Traditional Chinese Medicine Nursing Protocols for Sudden Deafness (Sudden Sensorineural Hearing Loss)

ABSTRACT: Sudden deafness is one of the commonest acute symptoms in otolaryngology. In recent years, the incidence of sudden deafness is on the rise all over the world, but its etiology is still unclear, and the prognosis is greatly different. Traditional Chinese medicine (TCM) believes that the onset of sudden deafness is related to the liver, gallbladder, heart and triple energizer meridians. This article mainly explored the key points of common syndromes, TCM nursing methods and health guidance of sudden deafness.

KEY WORDS: sudden deafness; hearing loss; tinnitus; dizziness; nursing of traditional Chinese medicine

Sudden deafness, also called sudden sensorineural hearing loss (SSHL), is one of the commonest acute symptoms in otolaryngology. It refers to the sudden, unexplained hearing loss of at least 30 dB in at least 3 contiguous frequencies within 72 hours[1]. In recent years, the incidence of sudden deafness is on the rise all over the world, but its etiology is still unclear, and the prognosis is greatly different. It has been reported that a variety of factors may result in SSHL, including infections, ototoxic drugs, membrane labyrinth rupture, carcinomas, circulatory system diseases, autoimmune diseases, brain lesions, mental diseases, congenital or inherited diseases[2-4]. Up to now, there are as yet no effective treatments in clinic.

According to Traditional Chinese medicine (TCM) theory, the onset of sudden deafness is related to the liver, gallbladder, heart and triple energizer meridians. The liver stores the essence, and the liver and kidney have a common source. Deficiency of liver-yin and kidney-yin and hyperactivity of liver-yang cause Qi and blood to vanish in ears, leading to sudden deafness. The heart dominates blood vessels, and its divergent collaterals are the ears. The blood is easy to stagnate in meridians to cause stagnation of ear meridians, consequently resulting in sudden deafness if the heart Qi is deficient. The liver is closely associated with gallbladder, and their meridians circulate into ears. Sudden deafness can be caused by Qi stagnation and blood stasis in ear meridians if the liver and gallbladder fail to disperse. Lietal.[5]found that acupuncture combined with routine drugs or comprehensive therapy was superior to that of acupuncture or routine drugs alone in improving markedly effect. Yingetal.[6]also pointed that acupuncture combined with hyperbaric oxygen therapy could effectively improve the blood viscosity, microcirculation and treatment efficacy of patients with sudden deafness. Therefore, TCM has some advantages for sudden deafness. In order to maintain and develop the advantages of TCM nursing, improve its efficacy and standardized its behavior, TCM nursing protocols for sudden deafness is formulated byStateofAdministrationofTraditionalChineseMedicineofThePeople'sRepublicofChina.

Keypointsofcommonsyndromes

Syndromeduetoinvasionofpathogenicwind: sudden deafness, accompanied by stuffy nose, running nose, or headache, ear swelling and distress, or aversion to cold, fever, pain of body; red tongue with thin white coating.

Syndromeduetohyperactivityofliverfire: sudden deafness, tinnitus like tide or wind and thunder, aggravated by emotional depression or anxiety, accompanied by bitterness in the mouth, dry mouth, constipation, yellow urine, flushed face, red eyes; red tongue with yellow coating.

Syndromeduetostagnationofphlegmfire: deafness, tinnitus, swelling and distress in the ear, or dizziness, abdominal fullness, cough with much phlegm, bitterness or no taste in the mouth, difficulty in urination and defecation; red tongue with yellow greasy coating.

Syndromeduetobloodstasisintheears: sudden deafness, frequently accompanied by ear swelling and distress or earache, ceaseless tinnitus, or vertigo; dark red tongue.

Syndrome due to qi and blood deficiency: decreased hearing, aggravated by fatigue, or tireness, weakness, low voice, lusterless facial complexion, anorexia, abdominal fullness, loose stool, restless sleep at night; light red tongue with thin white coating.

Nursingforcommonsymptoms/syndromes

Deafness

·Assess the degree of deafness and whether there are concomitant symptoms like vertigo.

·Forbid to use earplugs, warn patients not to pick ears vigorously, and avoid waste water into ears.

·Perform auricular-plaster therapy at kidney, inner ear, subcortex and adrenal gland acupoints according to the doctor's advice. Acupoints on the liver meridians can be added for patients with hyperactivity of liver fire. Acupoints on the lung meridians can be added for patients with invasion of pathogenic wind.

·Conduct acupoint massage according to the doctor's advice. The acupoints like Tinghui, Tinggong, Hegu, Ermen, Yifeng and so on can be selected.

·Perform scraping therapy according to the doctor's advice. The acupoints like Fengchi, Yifeng, Tinggong, Ermen and so on can be selected; Dazhu, Fengmen and Feishu on the back can also be selected.

Tinnitus

·Keep the environment quiet, and avoid noise.

·Perform auricular-plaster therapy at inner ear, Shenmen, kidney and heart acupoints according to the doctor's advice.

Swellinganddistressintheear

·Observe whether there is earache.

·Guide the patients to blow nose correctly if stuffy nose and running nose are accompanied.

·Perform air-blowing therapy, including pinch nose, close lips and do air-blowing.

·Conduct acupoint massage according to the doctor's advice. The acupoints like Tinghui, Tinggong, Ermen, Yifeng and so on can be selected.

Dizziness

·Observe the duration and concomitant symptoms of dizziness.

·Be slow when the body position is changed, avoid the movements like lowering the head and rotation.

·Perform auricular-plaster therapy at Shenmen, liver, heart and subcortex acupoints according to the doctor's advice. Acupoints like Jiangyagou and Ganyang can be added for patients with hyperactivity of liver fire accompanied by hypertension.

·Conduct acupoint massage according to the doctor's advice. The acupoints like Yintang, Taiyang, Fengchi, Baihui can be selected.

Restlesssleepatnight

·Perform auricular-plaster therapy at heart, kidney, Jiaogan and Shenmen acupoints according to the doctor's advice.

·Conduct acupoint massage according to the doctor's advice. The acupoints like Shenmen, Sanyinjiao, Shenshu, Yongquan can be selected. Neiguan and Xinshu can be added for palpitation.

·Wash with Chinese herbs following the doctor's advice.

TCMspecialnursing

Medications

InternalapplicationofChineseherbs

·Medication time: Each dose of herbs can be taken generally in twice or three times. The specific medication time depends on the property and function of herbs as well as the patients' pathological condition. Chinese herbs for relieving exterior and clearing heat should be taken 1 h before meals, in which application of exterior-reliving Chinese herbs should avoid wind chill, or putting on more clothes or having some porridge induces diaphoresis. Chinese herbs for promoting digestion, purgation, expelling parasites, tranquilization and tonification are taken respectively after meals, before meals, on an empty stomach in the morning, before sleep and on an empty stomach. Emergency drug use follows the doctor's advice.

·Medication temperature: The administered warm is usually adopted. For the patients with special treatment, it should be followed the doctor's advice.

·Medication dose: 200 mL is taken per time for the adult; 100 mL is taken per time for the patients with heart failure and those of controlling the dose. The elderly and children should take according to the doctor's advice.

Injection

·Inquire the history of allergy carefully before medication.

·Make allocation and administration according to the requirements and injection speed recommended in the drug instructions.

·Apply TCM injection alone, and use it right after it was ready.

·Chinese and western drugs should be separated when Chinese and western injections are in combination.

·It is inappropriate to use a venous channel for two or more kinds of drugs except for special instructions.

·Medication reactions are observed closely, especially for the elderly, children, people with liver and kidney dysfunction and those that use TCM injections initially. Medication is suspended, and the doctors should be told to deal with it if adverse reactions occur.

·Nursing for allergic reactions: stop to use the drugs immediately, change the infusion channel and inform the doctor; seal the liquid and channel that cause adverse reactions; do allergic identification and inform patients and their relatives firmly to avoid re-medication; guide the patients to have a bland diet during the treatment of allergic reactions, forbid to eat the food like fish, shrimps, etc.

ExternalapplicationofChineseherbs

·Keep dry and clean skin before medication, and do local debridement if necessary.

·Observe reactions closely after medication. For example, the doctor should be informed immediately if local symptoms like scorching heat, redness, pruritus and stabbing pain appear; The medication should be stopped immediately if the symptoms, such as dizziness, nausea, palpitation and shortness of breath, appear, and meanwhile, corresponding measures should be taken and the doctor should be informed.

·Use with caution for patients with allergic constitution.

Specialtechniques

Auricular-plastertherapy

·Embed beans at auricular points and select acupoints correctly according to the doctor's advice.

·Assess the condition of ear skin and degree of tolerance to the pain, prohibit to use them in the inflammatory, ruptured and frozen skin as well as in pregnant women.

·Keep the intensity of probe moderate and accurately seek the sensitive point in acpoint area.

·Scrub the ears with 75% alcohol.

·Observe the patients' condition, stop immediately and inform the doctor to deal with it if discomforts occur.

·Select one ear for routine performance, keep the beans usually for 3-7 days and use them in two ears alternately; guide the patients to press them correctly.

·Observe the fixed degree of auricular point sticking and the condition of symptoms and ear skin (redness, swelling, rupture, etc.).

·Record the bean-embedded location and time at auricular points as well as the patients' feelings after performance.

Acupointmassage

·Conduct acupoint massage according to the doctor's advice.

·Assess the skin condition around the massage area and degree of tolerance to the pain; prohibit to use it in women during menstruation and pregnancy.

·For the operator, trim the fingernails to prevent the skin from injury.

·Keep the strength even and moderate, and pay attention to keep warm for the patients and protect their privacy.

·Observe the patients' reactions closely when operation is done; stop the massage and take corresponding measures once discomforts occur.

·Record the massage acupoints, techniques and time as well as the patients' feelings.

Scrapingtherapy

·Conduct scraping therapy following the doctor's advice, and select appropriate scraping tools according to different parts.

·Assess the skin condition and constitution of patients, use it with caution for the thin, and prohibit to use it for the patients with local skin ecchymosis, blister, scar, inflammation and bleeding tendency; evaluate the syndrome manifestation, and select scraping oil and direction based on syndrome differentiation; assess the patients' tolerance to confirm the strength of scraping techniques; prohibit to use it in women during menstruation and pregnancy.

·Keep the room temperature at 22-24 ℃, expose the scraping location, and pay attention to keep warm and protect the privacy.

·Be attention to the strength of scraping techniques, make the local skin red or have purple petechia. It is unnecessary to have petechia and violence is forbidden.

·Do scraping therapy better 1-2 hours after meals, not to be excessively hungry or full.

·Do not use strong force in the parts, including joints, spine, head and face, and make scraping time short.

·The scraping techniques are characterized by not too much strong force, fast speed and long time for the patients with diabetes mellitus due to poor skin tolerance and increased fragility of blood vessels. It is better to do scraping from the lower to the upper for the patients with varicose vein of lower limbs and those with edema of lower limbs.

·Inquire the discomforts of patients during scraping, and stop it immediately, make the patients lie on the back quickly, drink one cup of glucose saline and inform the doctor to deal with it if dizziness and nausea, even syncope, occur.

·Notifications: The local pain and burning sensation may appear when scraping is performed; The medical staff should be informed promptly if dizziness, nausea and weakness of limbs appear during scraping; Petechia may occur in scraping area, and mild skin pain and itching belong to normal phenomenon 1-2 days after petechia; After scraping, it is better to keep warm, drink a lot of hot water, be away from wind chill and taking bath within 3 hours.

·Record the scraping location and time as well as the patients' feelings after operation.

WashingwithChineseherbs

·Conduct to wash with Chinese herbs following the doctor's advice.

·Assess the washing skin and sensory perception of lower limbs to the temperature, use it with caution for the patients with skin lesion and those with drug and skin allergy, and prohibit to use it for the patients with severe cardiopulmonary dysfunction and hemorrhagic disease.

·Inform the patients of washing process and cautions before operation, and communicate with the medical staff promptly once discomforts occur.

·It is inappropriate to wash with Chinese herbs in fasting state and within 1 hour after meals. Immediate washing after meals can affect digestion due to local peripheral vasodilation.

·Keep the operation environment warm, close door and windows, and be cautious to keep the patients warm and protect their privacy.

·Expose the washing location thoroughly, and make the ankle of two feet soak in the liquid.

·Keep the liquid temperature at 37-40 ℃ and the washing time for 20-30 min. Take the difference of disease categories into account to prevent from burn.

·Observe the local and systemic conditions of patients during treatment, and inform the doctor immediately to deal with it if the symptoms including erythema, pruritus, palpitation, sweating and dizziness occur.

·Gently make the skin dry with light towel after washing, especially interphalangeal skin, and trim the toenails if they are long.

·Inform the patients of drinking 200 mL of warm water after washing with Chinese herbs.

·Record the washing temperature, time, skin condition and the patients' feelings after operation.

Healthyguidance

Dailylife

·Keep the environment quiet, and avoid to use the mobile for a long time.

·Avoid to go out alone for the patients with severe deafness of two ears, and pay attention to walking safely.

·Avoid to cough severely.

·Guide the patients to blow the nose correctly to prevent nasal discharge from pouring into the ears.

Dietguidance

·Syndrome due to invasion of pathogenic wind: It is advisable to eat foods that can dispel wind and relieve exterior as well as remove pathogens and free orifice, such as peppermint porridge, Gegen porridge, etc.

·Syndrome due to hyperactivity of liver fire: It is advisable to eat foods that can clear liver and purge heat, such as mung bean, white gourd, pear, chrysanthemum leaf, celery, etc. Dietary formulae: Celery and lean porridge.

·Syndrome due to stagnation of phlegm fire: It is advisable to eat foods that can clear heat and resolve phlegm, including coix seed, pear, loquat, lotus root, lily, etc. Dietary formulae: Lily porridge.

·Syndrome due to blood stasis in the ears: It is advisable to eat foods that can activate blood to remove blood stasis, including brown sugar, hawthorn, fragrant-flowered garlic, black fungus, peach seed, etc. Dietary formulae: Peach seed mixed with black fungus.

·Syndrome due to qi and blood deficiency: It is advisable to eat foods that can reinforce spleen and tonify qi as well as replenish blood, such as Chinese date, medlar, Chinese yam, longan, etc. Dietary formulae: Red date & longan porridge.

Emotionaladjustment

·Various kinds of communication ways can be adopted, such as handwritten letters, etc.

·Successful cases can be introduced to the patients to enhance their confidence.

·Teach patients to grasp the method of emotional adjustment and psychological counseling, such as distracting attention.

Rehabilitationguidance

·Regulate the breath, make two palms close to two external auditory canals in order to keep external auditory canals temporarily in isolation; put fingers in the occiput, and put index finger on the middle finger, and then slide down index finger from middle finger to gently rap the brain occiput. The rapping is conducted 24 times respectively by left hand and right hand, and then 48 times by both hands.

·Press the auricle with both hands, and rub it up and down, 15 min every time.

·Massage the tragus with index or middle finger, immediately put the finger down after pressing, and press 20-30 times every time. Be cautious to massage with left hand first, and then with right hand alternately or with both hands simultaneously.

·Pinch two sides of ala nasi with hands, close lips after inhalation with mouth, and then exhale vigorously with nose. These movements can be conducted over and over again to keep auditory tube smooth. However, it is inappropriate for the patients with acute rhinitis or much thick discharge in nasal cavity.