Hearing Loss and Deafness 1

Hearing loss and
deafness
Hearing loss, or hearing impairment
happens when one or more parts of the ear
or ears are not functioning
Or
Hearing loss, hearing impairment,
or deafness, is a partial or total inability
to hear
Etiological factors
Aging (presbycusis)
N0ise exposure
Disease
Injury to the ear
Chinldren – ear infections, congenital defects
At age 50, one of every eight persons is
hearing impaired.
•Impacted •Otitis media
cerumen •Serous otitis
•Foreign bodies
•External otitis •otosclerosis
External ear Middle ear
•Menieres disease
•Noise exposure
•Presbycusis
•ototoxicity
Inner ear
Types
Conductive hearing loss
Sensorineural hearing loss
Mixed hearing loss
Central and functional hearing loss
Noise induced hearing loss

Conductive hearing loss
Conductive hearing loss results form
interference with the conduction of sound
impulses through the external auditory canal,
tympanic membrane or the ossicles of the
middle ear.
It can caused by anything that blocks the
external ear such as cerumen, infection or a
foreign body.
It may also be caused by thickening, retraction,
scarring or perforation of the tympanic
membrane or any pathophysiologic change in
the middle ear (tumours, previous surgeries,
otosclerosis)
Sensorineural hearing loss
It results form disease or trauma to the inner
ear, neural structures, or nerve pathways
leading to the brain stem
Diseases that effect may be systemic or local
infections or may be drug induced.
Systemic diseases – diabetes mellitus,
arteriosclerosis and infectious disease such as
measles, mumps and meningitis
Local diseases - neuromas of the eighth cranial
nerve, otospongiosis, trauma to the head or ear,
degeneration of the organ of corti
Mixed hearing loss
It is caused by a combination of conductive
and sensorineural losses
Central and functional hearing
loss
Central auditory dysfunction- it is a rare
form of sensorineural hearing loss in which
hearing ability remains intact but the patient
is deaf because the central nervous system is
unable to interpret normal auditory stimuli.
Central deafness can results from tumors or
stroke
Functional hearing loss – by an emotional
or a psychologic factor. The patient does not
seem to hear or respond to hearing tests, but
no organic cause can be identified.
Classification of hearing loss
(based on severity)
The decibel (dB)is a measure of the loudness
or intensity of sound.
A hearing loss of 15 to 50 dB is a mild to
moderate loss (impaired hearing)
A loss of 50 to 80 dB is severe hearing loss
A loss of more than 80 dB in both ears is a
profound hearing loss and referred as DEAF.
Noise induced hearing loss
Hearing loss due to exposure to noise accounts
hearing impairment among people between 35
to 65 years.
If hearing loss results from a single exposure
to a sudden loud noise or blast is referred as
ACOUSTIC TRAUMA.
Hearing loss occurs over time from repeated
injury from noise is referred as NOISE –
INDUCED HEARING LOSS.
 OSHA (OCCUPATIONAL SAFETY AND
HEALTH ADMINISTRATION) has establish
acceptable noise levels in work environment.
 Ordinary speech is 60 dB and in heavy traffic it is
80 Db
 Exposure to 85 to 90 dB for months can cause
cochlear damage.
 Based on OSHA regulations, the work
environment exceeding noise above designated
limits should wear EAR PROCTECTION DEVICES.
PRESBYCUSIS
Hearing loss associated with aging that
becomes more common after 50
Changes in the delicate labyrinth structures
over decades cause hearing loss
Clinical features
Asking others to speak up
Straining to hear
Cupping hand around ear
Answering questions inappropriately
Not responding when not looking at the
speaker
Showing irritability with others
Increasing sensitivity to slight increases in
noise level.
Family and friends who get tired of repeating
or talking loudly are often first to notice
Tinnitus
Ringing noise
Tinnitus accompanies most sensorineural
hearing losses and is often a warning of
impending or worseing hearing loss
Persistent tinnitus is very annoying and the
only cure is correct the underlying condition.
Deafness is often called the UNSEEN
HANDICAP.
Patient refuses to admit or unaware of impaired
hearing

Diagnostic features
History collection from the family members
or friends
Physical examination
All diagnostic measures for testing ear
function should done to rule out the exact

cause of the hearing loss and also to treat the
underlying disorders
CT scan, MRI, Blood test and cultures,
Management
Health promotion
Use of ear protectors while working in noisy
conditions
Treating the ear disorders as early as
possible
Avoiding drinking and driving
Avoid alcoholism
Organize health teaching programs in
schools, communities and factories for
preventing the hearing impairment
Immunizations
Various viruses can cause deafness as a result
of fetal damage and malformations affecting
the ear
Mumps, measles and rubella immunization
should be provided
Infection during the first 8 week of pregnancy
with rubella can leads to sensorineural
deafness
Ototoxic substances
Chemicals used in industry (toluene, carbon
disulfide and mercury) may damage the inner

ear
Drugs – antibiotics, salicylates, diuretics and
antineoplastic drugs
Symptoms of ototoxicity are tinnitus,
impaired hearing and vestibular dysfunction

If symptoms develop immediate withdrawal of
the drug may prevent further damage.

Assistive devices and techniques
Hearing aids – can assist individuals with
hearing impairments.
Hearing aids should be fitted by an
audiologist or a speech and hearing specialist

after a through physical examination and
hearing tests.
Hearing aids amplify sound in a controlled
manner.
Hearing aids consist of
A. A microphone to receive sound waves from the air
and change sounds into electrical signals
B. An amplifier to increase the strength of the
electrical signals
C. A battery to provide the electrical energy to
needed to operate the hearing aid
D. A receiver (loudspeaker) to change the electrical
signals back into sound waves.
Types of hearing aids
Five basic types
MICRO CIC (completely in the canal) hearing
aid
ITC (in the canal ) hearing aid
HS (half shell) hearing aid
ITE (in the ear) hearing aid
BTE (behind the ear)hearing aid

HALF IN THE
SHELL EAR
Adjusting with the hearing
aids
The nurse should explain the uses of it in detail
The patient must adjust the voices and household sounds
Experiment by increasing and decreasing the volume
If the patient is adjusted to the background noise, the
patient is ready to go for a small party where several

peoples talk simultaneously
After adapting to controlled situations, the patient can
encounter environments such as shopping mall etc

Care of a hearing aid
When the hearing aid is not being worn, it
should be keep in a dry, cool area
The battery should be disconnected or removed
Battery life is 1 -4 week (different based on the
types)
Wash the ear mold frequently with mild soap
and water
Toothpicks and pipe cleaners may be used to
clear a clogged ear tip.
Turn the hearing aid off when not in use
Keep an extra battery
Do not wear ear aid if an ear infection is
present
If the Hearing aid fails to work
-
Check the on-off switch
Inspect the ear mold for cleanliness
Examine the battery for correct
insertion
Change the battery
Check for any break in the aid

Implantable hearing devices
They are of two types
Cochlear implants
Bone conduction devices
Cochlear implant devices
It is used as a hearing device for people with
severe to profound deafness who get little or no
benefit from a hearing aid
The implant is an electronic hearing device that
stimulates nerves within the inner ear
The system consists of a surgically implanted
induction coil beneath the skin behind the ear
and an electrode wire placed in the cochlea
The implanted parts interface with an externally
worn speech processor
The device does not allow the person to hear
speech but creates an awareness of
environmental sounds such as doorbells or
telephones etc.
Bone conduction devices
It transmit sound through the skull to the
inner ear
Surgically implanted titanium screw
implanted under the skin into the skull
behind the ear
Once it heals, it is loaded with a vibrating
hearing aid.
AURAL REHABILITATION
If hearing loss is irreversible and not surgically
correctable, AURAL REHABILITATION is
recommended
It includes auditory training, speech reading,
speech training, sign language to maximize the
communication of a hearing impaired person
Speech reading
It is also called as lip reading – helps in
increasing communication skills.
The patient is able to use visual cues
associated with the speech, such as gestures
and facial expression to clarify the spoken
message
In speech reading several words will look like
alike (for ex: Oman, women )
The nurse should help the patient by using and
teaching verbal and nonverbal communication
techniques.
Nonverbal aids
Draw attention with hand
movements
Have speakers face in good light
Avoid covering mouth or face with
hands
Avoid chewing, eating, smoking
while talking
Maintain eye contact
Avoid distracting environments
Avoid careless expression
Use touch
Verbal aids
Speak normally and slowly
Do not over exaggerate facial
expressions
Use simple sentences
Write name or difficult words
Avoid shouting
Sign language
Sign language is used as a form of
communication for deaf people
It is a visual – spatial language that involves
gestures and facial features such as eyebrow
motion and lip mouth movements.
Sign languages is not universal.
Updates in hearing aids
Bluetooth® and Wireless
Accessories
Allows users to connect hearing instruments
directly to peripheral accessories such as:
 Cellular and home phone
 Television and music players
 Signaling devices like door bells and fire alarms
With this technology, hearing instruments are

becoming more like personal communication devices.

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Hearing loss and

Injury to the ear

Chinldren – ear infections, congenital defects

At age 50, one of every eight persons is

Sensorineural hearing loss

Mixed hearing loss

Central and functional hearing loss

Noise induced hearing loss

All diagnostic measures for testing ear

function should done to rule out the exact

disulfide and mercury) may damage the inner

impaired hearing and vestibular dysfunction

the drug may prevent further damage.

Hearing aids – can assist individuals with

audiologist or a speech and hearing specialist

HS (half shell) hearing aid

ITE (in the ear) hearing aid

BTE (behind the ear)hearing aid

The patient must adjust the voices and household sounds

Experiment by increasing and decreasing the volume

If the patient is adjusted to the background noise, the

patient is ready to go for a small party where several

encounter environments such as shopping mall etc

Inspect the ear mold for cleanliness

Examine the battery for correct

Check for any break in the aid

Do not over exaggerate facial

Write name or difficult words

With this technology, hearing instruments are

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