The nurse is preparing to conduct a physical assessment on a patient with otosclerosis. Which finding should the nurse anticipate in this patient?
1. Rinne test results show that bone conduction is equal or greater than air conduction.
2. Severe vertigo is present when questioned.
3. Purulent drainage is observed or reported with cyanosis of the tympanic membrane.
4. Diminished hearing is noted in the lower tones, such as a man's speaking voice.
Correct Answer: 1
The Rinne test differentiates between bone and air conduction. In otosclerosis, there is greater bone conduction due to the calcification and fixation of the malleus, incus, and stapes (bony ossicles). Talking on the phone is retained longer than direct verbal communication, since it involves bone conduction rather than air conduction. Severe vertigo is the hallmark symptom of inner ear disturbances, not the middle ear stapes fixation associated with otosclerosis. Purulent drainage with cyanosis of the tympanic membrane represents an acute or chronic middle ear infection that has caused a rupture of the tympanic membrane. Infection is not related to otosclerosis. Diminished hearing begins in the upper tones or higher pitches which are lost first. Lower tones, such as the deeper pitch of men's voices, are more easily heard by a patient with otosclerosis.
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