MEDICAL SURGICAL NURSING 2ND SEMESTER

ADHARA 2023
AUDITORY DISORDER
FEB 23
AY 2021-2022

3RD YEAR NURSING

03
1

TABLE OF CONTENTS ● It is the basis for social interactions and

1 Auditory System communication
● Having a hearing impairment can lead to major
2 Anatomy of the Ear
challenges that can negatively affect well-being
A. Outer Ear
B. Middle Ear ● In adult, difficulties with related concepts, including
C. Inner Ear functional ability and cognition, may be present with
D. Transmission of Sound hearing loss
3 Assessment of Auditory System
A. Past Health History ANATOMY OF THE EAR
B. Gordon’s Functional Health Patterns
C. Physical Examination
D. Diagnostics
4 Meniere’s Disease
A. Incidence Report
B. Pathophysiology
C. Etiology
D. Risk Factors
E. Symptoms
F. To Know About Meniere’s Disease
G. Stages
H. Diagnostic Evaluations, Studies, & Laboratories
I. Management.1,2,3 (Nonpharma., Pharma., Surgical)
J. Complications
K. Nursing Diagnosis
L. Nursing Management
M. Patient Education (Dietary Guidelines)
N. Management (Others)
O. Post Operative Instructions
P. Prognosis
Q. Overview of Meniere’s Disease
R. Mnemonic for Meniere’s Disease
5 Hearing Impairment
A. Auditory System
B. Definition of Hearing Impairment
C. How Do We Hear?
D. Prevalence of Hearing Loss
E. Incidence and Prevalence (based on WHO)
F. Gerontologic Considerations
G. Pathophysiology
H. Risk Factors
I. Diagnostics
J. Types of Hearing Impairment
a. Conductive
b. Sensorineural
c. Mixed
K. Degree and Types of Hearing Impairment
L. CDC
M. Prevention
N. Treatment
O. Hearing aid VS. Cochlear Implant
P. BAHS VS. Cochlear Implant
Q. Post Operative Care: Cochlear Implant
R. Post Operative Care: BAHS
S. Psychological Effects
T. Therapeutic Interventions
U. Coping and Support
V. Nursing Diagnosis
6. Conclusion
7. (Additional) Myths VS. Facts of Hearing Loss
Book Recommendation Medical Surgical Nursing Lewis 377

AUDITORY SYSTEM OUTER EAR

● Hearing is a complex process that allows us to ● Auricle or pinna: outside part of the ear
interact with the environment

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● Auditory canal or tube: ear canal

● Tympanic Membrane or eardrum
○ Divides the external ear from the middle ear

MIDDLE EAR
● Eardrum (Tympanic membrane)
● Tympanic cavity
● Ossicles: three tiny bones
○ Malleus (hammer)
○ Incus (anvil)
○ Stapes (stirrup)
■ Smallest bone in the body

INNER EAR
● Semicircular canals: ASSESSMENT OF AUDITORY SYSTEM
○ Filled with fluid, make up of the organ of balance ● Help the patient describe the symptoms and
● Cochlea problems to determine the source of the problems
○ Contains the nerves for hearing ● Assessment of hearing and equilibrium should be
○ Usually damaged include because the auditory and vestibular system
● Vestibule are closely related
○ Contains receptors for balance ● Problem with balance may manifest as:
○ Vertigo: is a sense that the person or objects
around are moving or spinning
○ Nystagmus - abnormal eye movement -
twitching of the eyeball

PAST HEALTH HISTORY

● Record the:
○ Frequency of acute middle ear infections (otitis
media)
○ Surgical procedures (myringotomy)
○ Perforation of the eardrum
○ Drainage
○ History of mumps, measles, or scarlet fever
● Assess for systemic condition
○ Hypertensive
● Document head injury because it may result in
TRANSMISSION OF SOUND
hearing loss
● Information about food and environmental allergies
● Record symptoms such as vertigo, tinnitus and
hearing loss
● Information about family members with hearing loss
and type of hearing loss
● Some congenital hearing loss is hereditary

MEDICATIONS
● Obtain the information about present or past use of
ototoxic drugs
○ Ask about hearing and balance problems

SURGERY OR OTHER TREATMENTS

● Document previous hospitalization for ear surgery
○ Myringotomy
○ Tympanoplasty
○ Tonsillectomy, and adenoidectomy
○ Record the use of and satisfaction with hearing
aid
○ Note any problems with impacted cerumen (or
the ear wax)
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GORDON’S FUNCTIONAL HEALTH PATTERNS INDICATORS OF POSSIBLE HEARING LOSS

HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN ● Does not respond to or understand oral
communication
● Note the onset of hearing loss. Whether sudden or
● Has excessively loud or soft speech
gradual and who noted the onset
● Answer questions inappropriately
NUTRITIONAL-METABOLIC PATTERN ● Tilts head, leans forward when listening
● Ask the patient about any ear pain (otalgia) or ● Constantly needs to clarify conversation
discomfort associated with chewing or swallowing ● States other people mumble all the time
● Increases the volume of radio or TV
ELIMINATION PATTERN ● Difficulty hearing over the phone
● Frequent constipation or straining with bowel or
bladder elimination may interfere with healing or NORMAL PHYSICAL ASSESSMENT OF AUDITORY
repair of a perilymph fistula SYSTEM
● Ear symmetric in location and shape
ACTIVITY-EXERCISE PATTERN ● Auricles and tragus nontender, without lesions
● Identify activities that relieve or worsen symptoms ● Canal clear, tympanic membrane intact, landmarks
and how they relate to the time of the day and light reflex intact
● Able to hear low whisper at 30 cm
SLEEP-REST PATTERN ○ Weber test results, no lateralization
● Ask if with chronic tinnitus about sleep problems ○ Rinne test results AC > BC AC, Air conduction;
● Assess for snoring BC, bone conduction

COGNITIVE-PERCEPTUAL PATTERN DIAGNOSTICS

● Ask to describe the pain, presence of drainage PHYSICAL/OTOSCOPIC EXAMINATION
(otorrhea), history of teeth grinding and treatments
used for relief ● Look at the outer ear canal and eardrum
● Note the effect on the pain level when you move the ● The doctor may dim the lights in the exam room to
auricle or palpate the tragus make it easier to see your ear canal and eardrum
● Physical examination with an otoscope

SELF-PERCEPTION - SELF-CONCEPT PATTERN

● Ask to describe how the ear problem has affected
his or her personal life and feeling about himself or
herself

ROLE-RELATIONSHIP PATTERN
● Ask about employment or contact with environments
that have excessive noise levels, such as work with
jet engine, and machinery and electronically AUDIOMETRIC EXAMINATION
amplified music ● The test is used to determine the minimum volume,
or intensity, necessary for the subject to hear each
SEXUALITY-REPRODUCTIVE PATTERN tone
● Determine whether hearing loss or vertigo has ● More sensitive than a simple screening test and can
interfered with having satisfactory sex life detect the early stages of hearing loss
● In a closed room, or sound proof room.
COPING-STRESS TOLERANCE PATTER
● Ask about his or her usual coping style, stress
management strategies and available support

VALUE-BELIEF PATTERN
● Ask about any conflicts produced by the problem or
treatment related to values or beliefs
● If there are any discomforts
AUDIOMETRIC BRAINSTEM RESPONSE
PHYSICAL EXAMINATION
● Also known as ABR or BAER
● During the interview to obtain a health history, obtain ● Measures electrical peaks along auditory pathway of
objective data about the ability to hear inner ear to brain and provides diagnostic
● Look for cues that cannot hear information related to acoustic neuromas, brainstem
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problems and stroke inner ear

● For patients with history of hearing loss ● Sit in a turning chari that’s controlled by a computer
○ This lets the doctor see how eye movements
affects inner ear

ELECTRONYSTAGMOGRAPHY
● It is used to evaluate people with vertigo and certain
other disorders that affect hearing and vision
● Is a test of the inner function (particularly the
semicircular canals

POSTUROGRAPHY
● Balance test that can isolate one semicircular canal
from others to determine site of lesion
● Test is done in a boxlike device in which the floor
moves in response to a correction in balance by
client
IMAGING STUDIES
MAGNETIC RESONANCE IMAGING
TYMPANOMETRY ● Brain scan should be done to rule out abnormal
● Used to detect middle anatomy or mass lesion
ear and mobility of
eardrum CT SCAN
● Measurements are made ● Reveal dehiscent superior semicircular canal and or
of movement of eardrum widened cochlear and vestibular aqueducts

MENIERE’S DISEASE
● “The disorder takes its name from a french doctor,
Proper Meniere, who suggested in the 1860s” that
inner ear and not the brain , as most people
believed”
TUNING FORK TEST (Weber and Rinne Test) ● Is an abnormality in the inner ear fluid balance
caused by a malabsorption in the endolymphatic sac
or a blockage in the endolymphatic duct
● Also known as “Idiopathic Endolymphatic
Hydrops”

INCIDENCE REPORT
● Male are affected more than female
● Disease is mainly unilateral
● It is more common in age group 40-60 years
● About 50,000-100,000 people of world would
develop Meniere’s disease in a year
● About 50% of the patients who have Meniere’s
disease have a positive family history of this disease

PATHOPHYSIOLOGY
Obstruction of endolymphatic duct/sac
↓
Weber Test Rinne Test Over production and absorption of endolymph
● Assess the bone ● Indicates that air ↓
conduction of sound conduction remains Excessive accumulation in inner ear
with tuning fork) better than bone ↓
conduction) Increased in pressure and rupture of membrane
↓
ROTARY CHAIR TESTING Vertigo, tinnitus, hearing loss
Permanent loss of auditory & vestibular function
● This lest the doctor see how eye movements affect
(Meniere’s)
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ETIOLOGY ○ New onset of headache, sudden onset of

● The exact cause of meniere’s disease is unknown deafness
● Is the result of constrictions in blood vessels similar
to those cause MIGRAINES headaches STAGES
● Consequence of: EARLY
○ Viral infection
● Sudden unpredictable vertigo
○ Allergies
● Hearing loss and tinnitus
○ Autoimmune reactions
● Hearing and full sensation returns between attacks
● Genetic variations that cause abnormalities in the
volume or regulation of endolymph fluid
MIDDLE
RISK FACTORS ● Vertigo attacks less severe
● Hearing loss and tinnitus often become worse
● Smoking
● Periods of remission
● Alcohol use
● Fatigue
● Respiratory infection LATE
● Stress ● Less frequent vertigo
● Use of certain medications, including aspirin ● Hearing loss and tinnitus become worse
● Genetics may also play a role ● Problems with balance

SYMPTOMS DIAGNOSTIC EVALUATION

● Vertigo HISTORY
○ Because the inner ear is the main target of this ● Patterns of symptoms association between hearing
disease, the body’s balance, as a consequence, loss, tinnitus, and vertigo
get thrown off ● At least two episodes of vertigo that last from 20
● Tinnitus minutes to 12 hours (recurrent & spontaneous)
○ With an impaired inner ear, sound detection ○ Objective measurement of low to medium
goes awry as well. Most people living with frequency hearing loss in one ear before, during
Meniere’s Disease experiencing Tinnitus or the and after an episode of vertigo
persistent sensation of ringing in the ear
● Loss of balance DIAGNOSTIC EVALUATION
○ With the inner ear as the overseer of keeping
● Other associated aural symptoms of affected ear,
our bodies in balance, of the onset of Meniere's
including tinnitus, hearing issues or aural fullness
disease, this gets thrown off. This can cause
● If cause known , then it is Meneire’s Syndrome
loss of balance with other possible complications
such as nausea, vomiting, headache, sweating,
and intenes
● Aural fullness
○ This feeling is akin to pulling ear plugs in your
ear. It is as if your ear is stuffed and the sound
coming out is muffled.
● Loss of hearing
○ In extreme cases, there have been reports of DIAGNOSTIC STUDIES
loss of hearing in affected areas. ● Audiometric testing
● Rotating chair testing
TO KNOW ABOUT MENIERE’S DISEASE ● Electronystagmography (ENG)
● VAST ● Posturography
○ V - Vertigo ● MRI
○ A - Aural Fullness ● CT scans
○ S - Sensorineural Hearing Loss
○ T - Tinnitus LABORATORY TEST
● Triggers ● TSH
○ High salt intake, chocolate, caffeine, menstrual ● Blood glucose
cycles, alcohol, smoking, psychological ● Blood test
stressors ○ CBC
● Post-attack symptoms ● Antinuclear antibody
○ Ongoing nausea, fatigue, unsteady can last ● Venereal Disease Research Laboratory Test
hours to days
● Red flags

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MANAGEMENT
NONPHARMACOLOGICAL MANAGEMENT
● GOAL:
○ To control vertigo
○ Preserve hearing
○ Stabilize tinnitus

DIETARY MANAGEMENT
● Low sodium diet (2,000 mg/day)
● Avoidance of caffeine, nicotine and alcohol

PHYSICAL THERAPY
● BRANDT-DAROFF EXERCISE for Vertigo
○ Begins in the seated position and then leans
rapidly to one side, placing the head on the bed
or table
○ The client remains there until the vertigo
subsides and then returns to the seated upright
position
○ Remaining there until all symptoms subside
○ The maneuver is repeated toward the opposite
side, completing one full repetition
○ Ten to 20 repetitions should be performed two POSITIVE PRESSURE THERAPY
times a day ● To apply pressure to the ear canal through a tube
● This improves how fluid moves through the ear

PHARMACOLOGICAL MANAGEMENT
● Vestibular Suppressants (e.g. Meclizine)
○ Reduce dizziness
● Diuretics (e.g. Hydrochlorothiazide)
○ Decrease the fluid pressure load in the inner ear.
● Vasodilator
○ Dilate blood vessels
● Anticholinergic
○ Dizziness, motion sickness
● Antiemetic e.g. Trimethobenzamide 250 mg TDS
○ Reduce N/V
● Anti-inflammatory (steroids)
○ Reduce Inflammation

SURGICAL MANAGEMENT
OTOTOXIC ABLATION THERAPY
● Trans-tymphanic injection of antibiotics
● Is injected through the eardrum using a narrow
needle
● The drug is left in the middle ear for 30 minutes to
drain out through the eustachian tube into the throat.
○ Usually gentamicin is used but some use
corticosteroids because of the issue of further
VESTIBULAR REHABILITATION THERAPY ear damage to inner ear/hearing loss with
gentamicin use.
● Is an exercise program that retains the brain to use
other senses, such as vision, to help with balance.
ENDOLYMPHATIC DECOMPRESSION
● Is a treatment that is performed to maintain the
hydrostatic pressure and endolymph homeostasis in
the inner ear.
● Consists of draining the endolymphatic sac and

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inserting a shunt to enhance the fluid drainage NURSING MANAGEMENT

● Provide a nursing care during acute attack:
VESTIBULAR NERVE SECTIONING ○ Provide a safe, quiet, dimly lit environment and
● Process of cutting the vestibular part of the enforce bed rest
cochleovestibular cranial nerve. ○ Provide emotional support and reassurance to
● The surgeon will destroy the nerve that sends alleviate anxiety
signals about balance to the brain to stop the ○ Administer prescribed medications, which may
message that are causing vertigo. include antihistamines, antiemetics, and possibly
○ Cranial nerve 8 (to be cut to stop the message mild diuretics
that causes vertigo) ■ Some cases might be managed with bed
○ Mainly done by the neurosurgeon (can be done rest
by EENT before) ● Instruct the client on self care instruction to
control the number of acute attacks
COCHLEA SACCULOTOMY ○ Discuss the nature of the disorder
● A surgical option for the treatment of incapacitating ○ Discuss the need for a low-salt diet
vertigo in elderly patients with MD. ■ Salt has sodium which causes water
● Procedures that are intended to enhance the retention
drainage of endolymph by fistulation of the ○ Explain the importance of stimulants and
membranous labyrinth and decompression of the vasoconstrictors
endolymphatic sac. ○ Discuss medications that may be prescribed to
○ Mostly done and used for elderly meniere’s prevent attacks
disease patients
○ AIM: to drain the fluid ● Discuss, prepare and assist with surgical
options
LABYRINTHECTOMY ○ Assess the severity and frequency of attack, any
associated ear symptoms
● Is a procedure used to decrease the function of the
○ Help to prevent from aura, so has time to
labyrinth of the inner ear.
prepare for an attack
● Surgeon destroys the parts of the ear that control
○ Encourage to lie down during attack in safe
balance
place
○ If not done, can cause permanent or reversible
○ Put side rails in bed
deafness
○ Place pillow to restrict movement
● The goal of the procedure is to completely destroy
○ Administer or teach anti-vertiginous medication
the vestibular end organs to eliminate vestibular
and sedation medication as prescribed
function. This will relieve the symptoms associated
○ Attacks can cause N/V, sedation may be given
with vertigo.
to help them
● Complications associated with a labyrinthectomy can
○ Avoid noises and glary bright light which may
be severe and include:
initiate attack
○ CSF leak
○ Advise to avoid food that cause allergy
○ Vomiting or nausea
○ Assist with ambulation when indicated
○ Complete loss of hearing on the affected ear
○ Provide comfort measures and avoid stress
○ Facial nerve injury
producing activities
○ Loss of balance function in affected ear
○ Incomplete procedure that does not eliminate
symptoms PATIENT EDUCATION: DIETARY GUIDELINES
COMPLICATIONS: MD ● Limit food high in salt or sugar.
○ Salt contains sodium, it can make our body hold
● Partial or total blood loss of hearing
extra fluid (where salt goes, water follows) and
● Constant tinnitus
can lead to meniere’s disease attacks
● Permanent balance disability
● Eat meals and snacks at regular intervals to stay
● Fear, Phobia
hydrated.
● Dehydration
● Eat fresh fruits, vegetables, and whole grains
● Drink plenty of fluids daily
NURSING DIAGNOSIS ○ Fluids - to help the body release those extra
● Risk for injury R/T altered mobility salts in the body
○ because of gait disturbance and vertigo ● Limit alcohol intake
● Altered auditory sensory perception R/T altered state ○ Alcohol and caffeine can decrease blood supply
of the ear to the ear
● Impaired adjustment R/T disability ● Avoid monosodium glutamate(MSG)
○ Requiring change in lifestyle because of ○ MSG - this can trigger attacks (since it contains
unpredictability of vertigo a form of sodium)

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● Pay attention to the intake of foods containing

potassium if taking diuretics MENIERE’S DISEASE OVERVIEW
● Avoid aspirin and aspirin containing medications.
○ Aspirin - can cause tinnitus, can also manifest
meniere’s

MANAGEMENT (OTHERS)
GENERAL MEASURES
● Reassurance: psychological support
● Cessation of smoking
● Low salt diet
● Avoid excessive intake of water
● Lifestyle modification

MANAGEMENT OF ACUTE ATTACK Some manifestations can be relieved on their own with
● Reassurance resting
● Bed rest
● Vestibular sedatives: diazepam MENIERE’S DISEASE CAUSES
● Vasodilators: adenosine triphosphate MNEMONICS: Men Always SHAVE
● Men - Men
MANAGEMENT OF CHRONIC PHASE ● A - Allergy
● Vestibular sedative ● S - Sodium and water retention
● Vasodilators ● H - Hypothyroidism
● Diuretics - to release excess fluid ● A - Autoimmune and virus
● Avoid allergen ● V - Vasomotor disturbances
● Chemical Labyrinthectomy: Intratympanic ● E - defective absorption by Endolymphatic sac
gentamicin therapy
PAHINGA MUNA ADHARA
POST OPERATIVE INSTRUCTIONS
● Antibiotic and other medication are to be taken as
Prescribed.
● Nose blowing to be avoided (few weeks).
● Sneezing and coughing should be done with the
mouth open for a few weeks after surgery
● Heavy lifting, straining and bending are to be
avoided for a few weeks after surgery
○ Can increase inner ear pressure
● Minor discomfort is expected can relief by analgesic,
excessive pain should be reported to surgeon
● Head up 30 degrees (3-10days)
● Avoid: Chewing, sneezing coughing
● Prevent water in ear: 6weeks
● Never put oil in ear
● Hearing may be impaired for few months RT edema,
blood, fluid HEARING IMPAIRMENT
AUDITORY SYSTEM
PROGNOSIS ● Hearing is a complex process that allows us to
● The outcome varies. Meniere's disease can often be interact with the environment
controlled with treatment. ● It is the basis for social interaction and
● The condition may get better on its own sometimes. communication
● Meniere's may be chronic disabling causing ● Having a hearing impairment can lead to major
permanent hearing loss. challenges that can negatively affect well-being
● In the adult, difficulties with related concepts
including functional ability and cognition, may be
present with hearing loss

HEARING
● Refers to the reception of sound by the ears

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○ Its analysis, and

○ Its transmission to the brain INCIDENCE AND PREVALENCE
● The number of people with disabling hearing loss wil
IMPAIRMENT grow over the years
● Any loss or abnormality of psychological, ○ Up to 630 million by 2030
physiological, or anatomical structure or function ○ Over 900 million in 2050
● Disabling hearing loss refers to:
HEARING IMPAIRMENT OR HEARING LOSS ○ hearing loss greater than 40 decibels in the
● Occurs when you lose part or all of your ability to better hearing ear adults (15 years or older)
hear ○ greater than 30 decibels in the better hearing
● Other terms that are uses to refer hearing hear in children (0 to 14 years)
impairment are: deaf, and hard of hearing ● 60% of childhood hearing loss is due to preventable
● A hearing loss above 90 decibels is generally causes
considered deafness ● Unaddressed hearing loss poses an annual global
○ Which means that a hearing loss below 90 cost of US$ 750 Billion
decibels is classified as a healing impairment ● 1.1 billion young people (aged between 12-35 years)
○ 10 - 15 decibels - NORMAL are at risk of hearing loss due to exposure to noise
● It's quite common, which causes problems with in recreational settings
hearing and affects our ADLs ● Hearing loss occurs in men more often than women

HOW WE HEAR IN THE PHILIPPINES

● Nearly 1 in 6 has serious hearing problems
● Study finds, 15% of the population have a moderate
or worse hearing loss
● Current available statistics
○ Approximately 28% of the population or roughly
a total of 26 million Filipinos have hearing loss
○ 8.8% of which or a total of 2.3 million are
hearing-diabled

GERONTOLOGIC CONSIDERATIONS
EFFECTS OF AGING ON AUDITORY SYSTEM
● Presbycusis or hearing loss due to aging
○ Is the third most common health issue in older
adults, after arthritis and heart disease
PREVALENCE OF HEARING LOSS: WHO GLOBAL ○ Progressive hearing loss due to aging
ESTIMATES ● Sound transmission is diminished by calcification
of the ossicles
● Tinnitus, or ringing in the ears, may accompany the
hearing loss that results from the aging process
● Cerumen glands atrophy, causing cerumen
(earwax) to be much drier
● The hair in the ear becomes thicker and coarser,
entrapping the hard, dry cerumen in the canal
● Accumulation of dry cerumen in the external canal
can interfere with the transmission of sound
● A decline in balance results from atrophy of
vestibular structures in the inner ear, slowing of
motor responses, and musculoskeletal limitations

CARE OF OLDER PATIENTS INCLUDE

● Recognizing, emotional reactions related to hearing
loss
● Feelings of insecurity
● Hearing loss can also interfere with relationships due
to loss of communication
● Depression, isolation and decrease in cognitive
function
● Feeling of isolation, confusion, alteration in daily
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living activities ● Trouble healing consonants

PATHOPHYSIOLOGY ● Frequently asking others to speak more slowly,
Damage to the outer, middle & inner ear, aging clearly, and loudly
process, exposure to loud sounds ● Needing to turn up the volume of the television or
↓ radio
Cause wear and tear on the hairs or nerve cells in the ● Withdrawal from conservations
cochlea that sounds signals to brain ● Avoidance of some social settings
↓ DIAGNOSTICS
Electrical signal cannot be transmitted efficiently
↓ PHYSICAL EXAM
Symptoms of hearing loss such as asking other ● Will look in ear for possible causes of hearing loss
person to repeat back, “Hah”, leaning forward such as earwax, or inflammation from an infection
● Also look for any structural causes of hearing
problems
● Physical exam - check for blockage which can
impede hearing (e.g. cerumen in the inner canal,
inflammation, structural problems of the ear)

GENERAL SCREENING TESTS

● Use the WHISPER TEST, asking to cover one ear at
a time to see how well hear words spoken at various
volumes and how to respond to other sounds
● Its accuracy can be limited

APP-BASED HEARING TESTS

● Mobile app are available that can use by on tablet to
screen for moderate hearing loss
RISK FACTORS
● Aging
● Loud noise
○ common teenagers, can cause damage to the
ears
● Hereditary
● Occupational noises
○ jobs with loud working areas (construction
worker, factory workers)
● Recreational TUNING FORK TESTS
○ exposure to firearms, jet engines ● Are two-pronged, metal instruments that produce
● Some Medication sounds when struck
○ antibiotics can cause damage to our hearing, ● Simple tests with tuning forks can help detect
also some chemotherapy hearing loss
● Some Illness ● This evaluation may also reveal where ear the
○ common to those who have fever damage has occurred
● Family history of sensorineural impairment
● Congenital malformations of the cranial structure
(ear)
● Low birth weight (<1500 g)
○ 3 days after delivery
■ Those babies who have low birth weight
are recommended to go back to the
hospital to test for hearing loss (as a
preventive measure)
● Use of ototoxic medication

CLINICAL MANIFESTATIONS
● Muffling of speech and other sounds
● Difficulty understanding words, especially against
background noise or in a crowd people

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● CN VIII - responsible for transmitting sound from ear

to brain, and is involved in balance
● Most common hearing loss in the elderly but can be
prevented

CAUSES
● Congenital
● Loud noises
● Presbycusis - gradual hearing loss in both ears due
to aging (Hopkins Med, 2021)

TREATMENT
● Continuing observation with repeated hearing tests
● Medical therapy - corticosteroids
● Evaluation and fitting of a hearing aid(s) or other
assistive listening devices
● Surgery to correct the cause of hearing loss
AUDIOMETER TESTS ○ Usually, hearing aid are given
● During these
more-through tests MIXED HEARING IMPAIRMENT
conducted by an ● Caused by anything that affects the auditory
audiologist, patients wear pathway from the outer ear to the central auditory
earphones and hear sounds system. Can be temporary or permanent
and words directed to each ● Sometimes treatable
other ○ Treatable if detected early
● Each tone is
repeated at faint levels CAUSES
to find the quietest sound ● Illness
can hear ● Drugs
○ Sa loob ng kwarto ● Genetic causes
na sound proof ● Head trauma and/or malformation of the inner ear
○ Common to new nursing jobs - to check for
hearing of the nurses
TREATMENT
TYPES OF HEARING IMPAIRMENT ● Medications
● Surgery
CONDUCTIVE HEARING IMPAIRMENT
● Occurs when sound cannot travel to your inner ear THREE TYPES OF HEARING LOSS
because of problems with the parts in your outer or
middle ear
● Most cases are temporary, some are permanent

CAUSES
● Ear infections
● Fluid buildup in the middle ear (usually due to
allergies or a cold)
● Hole in the eardrum
● Blockage caused by earwax TYPES OF HEARING LOSS
● Some might have tumor in the heart Sensorineural Mixed Conductive
● Structural defects can also cause hearing problems ● Aging ● Genetic ● Fluid
● Noise damage disorders ● Foreign
TREATMENT ● Drug effects ● Infections bodies
● Medication ● Auditory ● Head trauma ● Allergies
● Surgery tumors ● Ruptured
● A treatable condition ● Blast/ eardrum
Explosion ● Impacted
earwax
SENSORINEURAL HEARING IMPAIRMENT
● Is caused by impairment of function of the inner ear DEGREE AND TYPES OF HEARING IMPAIRMENT
or the vestibulocochlear nerve (CN VIII)
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● Sounds are measured in decibels (dB) Severe-to 80-90 dB Difficulties with

● Anything over 85 dB is considered dangerous as profound speech,
it can caused permanent damage to the delicate hearing loss comprehension
hair cells within the inner ear becomes impossible
● normal : 10-15 dB without amplification
Profound 90 dB and greater Amplified speech or
THE CENTER FOR DISEASE CONTROL AND hearing loss 90 dB - indicates devices are still
PREVENTION PUT TOGETHER A HANDY CHART OF you have hearing difficult or impossible
NOISE LEVELS BY DECIBELS loss to hear and
● Normal breathing - 10 dB understand
● Whisper - 30 dB
● Normal conversation - 60 dB
● City traffic - 80 dB
● Motorcycle - 95 dB
● Sporting events - 100 dB
● Police siren - 120 dB
● Firecracker - 140 dB

DECIBEL SCALE

PREVENTION FOR HEARING IMPAIRMENT

● Protect your ears in the workplace
○ Specially designed earmuffs that resemble
earphones can protect ears by bringing most
loud sounds down to an acceptable level.
● Have your hearing tested
○ Consider regular hearing tests if you’re working
in a noisy environment.
○ Knowing (your condition) can help you and put
you in a position where you can take steps to
prevent further hearing loss.
● Avoid recreation risks
DEGREE OF HEARING HEARING LOSS ○ Some activities (e.g. hunting, listening to
HEARING THRESHOLD IN extremely loud music for longer periods of time)
LOSS DECIBELS (DB) can damage hearing.
Normal hearing 0-25 dB No perceived
hearing loss TREATMENTS FOR HEARING IMPAIRMENT
symptoms ● Depends on the cause and severity of the hearing
Mid hearing loss 25-40 dB Difficulty hearing and loss:
understanding ○ Removing wax blockages
quiet/soft ○ Use of hearing aids
conversations, ○ Use of cochlear implants
especially situations ○ Use of BAHS
with a lot of
background noise
REMOVING WAX BLOCKAGES
Moderate 40-50 dB Difficulty
hearing loss understanding ● Cleaning the outside of the ear by wiping with a
speech, higher cloth.
volume levels are ● Putting cerumenolytic solutions (solutions to dissolve
required for hearing wax) into the ear canal)
TV and radio ● Irrigation or syringing the ear.
● Removing the wax manually using special
Severe hearing 60-80 dB Speech has to be
instruments.
loss louder than normal,
● Wax cleaning/removal - an OPD procedure
group conversations
● When cleaning (at home), di na need ipasok ang
are difficult
earbuds sa loob ng tenga. MNG: use cotton na
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binalot daw

USE OF HEARING AIDS

● Is a small electronic device that wears in or behind
the ear. It makes some sounds louder.
● A hearing aid can help people hear more in both
quiet and noisy situations.
● Price in the PH: 35K - 60K

HOW COCHLEAR IMPLANTS WORK

USE OF COCHLEAR IMPLANTS

● Is a small, complex electronic device that can help to
provide a sense of sound to a person who is
profoundly deaf or severely hard of hearing.
● The implant consists of an external portion that sits
behind the ear and a second portion that is surgically
placed under the skin.
● Done in the OR, where the physician implants an
electrode into the cochlea. It will send signals to the
auditory nerve
● Price in the PH: 1.2 M

DIFFERENCE BETWEEN HEARING AID AND COCHLEAR

IMPLANT

HEARING AID VS. COCHLEAR IMPLANT

HEARING AID COCHLEAR IMPLANT
Does not require surgery and Does require surgery and are
is best suited for people with best suited for people with
less severe hearing loss and more severe hearing loss and
fair speech understanding. poor speech understanding.

USE OF BONE ANCHORED HEARING SYSTEM (BAHS)

● Surgically implantable system for treatment of
hearing loss that works through direct bone
conduction.

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surgery
● Stitches or staples are removed approximately 10
days after surgery
● Activation of the implant takes place four to six
weeks after implantation
● The four to six weeks recovery period permits
complete healing around the implant site before
returning to the clinic to be fitted with the external
components of the system
● Programming of the external speech processor is
performed by the audiologist
● The client will begin to hear their first sounds from
the implant
● The implant system is programmed to suit each
How BAHS Works? individual’s needs. The implant team continues to
work with the implant recipient as long as it is
WHAT IS THE DIFFERENCE BETWEEN A COCHLEAR necessary to ensure optimal benefit from the device
IMPLANT AND A BONE ANCHORED HEARING ● Advise to call for fever, bleeding, discharge,
SYSTEM? increased pain or swelling
Cochlear Implant Bone Anchored Hearing
System RISK AND COMPLICATIONS OF COCHLEAR IMPLANT
● Their cochlea have limited ● Titanium bone implant SURGERY:
function and the candidate ● A bone anchored device ● The normal risks of general anesthesia
has poor speech makes use of the ● Temporary dizziness and/or temporary disturbance
discrimination ability individuals’ existing of balance.
● The cochlear implant cochlear function. ● Temporary increase in tinnitus or ringing in the ear.
electrode is surgically ● The bone anchored ● Numbness in area of scar
implanted into the cochlea. system stimulates the ● Change in taste sensation.
● The implant enables the cochlea through vibration ● Risk of bleeding and infection
recipient to hear sounds via bone conduction. ● Facial nerve bruising
and it improves their ● These individuals have ● Device failure. Any man made device can fail, break
speech discrimination good speech or function improperly.
ability to varying degrees discrimination ability once ● Loss of hearing: During surgery any remaining
depending on the the sound gets to the hearing in the implanted ear will be permanently lost.
individual recipient. cochlea.
POST OPERATIVE CARE: BAHS
POST OPERATIVE CARE: COCHLEAR IMPLANT ● Leave the head dressing in place until the surgeon
● A head wrap dressing stays on overnight removes it at 6-8 days after surgery.
● Clients are usually able to get out of bed and walk ● Take antibiotics and pain medication as prescribed.
around the day after surgery and are generally are ● There are no dietary restrictions, although if nausea
discharged from the hospital on the first post-op day is present, it is best to start with clear liquids.
● Pain is mild to moderate for several days and can be ● Numbness of the scalp or ear is not unusual, and it
controlled with oral pain medicines can last for 9 months. When the bruised nerves are
● Some experience imbalance for a few days after recovering they often cause sharp shooting pains
surgery but this usually resolved spontaneously around the wound or over the back of the head.
within the first week ● Keep the area DRY for 3 weeks. DO NOT allow any
● Please keep the incision dry from water exposure water to run over the wound for 3 weeks. Bath or
and coat with antibiotic ointment two or three times shower cap over the wound or with an assistant over
daily a sink (like at the hairdressers)
○ Antibiotic ointment since there is an excision ● Avoid sleeping on the side of the BAHA post for 4
of the skin weeks.
● Exercise and vigorous physical activity should be ● Do not perform any heavy lifting (more than 10 lbs) a
avoided for four weeks vigorous physical activity for three weeks after
● Should not drive if taking pain medication other than surgery.
tylenol, or if have any dizziness ● Small amount of bleeding is expected around the
● Clients generally report that they are at full-strength wound for 3 to 5 days.
and back to normal within a week or two after the ● Any heavy or prolonged bleeding should be
surgery reported.
● Clients return to school or work as soon as they feel ● A yellow discharge or fould odor at any time is an
well enough to do so, usually withins a week of indication to see the doctor

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○ Yellow discharge - could indicate infection more who are at risk to get hearing impairment
caused by noise pollution.
PSYCHOLOGICAL EFFECTS ● As the saying goes by “PREVENTION IS ALWAYS
● Depression BETTER THAN CURE”
● Anxiety ● Thus people should be made aware of the
● An often false sense that others are angry with you importance of taking care of one selves from the
● Shame, guilt and anger noise pollution made by human beings.
● Lack of concentration.
MYTHS VS. FACTS
THERAPEUTIC INTERVENTIONS Busting the Myths of Hearing Loss
MYTHS FACTS
● Use touch & eye contact
● Restate your message, if needed. Having hearing loss means Hearing loss changes the
● Encourage to use hearing aids I just need sounds to be quality of sounds being
● When speaking do the following louder. heard, making it difficult to
● Reduce or minimize environmental noise. understand and
● Face the patient in a good light and keep hands communicate with others.
away from mouth. Using portable music and 1.1 billion people are at risk
● Speak close to the patient's “better” ear. video devices does not of suffering hearing loss
● Avoid shouting or yelling affect my hearing. due to unsafe use of
● Use simple language and short sentences. portable music devices.
● Speak slowly & be patient Living with hearing loss is People with untreated
not a big deal. hearing loss are often left
COPING AND SUPPORT out of conversations,
resulting in loneliness and
● These tips can help you to communicate more easily frustrations.
despite hearing loss.
○ Position yourself to hear
○ Turn off the background noise
○ Ask others to speak clearly
○ Consider using an assistive listening device
○ Choose quiet settings
○ Written communication is an excellent
resource.

NURSING DIAGNOSIS
● Disturbed sensory perception
● Impaired verbal communication
● Disturbed body image

“Nurses serve as catalysts throughout the health care

system to ensure that accomodations are made to meet
the communication needs of the client.”

CONCLUSIONS
● Hearing Impairment, deafness, 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 meanwhile deafness is the
complete inability to hear sound.
● There are types of hearing impairment and each
type has its own management to overcome the
problem so that the client will have a better living
and improve their life by engaging with all people in
their surrounding.
● Hearing loss can be preventable and a more healthy
campaign of taking care of the ear should be
reinforced to create the awareness of the people
outside, especially young people nowadays who
love to listen to loud music.
● Those who work in the construction site and many

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