Hearing Loss: Types, Causes and Nursing Care

• Hearing impairment is a significant public health issue in the Philippines, influenced by genetics, noise exposure, infections, and limited access to early interventions.
• Hearing loss is the partial or total inability to hear sounds, occurring in one or both ears.

Types and Causes of Hearing Loss

• Conductive hearing loss occurs when sound waves do not reach the inner ear, often due to outer or middle ear issues like infections or earwax.
• Sensorineural hearing loss results from the incorrect processing of sound waves, linked to inner ear problems and conditions like aging or Meniere's disease.
• Mixed hearing loss is a combination of conductive and sensorineural hearing loss, affecting the outer, middle, and inner ear, often from head trauma or surgery.

Nursing Process and Hearing Loss

Assessment

• Speech deterioration presents as slurred words or a flat tone.
• Fatigue while listening is caused from straining to hear and can easily lead to irritation.
• Indifference is how a person who can't hear others becomes uninterested and possibly depressed.
• Social withdrawal is when a hearing impaired person removes themselves from possibly embarassing situations.
• Indecision and Procrastination increases due to the loss of self-confidence.
• Insecurity follows a fear of mistakes from the lack of confidence
• Suspiciousness may arise from hearing only parts of conversations and suspecting others are talking about them.
• False pride comes from concealing the hearing loss and pretending to hear.
• Loneliness and Unhappiness may happen often, as forced silence can become frightening.
• Tendency to Dominate the Conversation is a result of someone wanting to appear in control and avoid mistakes.
• Impaired Verbal Communication is a nursing diagnosis related to hearing loss, evidenced by difficulty understanding speech and expressing frustration through withdrawal.

Management

• Improve communication using devices or alternative methods like lip-reading.
• Determine the preferred communication and consider sign language interpreters.
• Fully focus on the person, avoid multitasking, and have them write the message if necessary.
• Repeating the message after understanding aids familiarization with their speech pattern.
• Written communication helps provide any additional resources.
• When speaking to someone who speech reads or lip reads, must face them as directly as possible.
• Have your face well lit and uncovered
• Before you begin, ensure they are aware of the topic.
• Enunciate slowly with more pauses.
• If uncertainty surfaces, check to be certain they fully understand the message.

Medical Intervention

• Hearing aids are small devices that amplify sounds.
• Cochlear implants are surgically implanted devices for severe hearing loss when hearing aids aren't sufficient.
• Infections (e.g., Otitis media): Use antibiotics or anti-fungals.
• Sudden Sensorineural Hearing Loss: Use steroids to reduce possible swelling
• Meniere's Disease: Use diuretics, anti-nausea medications, or steroids.
• Otosclerosis: Stapedectomy removes the stapes bone.
• Cholesteatoma or tumors: Surgical removal

Tinnitus

• Tinnitus involves the perception of sounds like ringing or buzzing without an external source, due to underlying conditions.

Causes of Tinnitus (HAMMER)

• Increase in blood pressure that affects the inner ear and disrupts the auditory system
• Reduced oxygen levels in the blood and insufficient oxygen supply to the inner ear
• Compression of the nerve or surrounding structures may interfere with normal sound processing.
• Disruptions in the brain’s processing of sensory signals
• Abnormal fluid buildup in the inner ear that causes alteration of hearing and balance
• Misinterpretation of the brain resulting in ringing or buzzing

Prevention

• Reducing volume
• Ear protecting devices
• Regular screening
• Monitoring and managing health conditions
• Lifestyle modifications

Meniere’s Disease

• Meniere's Disease comes an accumulation of fluid (endolymph) that can brings vertigo, hearing loss, tinnitus, and fullness in the affected ear.

Meniere's Triad

• Vertigo
• Tinnitus
• Hearing Loss
• Viral Infections cause inflammation or damage to the inner ear structures, especially the cochlea and vestibular system.
• Allergies cause inner ear inflammation.

Pathophysiology

• Impaired endolymphatic sac impairs from absorbing excess fluid
• Endolymph is a fluid found in the cochlea and vestibular system to help with sound vibrations and balance.
• Increased pressure in organs cause fluid build-up, and can have results like: disruption in balance (vestibular organs), and impaired transduction from the basilar membrane (cochlea)
• Rupture of soft/flexible/thin-walled membranous structures causes mixing of fluid compartments resulting in vertigo, worsening hearing loss, tinnitus, and aural fullness

Nursing Process for Meniere’s Disease

Assessment: Determine vertigo's frequency, duration, severity, and character with nausea and vomiting. Check for involuntary eye movements (nystagmus)

• Diagnostics: Detailed audiometric testing evaluates loss or possible changes in hearing ability.

Managing Risks

• Reduce fall-related injuries: Fall prevention strategies may prevent dizziness/imbalance during sudden movement of extremities
• Bed rest provides support to help with possible symptoms.
• Limit sodium, caffeine, and alcohol to lower the risk of additional related symptoms
• CRP helps reposition Canalith

Medical Management:

• Administer medication (ex: meclizine) to stop some symptom development.
• Client demonstrates improvement in management with reduced fall related injuries by remaining attached adherence to lifestyle modifications to lower vertigo.

Labyrinthitis

• Labyrinthitis is an inner ear inflammation, is characterized in 2 structures: the bony and membranous that are responsible for maintaining balance.

Causes

• Damage to inner ear structures can lead to inflammation/infection
• Inflamattory and autoimmune diseases may disrupt the immune system and affect balance
• Cause/Risk Factors triggers inflammaroty response that directy damages some cells which then can be fluid accumulation in regions.
• Disruption of sensory input can cause symptoms that involve dizziness related issues like vertigo.

Assessment

• Observe conditions related to ear conditions like recent respiratory infections
• Assess for involuntary eye movements and for romberg, have patients stand straight with eyes closed to determine level of possible swating.
• A rapid head movement may show abnormal eye movement that indicates vestibular involvement

Management

• Comfort through quiet dark rooms may reduce possible sensitivity to sudden lights or other triggers and or movements.
• Administer prescribed pain relievers
• Encourage rest in elevated position
• Teach balance exercises and anti vertigo medication
• Mobility can be supported to prevent falls.
• Positioning exercises should be made based on the patient
• Activity should rise gradually
• Administer to Ceftriaxone of Cefotaxime, Meclizine or Ondansetron

Otitis

• Otitis is ear inflammation that is common in children but can affect any age.

Otitis Externa (Swimmer’s Ear)

• Usually comes from outer ear canal by bacteria or fungi, from excess moisture or trauma.

Management

• Lower swelling in the ears with different medications.
• Ear should only be dried by an occasional amount, procedures need to be followed to maintain the ear canal safe.

Otitis Media:

• Middle ear infection, commonly derived from bacteria, viruses and/or nasal allergens.

Nursing Process and Interventions:

• History assessment (fever, recent infections, allergies) or recent sinus congestion
• Check for bulging or redden eardrum and ear abnormalities, monitor and educate the client on ear safety
• In dire cases, draining of fluid from the ears can require a Myringotomy

Noise-Induced Hearing Loss

• A type of sensorineural hearing loss that is caused mostly by exposure to loud noises.
• Damages Cilia, and in affect prevents the signal to be properly transmitted.

Noise Induced Process

• Assess for sensory impairments.
• Progressive hearing loss, difficulty hearing, tinnitus.
• Limit loud volumes, and for severe cases can get Cochlear implants for hearing

Disturbances of Smell and Taste

• Anosmia reduces the sensation of smell. It can be caused by Infections, sinusitis
• Assessment: Medical history, possible injury test possible smells.
• Educate on potential effects of anosmia and what to be aware of.
• Surgery or supportive treatment may need to be taken in order to help.
• Dysgeusia alters the sense of taste
• Monitor and educate on what is causing the tastes.

Senses Disturbance Conditions

Conditions from the olfactory system from possible infection, disorder, or nerve disorder.

• Hyposmia: Reduced Sensations
• Parosmia Alters the sensation of smell
• Phantosmia is olfactory Hallucinations

Intervertions/Managment

• Check Medical intervention
• Medical Treatment and safety precautions.

Carpal Tunnel Syndrome (CTS)

• Sensory impairment is a common theme here as the Carpal Tunnel Syndrome (CTS) is an entrapment neuropathy comes when the median nerve at the wrist is compressed by a thickened flexor tendon sheath, or soft tissue mass at the wrist.

CTS Intervetions

• Diagnosing an individual with CTS can be achieved by checking with normal reflexes or the Tinsel Test
• To help alleviate pain: Rest is often encourage and to avoid activities that cause wrist movements (typing), using a wrist splint, or surgery may be needed.

Peripheral Neuropathy

• Refers to the disorder of nerve damage in the peripheral nervous system, which may create complication or disease
• Common in the form of physical motor movements
• In rare events can stem from, infection disease, lack of vitamins, and is also hereditary.
• In order to see the actual symptoms, it is best to ask the patient on different form of questionings

Trigeminal Neuralgia

• Trigeminal Neuralgia is a condition that affects the trigeminal nerve, in effect causing pain.
• Neuralgia can make the affected area disrupt senses and even make touch sensations very disruptful.
• Check patient history and perform various tests if needed to prevent certain complications.

Benign Paroxysmal Positional Vertigo (BPPV)

• A intense dizziness/vertigo when the position of the head changes (BPPV).
• BPPV has relation with hearing loss, doesn't usually affect those
• BPPV can be a product of displaced calcified crystals move around in the canals
• Dix-Hallpike Maneuver Is used ti see the current problem by seeing the eye movements to see the problem.