1. Otosclerosis: disease of the bone of otic capsule; insidous, progressive deafness; most common cause of conductive deafness; cause unknown.
    1. Pathophysiology: formation of new spongy bone in labyrinth-fixation of stapes-prevention of sound transmission through ossicles to inner ear fluids.
    2. Risk factors:
      1. Heredity.
      2. Women, puberty to 45 years
      3. Pregnancy.
    3. Assessment:
      1. Subjective data:
        1. Difficulty hearing-gradual loss in both ears.
      2. Diagnostic tests:
        1. Rinne (tuning fork placed over mastoid bone)-reduced sound conduction by air and intensified by bone.
        2. Weber (tuning fork placed on top of head)-increased sound conduction to affected ear.
        3. Audiometry-diminished hearing ability.
    4. Analysis/nursing diagnosis:
      1. Auditory sensory/perceptual alteration related to hearing loss.
      2. Body image disturbance related to hearing aid.
      3. Ineffective individual coping related to grief reaction to loss.
      4. Impaired social interaction related to hearing loss.
    5. Nursing care plan/implementation, evaluation/ outcome criteria.
  2. Stapedectomy: removal of the stapes and replacing it with a prosthesis (steel wire, Teflon piston, or polyethylene); treatment for deafness due to otosclerosis, which fixes the stapes, preventing it from oscillating and transmitting vibrations to the fluids in the inner ear.
    1. Analysis/nursing diagnosis:
      1. Sensory/perceptual alteration related to edema and ear packing.
    2. Nursing care plan/implementation:
      1. Preoperative health teaching.
        1. Important to keep head in position ordered by physician postoperatively.
        2. Caution: sneezing, blowing nose (keep mouth open), vomiting, coughing-all of which increase pressure in eustachian tubes (blow one side gently).
        3. Breathing exercises.
      2. Postoperative:
        1. Goal: promote physical and psychological equilibrium.
          1. Position: as ordered by physician-varies according to preference.
          2. Activity: assist with ambulation; avoid rapid turning, which might increase vertigo.
          3. Dressings: check frequently; may change cotton pledget in outer ear.
          4. Give medications as ordered:
            1. Antiemetics.
            2. Analgesics.
            3. Antibiotics.
          5. Reassurance: reduction in hearing is normal; hearing may not immediately improve after surgery.
        2. Goal: health teaching.
          1. Ear care: keep covered outdoors; keep outer ear plug clean, dry, and changed.
          2. Avoid:
            1. Water in ear for 6 weeks:
              1. Use barrier when washing hair.
              2. Use two pieces of cotton; saturate outer piece with petroleum jelly.
            2. Pressure or vibration from loud noise, flying, or heavy lifting until advised by MD.
    3. Evaluation/outcome criteria:
      1. Hearing improves-evaluate 1 month postoperatively (may require hearing aid).
      2. Returns to work (usually 2 weeks after surgery).
      3. Continues medical supervision.