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The patient may experience dizziness, nausea, and vomiting as a result of stimulation of the labyrinth during surgery. The patient should take care to avoid sudden movements that may bring on or exacerbate vertigo. Actions that increase inner ear pressure, such as coughing, sneezing, lifting, bending, and straining during bowel movements, should be avoided. Place a cotton ball in the ear canal, and cover the ear with a small dressing.
It is not necessary to check a gag reflex. The patient will need assistance early postoperatively for safety reasons, so the nurse should not promote independence. The cotton padding may need to be changed if there is excess drainage.
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The patient has otosclerosis, which can be diagnosed with otoscopic examination revealing a positive Schwartz's sign along with tuning fork tests and an audiogram identifying air-bone gaps. In otosclerosis, spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window, thereby reducing the transmission of vibrations to the inner ear fluids. This results in conductive hearing loss. In benign paroxysmal positional vertigo (BPPV), free-floating debris in the semicircular canal causes vertigo with specific head movements, such as getting out of bed, rolling over in bed, and sitting up from lying down. An acoustic neuroma is a unilateral benign tumor that occurs where the vestibulocochlear nerve enters the internal auditory canal. The tumor can compress the trigeminal and facial nerves and arteries within the internal auditory canal. In Ménière's disease, the patient experiences significant disability because of sudden, severe attacks of vertigo with nausea, vomiting, sweating, and pallor.