A male client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?
A. “Lie in bed with your head elevated, and refrain from blowing your nose for 24 hours.”
B. “Try to ambulate independently after about 24 hours.”
C. “Shampoo your hair every day for ten (10) days to help prevent ear infection.”
D. “Don’t fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days.”
Correct Answer: D. “Don’t fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days.”
For 30 days after a stapedectomy, the client should avoid air travel, sudden movements that may cause trauma, and exposure to loud sounds and pressure changes (such as from high altitudes). The goal of any stapes procedure is to restore the vibration of fluids within the cochlea; increasing communication secondary to increasing sound amplification, bringing hearing levels to acceptable thresholds.
Option A: Immediately after surgery, the client should lie flat with the surgical ear facing upward; nose blowing is permitted but should be done gently and on one side at a time. The primary goal when operating on the stapes is to re-establish sound transmission through an ossicular chain that has likely been stiffened through the disease process known as otosclerosis. Otosclerosis, an otic capsule disease that involves absorption of compact bone and the redeposition of spongy-appearing, or spongiotic, bone, is the most common cause of acquired conductive hearing loss (CHL) as a result of stapes fixation.
Option B: The client’s first attempt at postoperative ambulation should be supervised to prevent falls caused by vertigo and light-headedness. Skilled post-anesthesia care unit nurses are invaluable in the immediate postoperative period, as stapedectomy patients may experience pain, vertigo with nausea and vomiting (the latter posing a risk to prosthesis dislodgement), and facial nerve weakness. These nurses play a crucial role in notifying the surgeon of any early-onset complications associated with the procedure.
Option C: The client must avoid shampooing and swimming to keep the dressing and the ear dry. A terrible complication of stapes surgery is the formation of reactive granulation tissue in and around the oval window. There are many ideas on what causes such a reaction, but it is believed that the use of powderless gloves, the avoidance of Gelfoam, or washing the prosthesis before introducing it into the middle ear space has reduced granulomatous formations, postoperatively.
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