CLASS NAME: PRIMARY CARE ACUTE CONDITIONS ACROSS THE LIFESPAN I LESSON 1: Evaluation and Management of Ear and Nose Disorders ASSIGNMENT: Differentiating Conditions of the Ear ASSIGNMENT INSTRUCTIONS: Introduction By the end of this assignment, you will be able to: • Describe the causes of various conditions of the ear. (CO7) • Demonstrate advanced skills in the physical assessment, pharmacology, and management of ear disorders. (CO7, CO8) Assignment Guidelines A patient presents to the clinic with complaints of inner ear disturbance. How would you differentiate between labyrinthitis, benign paroxysmal positional vertigo, and Meniere’s disease? Include pathophysiology, clinical presentation, physical examination, diagnostics, and treatment. Finally, select only one of the ear complaints to provide a brief patient SOAP note on at the end of your write up. Your response should be at least 2-3 pages. Be sure to write using APA format. Cite at least two peer-reviewed, reliable sources that you used to develop your plan. Provide both in-text citations and full APA citations of the sources.
Sample Essay on Differentiating Conditions of the Ear
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Sample Essay on Differentiating Conditions of the Ear
Pathophysiology
Labyrinthitis is mostly a short-lived illness where the membranous inner ear structures are inflamed. If the patient has Labyrinthitis, then the inner ear will be inflamed. The inflammation could also occur on the vestibulocochlear nerve (Buttaro et al., 2021). When the labyrinth or the vestibulocochlear nerves are infected, inflammation and irritation occur. This subsequently results in hearing loss in one ear, which is referred to as Labyrinthitis. Benign paroxysmal positional vertigo (BPPV) is the loosening of the otoconia from the utricle of the inner ear (Dains, Baumann, & Scheibel, 2019). Otoconia are tiny calcium crystals that could be detached. When otoconia crystals are detached, they could drift into the inner ears’ fluid-filled spaces. BPPV is mainly characterized by positional vertigo attacks and nystagmus. Meniere’s disease is also a disease of the inner ear that is characterized by vertigo, hearing loss, tinnitus, and congestion in the ear (Gibson, 2019). Meniere’s disease also affects one ear and causes spells of the above-mentioned symptoms. Meniere is considered to be a result of the increase of endolymph fluid in the labyrinth. When the fluid builds up, there is interference with the normal ear balance and hearing signals of the brain and the inner ear.
Clinical Presentation
Both Labyrinthitis and BPPV manifest as vertigo, but in the case of the former, movement in any plane could cause vertigo that persists for days. BPPV vertigo spell does not last for more than thirty seconds. Vertigo in BPPV mostly occurs by the change of head position and makes patients lose balance, thus risking injury. An episode of Meniere’s disease could also manifest as vertigo lasting for hours. Labyrinthitis could also cause nystagmus, dizziness, hearing loss, and loss of concentration. We have already noted that Meniere’s disease is characterized by symptoms including hearing loss, vertigo, tinnitus, and congestion in the ear (Liu, Yang & Duan, 2020).
Physical Examination and Diagnostics
While diagnosing any of the three conditions, including Labyrinthitis, BPPV, and Meniere’s disease, a physical exam has to be conducted first. The physical examination mostly includes hearing and balance tests. The nervous system may also be examined. Imaging tests of the brain could be carried out to rule out other diseases, such as stroke. The diagnosis of the specific condition will depend on the specific clinical symptoms described earlier.
Treatment
Labyrinthitis should be treated with corticosteroids to help reduce the inflammation of the inner ear nerves. If there are signs of a bacterial infection, then antibiotics should be used. If the symptoms do not go away after several weeks of treatment, then physical therapy exercises could be needed for rehabilitation. BPPV mostly does not require pharmacological treatment unless the patient is experiencing other symptoms, such as nausea. For BPPV, the Epley maneuver could, for instance, be used to sequentially turn the head to help the crystals drift ways from the semicircular canal and reposition them in their normal position (Azad, Pan & Verma, 2020). Meniere’s disease has no known cure, but some treatments could be used to control symptoms. Diuretics, for instance, may be used to reduce the pressure of fluid in the inner ear. Antihistamines and anti-nausea medicines may also be used to control vertigo symptoms. Hearing aids may be useful for hearing loss.
SOAP Note for Benign Paroxysmal Positional Vertigo
Subjective:
- The patient has presented to the clinic with complaints of inner ear disturbance.
- The patient denies other symptoms apart from periodic dizziness that first occurred three days ago.
- The patient is not on medication use and does not have a history of inner ear disturbance.
Objective:
- Pulse: 84 bpm, temperature: 370C, BP 110/70 mm HG, RR; 16 breaths per minute.
- HEENT exam: visual fields intact to confrontation, sharp optical disks, extraocular muscles intact, 15 beats of horizontal nystagmus, normal gait, and finger-to-nose tests, Romberg negative.
- Neurological exam: apart from nystagmus, cranial nerves are intact.
- Intense vertigo is reported upon performing the Dix-Hallpike maneuver. No hearing loss or tinnitus is noted.
- The rest of the abdominal and cardiovascular exams are within normal limits.
Assessment:
- Symptoms consistent with peripheral vertigo
- Benign Paroxysmal Positional Vertigo is likely.
- Meniere’s disease and Labyrinthitis are ruled out.
Plan:
- Perform Eply maneuver to resolve symptoms
- The patient is expected to feel well after the Eply maneuver.
- If the patient does not feel well, further treatment action will be taken.
References
Azad, T., Pan, G., & Verma, R. (2020). Epley Maneuver (Canalith Repositioning) for Benign Positional Vertigo. Acad Emerg Med, 27(7), 637-639. https://broomedocs.com/wp-content/uploads/2020/06/Azad-Epley.pdf
Buttaro, T., Trybulski, J., Bailey, P., & Sandberg-Cook, J. (2021). Primary care: Interprofessional collaborative practice (6th ed.). St. Louis, MO: Elsevier Mosby. https://evolve.elsevier.com/cs/product/9780323570152?role=student
Dains, J., Baumann, L., & Scheibel, P. (2019). Advanced health assessment & clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby. https://www.elsevier.com/books/advanced-health-assessment-and-clinical-diagnosis-in-primary-care/dains/978-0-323-55496-1
Gibson, W. P. (2019). Meniere’s disease. Vestibular Disorders, 82, 77-86. https://www.karger.com/Article/Abstract/490274
Liu, Y., Yang, J., & Duan, M. (2020). Current status on researches of Meniere’s disease: a review. Acta oto-laryngologica, 140(10), 808-812. https://www.tandfonline.com/doi/abs/10.1080/00016489.2020.1776385