration, and any other associated or predisposing factors. It helps in making an accurate diagnosis Mode of onset: Abrupt/acute/sub-acute/Insidious Abrupt: Sudden and unexpected Acute: Serious or something bad Insidious: Proceeding in a gradual or harmful way Course: Continuous/Episodic/Fluctuating/Deteriorating/Improving/ Unclear 47
Assessment of the Ear, Nose and Throat Precipitating factors: Feeding methods (breast or bottle)/frequent exposure to water/use of a foreign object to clean ears/poor personal hygiene Aggravating and relieving factors, if any.
Past Medical History
Seasonal allergies, allergens (pollen, insect stings and animal dander) Frequent ear or throat infections Rhinosinusitis, nasal polyps, allergic rhinitis Tonsillitis Trauma to head or ENT area/foreign bodies Audiometric screening results indicating hearing loss Prescription or over-the-counter medications used regularly
Past Surgical History
History of ENT surgery (tympanostomy tubes, repair of deviated septum), details of medication received, and the duration of illness and hospitalization
Family History of Illness
Family structure Others at home with similar symptoms Seasonal allergies Asthma Hearing loss
Personal and Social History
Feeding methods (breast or bottle), bottle propping Frequent exposure to water (swimmer’s ear) Use of a foreign object to clean ear Insertion of a foreign body in the ear Crowded living conditions Poor personal hygiene Dental hygiene habits Alcohol use Exposure to cigarette smoke, wood smoke or other respiratory toxins Recent air travel 48
CHAPTER
03
Common Disorders of Ear, Nose and Throat
Nursing Care of ENT Patients
I.
DISORDERS OF THE EAR 1. DISODERS OF THE OUTER EAR Cerumen Impaction Foreign Bodies External Otitis (Otitis Externa) Malignant External Otitis
2. DISORDERS OF THE MIDDLE EAR Tympanic Membrane Perforation Acute Otitis Media Acute mastoiditis Serous Otitis Media Chronic Otitis Media Otosclerosis Cholesteatoma Middle Ear Masses
3. DISORDERS OF THE INNNER EAR Tinnitus, Dizziness Benign Paroxysmal Positional Vertigo Labyrinthitis Vestibular neuritis Ototoxicity Meniere’s disease
Autoimmune Inner Ear Disease (AIED) Acoustic Neuroma Hearing loss
II.
DISORDERS OF THE NOSE AND THROAT Nasal Vestibulitis Nasal Polys Rhinitis Foreign Bodies in Nose Deviated Nasal Septum Epistaxis Sinusitis 77
Common Disorders of Ear, Nose and Throat Nasal Bone Fracture Tonsillitis Pharyngitis Peritonsillar Abscess Laryngitis Cancer Larynx
I . DISORDERS OF THE EAR Learning Objectives
After studying this section you should be able to Differentiate problems of external ear, middle ear and inner ear disorder Describe the different types of external ear, inner and middle ear disorder including definition, etiology, pathophysiology, clinical manifestations, diagnosis and management Compare the various types of surgical procedures used for manging middle ear disorder
DISORDER OF EXTERNAL EAR · Congenital · Inflammatory · Trauma
Congenital deformities of the external ear
Ear tags/accessory tragus or a branchial cleft: It is the extra cartilage fold of scapha portion of the ear Pre-auricular tags: It is a very common external ear disorder that involves only the skin but usually contains a long tail of cartilage extending into the cheek Mirror ear or polyotia : It is a rare congenital anomaly of large external auricle or large pinna. Pre-auricular pits and sinuses: It is often bilateral and frequently asymptomatic and it deeply involves the facial nerve Constricted/lop/cup ears: It is a folded, wrinkled or tight helical rim of the ear in which there is absence of skin and cartilages of ear. The ear is cup shaped 78
CHAPTER
04
Nursing Management of ENT Disorders
Nursing Care of ENT Patients
LEARNING OBJECTIVES 1. 2. 3. 4.
After studying this section you should be able to Assess the problems of ENT disorders Describe the various planning approaches for ENT disorders Describe the postoperative care of ENT disorders Describe the patient education on ENT disorders
Ear, nose and throat (ENT) are very common problems among people. People at some time in their lives suffer from nosebleeds, sore throats or earache. Many of these problems will be dealt with successfully at home, often with the advice of a pharmacist or general practitioner (GP). Some ENT problems, however, can be life threatening, requiring an immediate visit to an emergency department (ED), surgery and, in some cases, a period of nursing care at home following discharge. To nurse ENT patients effectively in a home or a hospital setting, a basic knowledge of the anatomy and physiology of the relevant structures, along with a thorough understanding of the clinical features of common disorders, is essential. The health visitor, community nurse, school nurse or occupational health nurse is often in a position to detect problems before the medical practitioner or even the patient is aware of them.
DUTIES AND RESPONSIBILITIES OF AN ENT NURSE An otorhinolaryngology nurse – also known as an ENT nurse – cares for patients with diseases or injuries of the ear, nose, throat, head or neck. Often referred to as ENT nurses, otorhinolaryngology nurses assist in the treatment of both acute and chronic conditions, including ear infections and allergies, laryngitis, sinusitis, tonsillitis, sleep apnoea and injuries such as broken bones. ENT nurses treat patients of all ages, from infants to the elderly. The several roles and responsibilities of the ENT nurse are as follows: · Conduct assessment of patients’ ears, nose, throat, head and/or neck, including the use of tongue depressors, otoscopes and various lights and mirrors. · Collect samples from affected areas and record symptoms and medical histories. · Administer medications and educate patients on how to care for their conditions or injuries at home. 199
Nursing Management of ENT Disorders · Assist in surgical procedures, preparation of patients for surgery and care for patients during recovery.
NURSING MANAGEMENT OF EAR DISORDERS Safe and Effective Care Environment
· Apply principles of infection control when examining an ear with drainage. · Implement precautions to prevent falls in patients experiencing vertigo or dizziness. · Correctly instil eardrops.
Reducing Anxiety
The nurse reinforces the information discussed by the otologic surgeon with the patient, including anaesthesia, the location of the incision (postauricular) and expected surgical results (e.g., hearing, balance, taste, facial movement). The patient is also encouraged to discuss any anxieties and concerns about the surgery.
Relieving Pain
Patients complain regarding incisional pain after mastoid surgery and have some ear discomfort. Aural fullness or pressure after surgery is caused by residual blood or fluid in the middle ear. The analgesic medication is prescribed for the first 24 hours after surgery to relieve pain. A wick or external auditory canal packing is used if a tympanoplasty was performed at the time of the mastoidectomy. For the next 2 to 3 weeks after surgery, the patient may experience sharp, shooting pains intermittently as the eustachian tube opens and allows air to enter the middle ear. Constant throbbing pain accompanied by fever may indicate infection and should be reported to the physician.
Preventing Infection
Measures are initiated to prevent infection in the operated ear. The external auditory canal wick, or packing, may be impregnated with an antibiotic solution before instillation to prevent from infection. Prophylactic antibiotics are administered as prescribed, and the patient is instructed to prevent water from entering the external auditory canal for 6 weeks. 200
CHAPTER
05
Rehabilitation and FollowUp for ENT Disorders
Nursing Care of ENT Patients
Learning Objectives
After studying this section you should be able to Describe about rehabilitation of ENT disorders Describe the different types of ear, nose and throat disorders like aural rehabilitation, vestibular rehabilitation and vocal rehabilitation Compare the various types of rehabilitation used for ENT disorders and its trends Describe about the various follow-ups for the ENT disorders Rehabilitation: Rehabilitation treatments are designed to facilitate the process of recovery from injury, illness or disease to a normal condition. Habilitation: It refers to a process of helping disabled people to attain improvement in skills and functioning for daily living. Disabilities: These refer to physical, mental, cognitive or developmental conditions that limit a person’s ability to engage in actions or participate in typical daily activities and interactions. Impairment: It is ‘a loss or abnormality of body structure or physiological or psychological function’ Activity limitation: It is ‘the nature or extent of functioning at the level of the person’. Rehabilitation from ENT Disorders 1. Aural rehabilitation 2. Vestibular rehabilitation 3. Nose and throat rehabilitation (vocal rehabilitation)
AURAL REHABILITATION Introduction
Hearing is an important sense for communication between people. It causes disability globally and is the third leading global cause of disability and second most common cause of disability in India (World Health Organization, WHO, 2008). The inability to communicate with others is one of the main impacts of hearing impairment. A total of 63 million people in India had auditory loss. This causes feelings of alienation and accordingly increase the presence of symptoms of depression. Rehabilitation of the hearing impaired in India remains a challenging task. Early detection and intervention helps in prevention of disability due to 309
Rehabilitation and Follow-Up for ENT Disorders hearing impairment. Use of a hearing aid is the best approach for treating hearing impairment as a part of aural rehabilitation
Aural Rehabilitation
Aural rehabilitation is an integral part of auditory training, speech reading and the use of hearing aids and hearing guide dogs. Auditory training emphasizes listening skills. Speech reading (also known as lip reading) can help fill the gaps left by missed or misheard words.
Goals
To preserve and develop communication abilities in individuals with hearing impairment.
Aural Rehabilitation
Aural rehabilitation provides adequate receptive and expressive communication in individuals with hearing impairment. It was facilitated by interdisciplinary members consisting of physicians, audiologists and speech-language pathologists The Rehabilitation Council of India Act, 1922, has defined ‘hearing handicapped’ as – hearing impairment of 70 decibels and above in the better ear or total loss of hearing in both ears Aural rehabilitation is a holistic approach to improve activity, participation and quality of life with the help of sensory management, instruction, perceptual training and counselling by reducing the hearing impairment
Purpose of Aural Rehabilitation
To maximize the communication skills of the person with hearing impairment.
Goal of aural rehabilitation
To increase the level of successful communication over the client’s lifetime.
Aims
To minimize and alleviate the communication difficulties associated with hearing loss.
Types of Aural Rehabilitation Therapies ·
Hearing aid orientation: It provides knowledge about the use of hearing aids for communication for people and their family members 310