MEDICAL SURGICAL NURSING

SPECIAL SENSES

THE EAR:

HEARING
LOSS/DEAFNESS
OVERVIEW OF THE ANATOMY AND PHYSIOLOGY OF THE EAR
PHYSIOLOGY OF HEARING
 When sound waves enter the ear, it goes down the ear canal
(auditory), and hit the eardrum, which vibrates.

 The vibrations from the eardrum pass to the three ossicles

(bones) called the malleus (hammer), incus (anvil) and
(stapes) in the middle ear. These occicles amplify the
vibrations

 The amplified vibrations are then picked up by small hair-

like cells in the cochlea; they move as the vibrations hit
them, the sound is sent through the auditory nerve to the
brain
DEFINITIONS
 Hearing impairment or hearing loss refers to the inability
to hear things, either totally or partially.
 In a simple definition hearing loss is the reduced ability
to hear sound.
 Deafness is the complete inability to hear sound.

 Deafness and hearing loss have many causes and can

occur at any age
RISK FACTORS/CAUSES
Conductive Sensorineural

 Impacted earwax/foreign  Presbycusis

body  Long-term exposure to
 Otitis media excessive noise
 Trauma which may cause  Congenital
injury to the ear drum  Meniere’s disease

 Ototoxic drugs

 Infections
TYPES OF HEARING LOSS
1. Conductive Hearing Loss
2. Sensorineural Hearing Loss
3. Mixed Hearing Loss
CONDUCTIVE HEARING LOSS
 This is caused by any condition or disease that impedes the
conveyance of sound in its mechanical form, from the outer
ear through the middle ear cavity to the inner ear.
 A conductive hearing loss can be the result of a blockage in
the external ear canal or can be caused by any disorder that
unfavorably effects the middle ear's ability to transmit the
mechanical energy to the stapes footplate.
 This results in reduction of one of the physical attributes of
sound called intensity (loudness), so the energy reaching the
inner ear is lower or less intense than that in the original
stimulus.
SENSORINEURAL HEARING LOSS
 Sensorineural hearing loss results from inner ear or
auditory nerve dysfunction.
 The sensory component may be from damage to the
organ of Corti or an inability of the hair cells to stimulate
the nerves of hearing or a metabolic problem in the
fluids of the inner ear.
 The neural or retrocochlear component can be the result
of severe damage to the organ of Corti that causes the
nerves of hearing to degenerate or it can be an inability
of the hearing nerves themselves to convey
neurochemical information through the central auditory
pathways.
MIXED HEARING LOSS
 A mixed hearing loss can be thought of as a sensorineural
hearing loss with a conductive component overlaying all or
part of the audiometric range tested
 So, in addition to some irreversible hearing loss caused by an
inner ear or auditory nerve disorder, there is also a dysfunction
of the middle ear mechanism that makes the hearing worse
than the sensorineural loss alone.
 The conductive component may be amenable to medical
treatment and reversal of the associated hearing loss, but the
sensorineural component will most likely be permanent.
 Hearing aids can be beneficial for persons with a mixed
hearing loss, but caution must be exercised by the hearing care
professional and patient if the conductive component is due to
an active ear infection
CLINICAL MANIFESTATION
 Signs and symptoms of hearing loss may include:
 1. Muffling of speech and other sounds

 2. Difficulty understanding words, especially against

background noise or in a crowd of people
 3. Trouble hearing consonants

 4. Frequently asking others to speak more slowly, clearly and

loudly
 5. Needing to turn up the volume of the television or radio

 6. Withdrawal from conversations

 7. Avoidance of some social settings

INVESTIGATION
 PHYSICAL EXAMINATION involves looking into the ear for possible
causes of hearing loss, such as earwax or inflammation from an infection.

 AUDIOMETER TESTS During these more-thorough tests conducted by an

audiologist, the patient wear earphones and hear sounds directed to one ear
at a time. The audiologist presents a range of sounds of various tones and
asks the patient to indicate each time they hear the sound.
 TUNING FORK TESTS A tuning fork evaluation may also reveal whether
hearing loss is caused by damage to the vibrating parts of your middle ear
(including eardrum), damage to sensors or nerves of inner ear, or damage to
both.
 THE RINNE TEST A Rinne test evaluates hearing loss by comparing air
conduction to bone conduction. Air conduction hearing occurs through air
near the ear, and it involves the ear canal and eardrum. Bone conduction
hearing occurs through vibrations picked up by the ear’s specialized nervous
system.
 THE SCHWABACH TEST It compares the hearing sensitivity of a patient
with that of an examiner.
MANAGEMENT AND COPING STRATEGIES
 HEARING AIDS: Sound amplification with a hearing aid
helps people who have either conductive or sensorineural
hearing loss. Unfortunately, a hearing aid does not restore
hearing to normal. A hearing aid should, however,
significantly improve a person's ability to communicate and
enjoy sounds. Many people are reluctant to wear hearing
aids because of social stigma..
Types of hearing aids:
 Behind-the-ear (BTE) hearing aids

 In-the-canal (ITC) hearing aids

 Completely-in-the canal (CIC) hearing aids

 Bone conduction hearing aids

 COCHLEAR IMPLANT: Most profoundly deaf people who cannot hear
sounds even with a hearing aid benefit from a cochlear implant. A
cochlear implant is needed when people with a hearing aid do not
understand more than half the words in sentences. Cochlear implants
provide electrical signals directly into the auditory nerve by means of
multiple electrodes inserted into the cochlea, which is the inner ear
structure containing the auditory nerve.

 EAR WAX REMOVAL:this involves removal of impacted wax from the

ear canal thereby relieving conductive hearing loss

 ASSISTIVE DEVICE: Several types of assistive devices are available

for people who have significant hearing loss. Light alerting systems and
other sensors enable people to know when the doorbell is ringing or a
baby is crying. Many television programs carry closed captioning, with
the dialog shown as visible text. Telephone communication devices are
also available.
 SIGN LANGUAGE: Sign language is a visual language. Sign
language itself has its own unique grammar rules and
foundation
 LIP READING: is an important skill for people who have
decreased hearing. It is particularly important for people who
can hear but have trouble discriminating sounds, typically
those with age-related hearing loss. Observing the position of
a speaker's lips allows people to recognize which consonant is
being spoken..
PREVENTION OF HEARING LOSS
 Avoid loud noises from TV, Radio, Music Players,
headphones, and Toys. According to research, children
especially are very sensitive to the damaging effects of
loud music.
 If working in a noisy environment, wear ear plugs or ear
muffs.
ROLE OF NURSE IN COMMUNICATING
WITH THE HEARING IMPAIRED CLIENT
 Speak clearly and naturally.
 Move closer to the listener.

 Face the listener while speaking.

 Restate your message, if needed.

 Do not cover your mouth.

 Be patient.

 Encourage to use hearing aid

 Encourage client to read lips, if that helps

NURSING CARE PLAN
 Nursing Diagnosis
Impaired Verbal Communication related to auditory
impairment as evidenced by absence of speech or verbal
responses and inattention to noise.
 Objective

Patient will be able to give response in conversation

after intervention and throughout hospitalization.
NURSING INTERVENTION AND RATIONALE

 1. Asses the level of hearing impaired of the patient (mild, moderate, severe)…As a
baseline data for further intervention
 2. Provide conducive environment (calm and quiet)…To encourage effective
communication between the patient and the nurses and patient’s relatives
 3. Communicate using clear and simple word…To ensure patient can understand and
interprete the message. Long sentences may cause the patient to misinterprete the
message.
 4. Phrase questions to be answered simply by yes or no…To reduce the confusion in
patient to process a lot of information
 5. Speak in normal tones and avoid talking too fast. Avoid pressing for
response….Pressing for response may result in frustration in patient
 6. Provide alternative methods of communication: pen, paper, pictures….To assist
patient in communication
 7. Assist patient to choose the best hearing aids according to the severity of the
condition…To help the patient to have a better life style in communicating with the
people around
 8. Encourage family members to use the alternative methods in communication with
the patient and take part in the activities…To give the patient moral support and to
help the patient to be assertive
 9. Inform doctor…For further intervention
 10. Documentation…To record all the nursing interventions
 Nursing Diagnosis

Deficient knowledge related to care or management of

condition secondary to hearing impairment

 Objective
Patient will be given information of home care
management and demonstrate understanding after
intervention and throughout hospitalization.
 NURSING INTERVENTION AND RATIONALE
 1. Asses patient’s ability to hear to determine the severity of the hearing impairment
As a baseline data for further intervention
 2. Minimize environmental noise when giving the information to the patient To
encourage effective communication between the nurse and the patient
 3.Teach patient or caregiver to administer ear medications by showing the position of
the head to allow the medication flow into the ear canal (in case of hard cerumen or
infection) To ensure the effectiveness of the medication taken
 4. Instruct patient or caregiver in safe techniques for cleaning ears.Thin wahclothes
and fingers are best for cleaning ears. Cotton-tipped applicators should be avoided to
prevent inadvertent injury to eardrum. To minimize the injury to the ear which may
worsen the condition of the patient
 5.Teach patient or caregiver to use and care of the hearing aid or other assistive
hearing devices. To promote hygiene and effectiveness of using the hearing aid
 6. Explore technology such as amplifiers, modifiers for telephones, and services for
the hearing impaired such as telephone hearing-impaired assitance) To help the
patient function and participate in meaningful activities
 7. Emphasize to patient the importance of routine examination by an audiologist.
Frequent examinations detect changes in hearing or need for change in hearing aid.
 8. Encourage family members to take part in the activities To provide moral support
 9. Inform doctor For further intervention
 10. Documentation To record all the nursing interventions
Thanks for listening