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Eye and Ear Diseases and Disorders 357
■ Treatment. Use of a hearing aid can be helpful ini
tially, but as the hearing declines, aids might become
less useful.
■ Prevention. Much of the hearing loss caused by
trauma and noise can be prevented. Avoiding activi
ties with damaging noise levels and wearing ear muffs
or ear plugs to protect the ears are helpful preventive
measures.
Motion Sickness
■ Description. Motion sickness is the nauseated feeling
some individuals experience when traveling by automo
bile, boat, or airplane.
■ Etiology. The cause of motion sickness is abnormal
movement of the organs of balance—the semicircular
canals—that are located in the inner ear. These semicir
cular canals are accustomed to traveling in a horizontal
plane, but movement in a vertical plane, as in a boat or
bumpy airplane ride, produces an abnormal sensation in
these organs, leading to motion sickness. Watching motion
on a widescreen picture also can cause motion sickness,
even though the individual is not actually moving.
■ Symptoms. Symptoms of motion sickness include
varying degrees of nausea, vomiting, diaphoresis, and
vertigo. Fortunately, motion sickness usually subsides
when movement stops.
■ Diagnosis. A history and description of symptoms
are usually adequate to diagnose this condition. Labo
ratory testing is usually not needed.
■ Treatment. Antihistamine medications are generally
used to treat and prevent this condition. These medi
cations appear to work by calming the stimulation of
the inner ear. Meclizine (Antivert®, Dramamine II®) can
treat symptoms. Motion sickness can also be relieved or
reduced by lying down and closing the eyes.
■ Prevention. Meclizine is also helpful in prevention of
motion sickness if taken at least one hour prior to travel.
Scopolamine is the most commonly prescribed
preventive medication. It is available in a skin patch
(Transderm Scop®) that is applied behind the ear; the
medication is then slowly absorbed into the skin. To be
most effective, this patch should be placed at least four
hours in advance of the motion activity. Effects of the
patch last up to three days.
Promethazine, dimenhydrinate, and cyclizine are
all preventive medications when taken prior to the
motion activity.
Other considerations that might decrease the
effect or prevent the occurrence of motion sickness
include:
■ Avoiding heavy meals prior to a trip.
■ Finding a seat in the most stable area of the boat or
plane.
■ During automobile rides, making frequent stops for
short walks in the fresh air.
■ Not reading while traveling.
■ Avoiding stuffy areas, especially those with odors
such as cigarette smoke.
■ Trying to stay cool with plenty of fresh air when
possible.
■ Avoiding too much heat.
Trauma
Corneal Abrasion
■ Description. The cornea, the transparent outer layer
of the eye, is subject to trauma because of its position.
■ Etiology. Corneal abrasions can be caused by:
■ Trapping a foreign object such as sand or sawdust
between the eyelid and the cornea.
■ Contact lenses that do not fit properly, are dirty or
scratched, or are worn for too long a time period.
■ Accidentally poking a finger in the eye.
■ Extreme light, as with welding.
■ Symptoms. Symptoms are often delayed, occurring
12 to 18 hours after the trauma, and include severe pain,
tearing, and photophobia.
■ Diagnosis. Diagnosis is made on the basis of history
and visual examination. Abrasions can be stained easily
with fluorescein and viewed with a slit lamp.
■ Treatment. Treatment includes removal of the foreign
body and administration of antibiotic ointment or drops
to prevent infection. Analgesic medications for pain
might be prescribed. A pressure dressing can be applied
to the eye to keep the eyelid from moving against the
cornea and to reduce the pain of photophobia. Interest
ingly, the pain caused by corneal abrasion comes from
the inside of the eyelid rubbing over the abrasion on the
cornea. The cornea does not have sensory nerves.
358 Chapter 1 6
■ Prevention. Abrasions can often be avoided by the use
of protective eyewear.
Retinal Detachment
■ Description. This is a disorder of the eye in which the
retina peels away from the underlying tissue. Detach
ment usually starts in a small area but can quickly
lead to detachment of the entire retina. If this occurs,
blindness can occur. Retinal detachment is a medical
emergency.
■ Etiology. Retinal detachment often occurs with
trauma, diabetes, and other retinopathies that cause an
opening or hole in the retinal layer. This opening allows
fluid from the vitreous humor to leak between the retina
and choroid layer. The fluid lifts or floats the retina away
from the choroid (Figure 16-20).
■ Symptoms. Because the retina has no sensory nerves,
this condition is painless. The individual experiences
loss of vision in the affected area with symptoms of
blurred vision, flashes of light, and floating spots. As
more of the retina detaches, the symptoms become
more pronounced.
■ Diagnosis. Ophthalmoscopic examination will read
ily show the detachment.
■ Treatment. Surgery is the usual treatment to seal the
opening and reattach the retina to the choroid layer.
This can be done using laser technology. The retina
usually regains function unless extreme detachment
has occurred.
■ Prevention. Most cases cannot be prevented, although
prompt treatment of the cause, when known, does
Hole in retina
Figure 16-20 Retinal detachment.
Figure 16-21 Ruptured tympanic membrane.
reduce risk. Some eye injuries cause damage to the ret
ina that leads to detachment. Prevention of these inju
ries by wearing safety glasses, sports glasses, or goggles
also reduces risk.
Ruptured Tympanic Membrane
■ Description. A ruptured tympanic membrane, also
called perforated eardrum, is a tear or hole in the tym
panic membrane (Figure 16-21). This thin membrane
separates the ear canal from the middle ear and vibrates
when sound waves strike it, starting the process of
hearing.
■ Etiology. The most common causes include severe
middle-ear infection or trauma from inserting some
thing, such as a pencil, into the ear canal.
■ Symptoms. Symptoms include pain, partial loss
of hearing, and usually bloody or purulent drain
age. The main risk of a ruptured membrane is from
infection.
■ Diagnosis. Diagnosis can be confirmed by otoscopy.
■ Treatment. Treatment can include antibiotics to pre
vent infection and surgical patching of the membrane
with a tissue graft. Minimal hearing loss is associated
with a ruptured tympanic membrane.
■ Prevention. Getting prompt and thorough treatment
for middle-ear infection and keeping the ears free of
foreign objects are preventive measures.
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Eye and Ear Diseases and Disorders 359
Rare Diseases
Effects of Aging on the System
Retinoblastoma
Retinoblastoma is a malignant tumor of the eye. It occurs
during infancy and childhood and tends to be hereditary.
Often, both eyes are affected. Retinoblastomas grow as
intraocular masses that fill the eye and can extend into
the optic nerve. The mass is usually recognized by a white
light reflex seen at the pupil (cat’s eye). Untreated reti
noblastoma is fatal. With treatment, 90% of affected chil
dren survive. Treatment includes enucleation (removal
of the eyeball), radiation, and chemotherapy.
Meniere’s Disease
Meniere’s disease usually affects individuals between
the ages of 40 and 60. The cause is unknown, although
predisposing factors appear to include middle-ear infec
tions and head trauma. Meniere’s disease is a chronic
disease of the inner ear characterized by tinnitus, ver
tigo, progressive hearing loss, and a feeling of fullness
in the ear.
Acute attacks can last from a few hours to several
days with symptoms of nausea, vomiting, diaphoresis,
and vertigo. Treatment for acute attacks includes medi
cations to control nausea and vomiting. A low-salt diet,
diuretics, antihistamines, and cessation of smoking are
usually effective for long-term treatment. Surgery can
be performed if the disease does not respond to treat
ment, but a major complication of surgery is permanent
deafness.
Otitis Interna
Otitis interna, also known as labyrinthitis, is the inflam
mation of the inner ear which usually results in vertigo.
The vertigo may be mild to severe. It has many possi
ble causes, including a viral infection, stress, allergies,
Meniere disease, autoimmune diseases, and unknown
factors. Symptoms of otitis interna include hearing loss,
vertigo, and ringing in the ears. Diagnosis is made by
patient history, symptoms, and ruling out other causes.
Treatment is based on the cause but physical ther
apy exercises are often helpful. These exercises might
include combinations of head and eye movements,
gazing and postural positions, and walking exercises
among others. Medications might be used if the cause is
an infection or inflammation of the ear. It is difficult to
prevent otitis interna unless the cause can be prevented.
The effects of aging on the sensory organs are signifi
cant. Changes in vision begin in middle age and progress
through the older adult years. The change is obvious in
most people, beginning with the inability to read small
print or to see well in low light. These changes affect the
older adult’s ability to function well in society and often
cause social isolation and dependence on others.
Vision changes begin around age 40 and continue
through the life span. Inability to focus on near objects,
diminishing color perception, some sensitivity to light,
and decreased visual acuity are all normal physiologic
changes that occur during the aging process. Although
the changes vary among individuals, most persons have
about a 20/70 visual acuity by age 65. Glaucoma and
cataracts are common problems of older adults, reduc
ing even further their ability to see. In the diabetic
older person, retinopathy is a very common problem
that often eventually leads to blindness. Arcus senilis is
an opaque, grayish ring at the periphery of the cornea
that frequently occurs in an older person. It results from
fatty granule deposits in, or hyaline degeneration of, the
lamellae and cells of the cornea (Figure 16-22). Age-
related macular degeneration (AMD) is the leading
cause of severe vision loss and blindness in the older
adult. Vision exams for older adults should include
screening for this problem. Since more individuals are
living into their 80s and 90s, AMD will continue to be a
significant problem for older adults in the future. Early
treatment is important.
Hearing changes in the older adult affect the abil
ity to perceive what is heard and might affect behavior,
personality, and attitudes. Many hearing problems can
Figure 16-22 Arcus senilis.
360 Chapter 1 6
Healthy Highlight
Natural Treatments
for Ear Problems
S
ome of the following strategies can be helpful to relieve minor symptoms in
the ear:
■ Heat—warm compresses or a moderately warm heating pad may bring some relief
■ Gargle with salt water—gargling helps soothe the inflamed throat and may facilitate
some clearing of the Eustachian tubes, thus relieving discomfort
■ Keep the head upright—keeping the head up may help drain the middle ear
■ Refrain from smoking—do not smoke or be in contact with anyone smoking inside
the home or any enclosed space
If symptoms become worse or the above strategies are not helpful, seek the advice
of a health care provider.
Source: WebMD (2021)
be corrected but, because of financial constraints or
social concerns, are not treated. The inability to hear
often affects the individual’s ability to communicate
and interferes with one’s social life and independence.
In some instances, speaking in a clear, concise manner
to someone with such hearing loss is more beneficial
than raising one’s voice.
As the individual ages, the tympanic membrane
becomes thinner and less flexible, reducing the conduc
tion of sound. This is a conductive hearing loss associ
ated with aging. If there has been damage to the eighth
cranial nerve, the individual has a sensorineural loss.
If both types of hearing loss are present, it is called a
mixed hearing loss.
The slow but gradual loss of hearing, called pres
bycusis, affects more men than women, and is due to
degenerative changes in neurons, the bones of the mid
dle ear, and the cochlea. High-pitched sounds become
the most difficult to hear at first, but gradual loss of
low-pitched sounds also occurs eventually.
Other hearing conditions apparent in the older
adult include otosclerosis, tinnitus, and Meniere’s dis
ease. Although some of these can begin in younger life,
they are most commonly detected in later years.
Summary
T
he sensory organs of the body are often regarded as the most important to the individual to maintain quality
of life. Visual and hearing impairments are often correctable, especially if diagnosed early in the degenerative
period. Other system diseases such as diabetes often affect the sensory organs and can destroy their ability to func
tion. Some of the most common disorders of the eyes include myopia, presbyopia, hyperopia, diabetic retinopathy,
cataracts, and glaucoma. The most common diseases of the ear include tinnitus, otitis media, conduction loss,
otosclerosis, and Meniere’s disease. In the older adult, sensory organ disorders are common. Some losses of vision
and hearing occur naturally through the aging process. Other losses of vision are a result of other system diseases.
Diagnosis and treatment of vision and hearing losses should be implemented early to prevent some of the compli
cations of sensory dysfunction.
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Eye and Ear Diseases and Disorders 361
Review Questions
Short Answer
1. What are some of the most common problems affecting the eyes?
2. What are some of the most common problems affecting the ears?
3. What diagnostic tests are used to diagnose or evaluate eye disorders?
4. What diagnostic tests are used to diagnose or evaluate ear disorders?
Fill in the Blanks
5. _____________is the chronic inflammation of the eyelid.
6. The lay term for ________________ is pinkeye.
7. Extreme sensitivity to light is called _________________ .
8. Another term for nearsightedness is _______.
9. Farsightedness is also called ___________ .
10. A common eye disorder that occurs with aging is called __________ .
11. The main symptom of a cataract is the gradual __________________ of vision.
12. In ___, aqueous humor is produced faster than it can be drained.
13. Sudden flashes or spots before the eyes can be a sign of ________ .
14. is the leading cause of blindness in the United States.
15. The cranial nerves that control the muscles of eye movement include ___________ , _______ , and ________.
16. Within the ear, the organ of hearing is the _______ .
17. The major symptom of ear disorders is ______.
18. Buzzing or ringing in the ear(s) is called _______.
19. Pediatric ear tubes can be placed through the tympanic membrane during a procedure called ______________.
20. is also commonly called swimmer’s ear.
21. The most common cause of a progressive hearing loss is ___________ .
22. The surgical treatment for progressive otosclerosis is a _________ .
23. Vertigo is the common complaint of an individual with _________.
24. The slow but gradual loss of hearing common in the older adult is called ________ .
25. Chronic otitis media can result in perforation of the ________ .
362 Chapter 1 6
Case Studies
■ Ms. Tesar is a 52-year-old woman who has been doing intricate needlework for years. She has exhibited
her work in many fairs and received awards for her unique original patterns. While having lunch with her one
day, she confides that she is having difficulty seeing the eye of the needle while trying to thread it. She is also
having some difficulty drawing the minute details of the patterns. She has noticed, however, that she can see a
little better if she holds the needle out away from her while threading it rather than holding it close, as she was
used to doing. Having just completed a unit on vision and hearing disorders in your Human Disease course, you
think you can explain what is probably occurring with Ms. Tesar’s eyesight. What would you tell her about this
problem? How would you explain the natural changes that occur with aging? Would you recommend she make
an appointment to have her eyes checked?
■ Suzie Lindquist is a friend who has suffered from motion sickness for several years. What medications might
help her? What other suggestions could you give her to decrease the frequency of her motion sickness problems?
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17
Reproductive
System Diseases
and Disorders
Key Terms
Bimanual examination
(p. 366)
Carcinoma in situ
(p. 379)
Cervicitis (p. 375)
Chancre (p. 394)
Cryptorchidism (p. 391)
Cystoscopy (p. 368)
Cytologic (p. 366)
Digital rectal
examination (p. 368)
Dilatation and curettage
(D&C) (p. 367)
Dysmenorrhea (p. 374)
Dyspareunia (p. 375)
Dysuria (p. 387)
Eclampsia (p. 386)
Ectopic (p. 374)
Endometritis (p. 375)
Fluorescent treponemal
antibody absorption
(FTA-ABS) test
(p. 368)
Gumma (p. 396)
Hysterosalpingogram
(p. 367)
Impotent (p. 391)
Laparoscopy (p. 367)
Leukorrhea (p. 375)
Mammography (p. 368)
Mammoplasty (p. 383)
Mastectomy (p. 383)
Multiparity (p. 386)
Nocturia (p. 388)
Oophoritis (p. 375)
Orchiectomy (p. 390)
Panhysterectomy
(p. 375)
Phimosis (p. 398)
Preeclampsia (p. 386)
Primigravid (p. 386)
Prophylactic (p. 382)
Puerperal (p. 382)
Pyuria (p. 387)
Rapid plasma reagin
(RPR) (p. 368)
Salpingitis (p. 375)
Septicemia (p. 375)
Sterility (p. 391)
Trichomonas (p. 374)
Learning Objectives
Upon completion of the chapter, the learner should be able to:
1. Define the terminology common to the
reproductive system and the disorders of the system.
2. Discuss the basic anatomy and physiology of the
reproductive system.
3. Identify the important signs and symptoms
associated with common reproductive system
disorders.
4. Describe the common diagnostics used to
determine the type and cause of reproductive
system disorders.
5. Identify common disorders of the reproductive
system.
6. Describe the typical course and management of
the common reproductive system disorders.
7. Describe the effects of aging on the reproductive
system and the common disorders associated with
aging of the system.
363
364 Chapter 17
Overview
T
he reproductive system is a complex system of structures with a variety of physiologic functions. Some
parts of the reproductive system are endocrine glands (ovaries and testes) with purpose throughout
a person’s lifetime, whereas other parts are strictly involved in procreation for a specific time during the
individual’s life span. Disorders of the system are common at all ages and can range from mild to severe,
especially if not diagnosed early in the development of the disorder. Changes in the system during the aging
process have both physiologic and psychosocial implications. ■
Anatomy and Physiology
The reproductive system is quite different between the
male and female. Although the anatomy and physi
ologic features have a few commonalities, there are
enough differences to discuss them separately.
Consider This...
Every human spent about a half an hour as
a single cell — as a fertilized ovum.
Female Anatomy and Physiology
The female reproductive system consists of external
structures that include the vulva, labia majora, labia
minora, clitoris, vestibule, hymen, vaginal orifice, and
vestibular glands. Internal structures include the ovaries,
fallopian tubes, uterus, cervix, and vagina (Figure 17-1).
The ovaries secrete the female sex hormones, estrogen
and progesterone, and produce ova, the reproductive
cells, within the Graafian follicles (microscopic sacs).
After a follicle releases an ovum, it develops into a cor
pus luteum, created by the luteinizing hormone from
the pituitary gland. The corpus luteum secretes estro
gen and progesterone. The fallopian tubes are ducts that
carry the ova (eggs) from the ovaries to the uterus.
The uterus is a pear-shaped muscular structure
lying above the bladder in the pelvis. It measures only
about 2 inches by 3 inches in the non-pregnant state.
The lower part of the uterus is called the cervix (neck);
the inner layer of the uterus is the endometrium.
During menstruation, part of this layer is sloughed
off and passed through the vagina and vaginal orifice.
Clitoris
Urethral meatus
Skene's glands
Labia minora
Vaginal introitus
Hymen
Fourchette
Perineum
Anus
Opening of
Bartholin's gland
Posterior
Sacrum
Rectouterine
pouch —-
Cervix
Rectovaginal
septum
Rectum
Anus
Superior
Ovary Fallopian tube ..
x
\ , e Ureter
Anterior
•** Myometrium
L
Endometrium
Symphysis
pubis
Urinary
bladder
Clitoris
Inferior
Vagina
Urethral
meatus
External genitalia.
Cross-section of internal structures.
Figure 17-1 The female reproductive system.
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Reproductive System Diseases and Disorders 365
The vagina is the structure that receives the penis
during intercourse and becomes the birth canal during
delivery of the fetus.
The hormones secreted by the ovaries are estrogens
and progesterone. Secretion occurs in response to the
effects of the follicle-stimulating hormone (FSH) and
the luteinizing hormone (LH) produced by the ante
rior pituitary gland. Estrogen affects the development of
secondary sex characteristics (characteristics occurring
at puberty), changes in the endometrium, and growth of
the uterus and vagina. Progesterone affects the develop
ment of the endometrium, assists in the development of
the placenta, causes enlargement of the breasts during
pregnancy, prevents ova from being produced during
pregnancy, and assists in the development of cells in the
mammary glands.
The menstrual cycle is the process of secretion of
hormones, the preparation of the endometrium for the
implantation of the fertilized egg, and, if the egg is
not implanted, the sloughing of the layer with bleed
ing from torn capillaries. The cycle runs for about 28
days but varies among individuals. The start of the
menstrual flow is the first day of the cycle and usually
lasts about four to five days. After that, estrogen is
secreted until the Graafian follicle matures and rup
tures, about halfway through the cycle. Progesterone
is then secreted by the corpus luteum. As the corpus
luteum ages, progesterone levels decline. Declining
progesterone levels cause menses and the beginning
of the next cycle. Pregnancy will sustain progesterone
levels, maintaining the endometrium. The menstrual
cycle can begin (menarche) in females as young as 10
years of age, but typically begins at age 11 or 12. The
cessation of the cycle is called menopause, which usu
ally occurs between ages 40 and 50 but also varies with
the individual.
The female breasts are located between the sec
ond and seventh ribs over the pectoralis major mus
cle of the chest. They are usually almost symmetrical
and might be small or very large, depending on the
individual’s structure, body weight, and other fac
tors. Endocrine secretions during menstruation and
pregnancy affect the breast size and composition. The
breasts show little sign of development until puberty,
when, over a two- to three-year period, the breasts
change from the flattened preadolescent stage to full
breast maturity. As the female enters menopause, the
breasts begin to atrophy and become more relaxed
with a reduction in size.
The female breasts consist of three types of tissue:
glandular, fibrous, and adipose (fat). The structure of
the breast includes the nipple, areola, lactiferous ducts,
lobules lined with milk-producing glands called acini,
and fibrous dividers (septa). The breast also contains
a network of lymph glands that drains the lymph and
returns it to the circulatory system.
Consider This...
The largest cell in the human body is the
female egg, while the smallest is the male
sperm.
Male Anatomy and Physiology
The male reproductive system includes the external
organs, scrotum and penis, and the internal organs,
testes, epididymis, vas deferens, urethra, semi
nal vesicles, bulbourethral glands, and the prostate
(Figure 17-2). The penis houses the urethra, a tube
that carries urine from the bladder and semen from
the ejaculatory duct. At the tip of the penis is the pre
puce (foreskin). The penis is composed of erectile
tissue and arteries that dilate during sexual arousal,
causing the penis to become erect for the purpose of
intercourse. The scrotum is a sac that hangs below the
penis and holds the testes. The testes secrete testoster
one (the male sex hormone) and produce sperm (the
reproductive cells). Testosterone is responsible for the
changes occurring during puberty and secondary sex
characteristics in the male.
The epididymis is the duct leading from each testis
to the vas deferens, the excretory duct. The vas deferens
from each testis extends up into the abdomen, where it
connects to create the ejaculatory duct that opens into
the urethra. The seminal vesicles sit behind the bladder
near the neck. They secrete fluid that is part of the thick,
white secretion called semen. The prostate gland and
bulbourethral glands also secrete fluid that becomes
part of the semen.
Consider This...
An average sperm can swim about 8 inches
per hour.
Figure 17-2 The male reproductive system.
Common Signs and Symptoms Diagnostic Tests
Common signs and symptoms of female reproductive
system diseases and disorders include:
■ Abdominal and pelvic pain
■ Fever and malaise
■ Abnormal vaginal drainage
■ Burning, itching, or both of the genitals
■ Pain during sexual intercourse
■ Any change in breast tissue
■ Abnormal discharge from the nipple
Common signs and symptoms of male reproduc
tive system diseases and disorders include:
■ Urinary disorders, including frequency, dysuria,
nocturia, and incontinence
■ Pain in the pelvis, groin, or reproductive organs
■ Lesions on the external genitalia
■ Swelling or abnormal enlargement of the reproduc
tive organs
■ Abnormal penile drainage
■ Burning, itching, or both of the genitals
Physical examination of the female reproductive sys
tem to aid in diagnosis of diseases begins with a pelvic
examination that includes inspection of the exter
nal genitalia, visual examination of the vagina and
cervix through a speculum (an instrument used to
spread and hold the vaginal wall in an open position)
(Figure 17-3), and palpation of female internal organs
by bimanual examination. A bimanual (two-handed)
examination is so named because the physician places
one hand on the abdomen and inserts fingers of the
other hand into the vagina to feel the female organs
between the two hands. A bimanual rectal examination
allows palpation of the posterior aspect of the uterus
and the rectum.
The most common test of the female reproductive
system is the Papanicolaou (Pap smear) of the cervix
(see Figure 17-3). Pap smears are cytologic (sigh-toe-
LOJ-ic; cyto = cell, logic = study) examinations to
discover cervical cancer. If an abnormal Pap smear is
obtained, follow-up can involve a cervical biopsy that
entails taking a small piece of tissue from the cervix
for microscopic examination. A special type of biopsy,
called a cone biopsy, refers to taking a cone-shaped
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