Hearing Loss Facts

# 1 disability problem of our nation.

* No matter what age you are you can develop hearing loss.

*Often not recognized by the person involved.

*Impairment of any sense affects our perception of our environment.

* Most of the time hearing difficluties begin in childhood.

*3-4 infants per 1000 will have permanent hearing loss.

*18-30 months average for Id of hearing loss.

Indications of Hearing Loss

School Aged child and Teenager

* Requests TV volume be turned up.

*Requests for things to be repeated.

*Inattentive at home or school.

*Responds to questions with an unre;ated answer.

*Frequently says :what"?

Indications of Hearing Loss

(cont'd)

Adult

* Misunderstands 15 for 50 or 60 for 16.

*Hears better with one ear than the other when using the telephone.

*Cannot hear from one room to another.

*Cannot hear speech with background noise.

*Misses punch lines of jokes.

Physiology of Hearing

*Sound enters the outer ear, travels through the auditory canal and sets up vibrations in the ear drum.

*The vibrations cause the bones in the middle eat to move back and forth.

*The last of these three bones, the stapes, sits in a small niche called the oval window.

Physiology of Hearing

(cont'd)

*The vibrations of the stapes makes the fluid of the inner era move and stimulates nerve nedings.

*The nerves send their signal along to the auditory centers of the brain.

Types of Hearing Loss

*Conductive- external and middle ear.

* Sensorineural- problems occur in the middle ear.

*Mixed loss- Conductive and sensor loss all together.

Otoacoustic Emissions Testing

*New born screening.

*Tiny plug inserted into baby's ear to project soft sounds.

*Normal hearing- A microphoned will record faint noises within the baby's ear in response faint noises within the baby's ear in response to auditory stimulation.

*Test is completed in 15 minutes.

Audiogram

*Measures hearing acuity.

*Sounds of varying intensity and tones are presented electronically through ear phones.

Tuning Fork

*Weber Test- Vibrations through the bone.

*Rinne

*Both useful in differentiating between conductive and senorineural losses.

Weber Tuning Fork Test

*Place vibrating tuning fork in middle of pt's head. Ask patient if sound is equal or louder in one ear.

Sensorineural- sound will be heard in the unaffected ear.

Conductive- Sounds in heard in the affected ear.

* Normal - Sound heard in both ears equally.

Rinne Test

*Compares client hearing by bone and air conduction.

*The vibrating tuning fork stem behind the cleints mastoid process and ask him when he no longer hears the sound.

Rinne Results

*Normal (positive)would be where the air conduction is greater than the bone conduction.

*Negative(conductive loss)a person hears bone conduction as long or sometimes lnger as air conduction

Behavioral Testing

*Involves placing a child in a sound proof room to see if he/she would respond to sounds as one would expect for the child's age.

*Three results:

1. degree of hearing loss.

2. Locate problem.

3. Provide information on childs ability to communicate.

BER testing

*Brainstem evoked Response.

*Used for children that do not respond to sound proof booth due to dvelopmental issues.

* Sounds are present through ear phones and activity is recorded from the hearing nerve.

*Responses measured through small electrolytes taped on the head and analyzed through a computer.

Tympanometry

*Tests mobility of tymapanic membrane and provides information about structures of the middle ear.

*Valauble in assessment of Eustachain tube patency and for following post surigical recovery of middle ear function.

*Nurse tests the mobility of the tymapnic membrane by gentle injecting a small puff of air through the penumatic device into the external canal and watches the tympanic membrane move.

Comparison of Conductive and Sensorineural Loss

(conductive)

Conductive Loss

* Soft voice.

*Discriminates speech.

*Good ability to hear on the phone.

*Weber Test- sound heard in affected ear.

*Rinne test AC<BC

Comparison of Conductive and Sensorineural Loss

(sensorinerual loss)

*People speak with lower voice.

*environemnetal noise trouble hearing.

*Difficulty hearing on phone.

*Hear better in normal ear.

*AC>BC

Conductive Hearing Loss

*Impacted cerumen

*Foreighn body.

*Insect in ear.

*External otitis.

*Damage to ear drum.

*serous otitis media.

*Acute otitis media.

Impacted Cerumen

(symptoms)

* Decreased hearing

*Feeling of plugged.

* Itching.

Impacted Cerumen

(Treatment)

*Don't irrigate if object could possibly swell when mositened.

Insect in Ear

(symptoms)

* pain.

* noise.

*wings buzzing.

Insect in Ear

(treatment)

* Shine flashlight in.

*Instill mineral oil

External Otitis

(swimmers ear)

Symptoms

*Itching

*pain

*discharge: sometimes bloody

*fever

*edema

*Reddened scaling skin canal.

External Otitis

(swimmers ear)

Treatment

*Antibiotics

*analgesics--->very painful

*steroids---->ear drops

*avoid getting H2O in ear till infection subsides

Damage to the Ear Drum

(causes)

*Perforation

*infection

*trauma

Damage to the Ear Drum

(symptoms)

*Pain

*drainage

*decreased hearing

Damage to the Ear Drum

(treatment)

* Systemic antibiotics.

*eg: amoxacillin, Biaxin,Augmentin

 example: a blow to the ear/previous in middle ear.

Heal spontaneoulsy and doesn't need to be treated

Serous Otitis Media

(not an infection)

causes

* Viral infection

*allergy

*sudden change in atmospheric pressure.

*Collection of fluid in middle ear.

Serous Otitis Media

(not an infection)

symptoms

*Plugged feeling in ear.

*hearing Loss.

*No fever

Serous Otitis Media

(not an infection)

treatment

* Mild-anthistamines decongestant.

* Severe-surgery

Acute Purulent Otitis Media

(etiology)

*Spread of infection from nose and pharnyx via Eustachian tube

*May follow forceful nose blowing

*smoking

Acute Purulent Otitis Media

(symptoms)

Is an infection

* Child cries, pulls on ear

*decreased appetite.

*Fever, chills, dizziness, pain, fullness.

*On exam the ear is red and bulging.

Treatment Purulent Otitis Media 

( True Infection)

*Antibiotics

*Decongestants- Help returning functioning of Eustachain tube by decreasinf swelling and mucus production.

Cholesteatoma

* Etiology- A benign growth of squamous cell epitheleum.

*Most often occurs in patients who have chromic otitis media with perforation.

*Tissue from the external canal grows into the middle ear.  It invades the ossicles and affects the facial nerve.

Treatment Cholesteatoma

*Tympanopalsty- reconstructive surgery on damaged middle ear.

Otosclerosis

(causes)

* Progressive condition (take 20-40 years) in which the normal bone of the middle ear is replaced by abnormal spongy bone.

*New growth forms about the stapes foot palte in the oval window.

*The stapes cannot vibrate.

*Cause is unknown.

*More commonly in women.

*Tends to run in families.

Otosclerosis

(symptoms)

*Hearing Loss.

*Progressive tinnitus

*disorder bilatereal in 80% of clients.

*BC>AC

Otosclerosis

(treatment)

*surgery only

*stapedectomy.

*Prosthesis is used to replace the stapes.

Sensorineural Loss

*Refers to things that interfere with processing of sound by inner ear, cranial nerve # 8 or CNS.

*Most hearing loss in older adults is senorineural.

Causes of Sensorineural Loss

*Excessive noise exposure.

*Destroy hair cells in certain regions of the cochlea.

*In addition noise makes blood vessels in the inner ear contract, causing a ministroke of the inner ear that furthers damage.

Sensorineural Loss

* Presbycusis- hearing loss assocaited with aging permanently.

*more common in men.

Sensorineural Loss

(symptoms)

not reversible

*bilateral gradual hearing loss.

*Group conversation more difficult.

*Mumbling.

Presbycusis Treatment

*No surgical treatment.

*Hearing aids.

*Help patient learn to live with loss.

 Sensorineural Los

(Meniere's disease)

etiology

*dysfunction of the labyrinth of the inner ear

*Caused by an excess of fluid in the inner ear.

 Sensorineural Los

(Meniere's disease)

symptoms

*dizziness

*nausea

*vomiting

*usually one ear involved.

*hearing loss

Treatment of Meniere's Disease

*low sodium diet.

*diuretics eg. Lasik

*Anti-vertigo meds.

*anti-nausea meds.

*life style changes.

*surgery

*postioning

*restoration of hearing

*decrease risk of infection

*prevent constipation

*potential for facial nerve trauma

*reinforce dressing

*potential for dizziness

* potential for nausea and vomiting

Tympanoplasty

* Tymapanoplasty may be done for repair of a trauma, otosclerosis, cholesteatoma, congeniteal defect.

*May be attempted to improve a conductive hearing loss.

Myringotomy

*Tiny incision made in the ear drum where a small ventilation tube is inserted.

*Ventialtion tube will remain and not be removed evnetually it will fall out

According to Age Group

*Prenatal- Rubella in 1st 8 weeks of pregnancy.

* childhood- mumps, measles, meningitis, chronic, otitis media.

*adult- viral or bacterial infections, trauma, drugs.

*aged adult arterioclerosis

Sensory Deprivation

Nursing Interventions

* encourage use of hearing aids.

*address client by name, and touch if culturally appropraite.

*Communicate meaningfully with client.

*Provide personal radio, TV, clocks or calendar

Guidelines for communication

*position yourself directly in front of the person.

*light

*do not shout

*keep hands and objects away from your mouth.

*quiet room

Levels of Prevention

(primary)

*Use of protective helmets or head gear.

*ear plugs.

*teens to avoid.

* Avoid polluted water and inserting objects into ear.

Levels of Prevention

(secondary)

*reprot hearing losses.

*Participation in screening programs

*monitor noise pollution

*monitor side effects of ototoxic drugs.

Tertiary Prevention

*Encourage participation in hearing rehabilitation programs.

*avodi situations where background noise in excessive.

*Teach use of hearing aid

*communication strategies.

Guidelines for communication

(cont'd)

*valdiate statments

*move close to patient

*hand gesture.

*write on blackboards/notepads

*do not show annoyance

* Normal- The membrane will move freely.

*Decreased mobility results from scarring, presence of fluid,, decreased mobility of the ossicles.