Nursing Care: Altered Sensory Perception: Hearing

Weber Test

● distinguishes between conductive and sensorineural hearing loss ● in normal auditory function, the client perceives a midline tone and the sound is heard equally in both ears

Weber Test: Sensorineural Hearing Loss Results

the sound is louder (lateralizes) in the normal (unaffected) ear

Normal Hearing

0 to 15 dB range

Rinne Test: Steps

1. hold the stem of a vibrating tuning fork against the client's mastoid bone (for BC of sound) and note the time 2. when the sound is no longer perceived behind the ear (BC of sound), note the time once again 3. move the still-vibrating fork close to the pinna (AC of sound) 4. have the client report when the sound next to the ear canal (AC) is no longer heard and note the time

Weber Test: Steps

1. stem of vibrating tuning fork is placed on midline of skull or forehead 2. the client is asked to indicate where the sound is heard best ​

Debbie's treatment includes hearing aids. The nurse providing education when the devices are delivered should include which information related to use and care? Select all that apply. A. Clean the ear molds weekly or as needed. B. Disconnect or remove the batteries when not in use. C. Initially restrict usage to quiet listening in the home. D. Replace the batteries monthly. E. Clean ears with cotton-tipped applicators daily.

A. Clean the ear molds weekly or as needed. B. Disconnect or remove the batteries when not in use. C. Initially restrict usage to quiet listening in the home. Basic hearing aid care includes cleanly the ear molds weekly and as needed, disconnecting the battery when the device is not in use, and restricting usage initially to allow the client time to adjust to the increase level of hearing. Batteries are replaced as needed. A client should not use a cotton-tipped applicator to clean their ears.

When teaching the client about Meniere's disease, which instruction should a nurse give about vertigo? A. Get up slowly while turning the entire body. B. Report dizziness at once. C. Change your position using the logroll method. D. Drive in daylight hours only.

A. Get up slowly while turning the entire body. Turning the entire body, not the head, will prevent vertigo. Dizziness is expected but can be prevented. The client shouldn't drive as he may reflexively turn the wheel to correct vertigo. Turning the client in bed slowly and smoothly will be helpful and logrolling isn't needed.

The nurse is caring for a client that is hearing impaired. Which approaches will facilitate communication? Select all that apply. A. Speak in a normal tone. B. Speak slowly. C. Move closer toward the better ear when speaking. D. Avoid covering mouth while speaking. E. Speak loudly. F. Exaggerate facial expressions. G. Speak frequently.

A. Speak in a normal tone. B. Speak slowly. C. Move closer toward the better ear when speaking. D. Avoid covering mouth while speaking. Speaking slowly in a normal tone to the client with impaired hearing and not shouting are important. The nurse should talk directly to the client while facing the client and speaking clearly. If the client does not seem to understand what is said, the nurse should express it differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse should avoid talking directly into the impaired ear. Exaggerating facial expressions can be distracting and interfere with what the nurse intends to communicate. The frequency of speaking will not impact how well the client is able to understand the nurse. Keep in mind that certain equipment, such as masks and face shields, may interfere with others clearly hearing and understanding what is being said, even if the client has no hearing impairment.

The nurse is assessing Debbie, an adult seeking help for difficulty hearing. Which factors do the nurse need to focus on and can contribute to hearing loss? Select all that apply. A. age​ B. recurrent otitis media and trauma​ C. diabetes D. excessive hair in the ear​ E. occupational exposure to loud noises​ F. current medications​ G. history of tobacco use​

A. age​ B. recurrent otitis media and trauma​ C. diabetes E. occupational exposure to loud noises​ F. current medications​ Contributors to hearing loss include age, recurrent ear infections, certain medications, certain diseases, diabetes, and environmental or occupational exposure to loud noises. Understanding the client's risk factors helps the health care team narrow the cause of any hearing loss that Debbie may be experiencing.​ Excessive hair in the ears and a history of tobacco use are more likely to contribute to infection than hearing loss.​

When teaching a group of older adults living with hearing loss, which common age-related hearing changes should the nurse include? Select all that apply. A. drier cerumen B. atrophy of the tympanic membrane C. auditory nerve degeneration D. tinnitus in both ears E. greater ability to hear high-pitched sounds

A. drier cerumen B. atrophy of the tympanic membrane C. auditory nerve degeneration D. tinnitus in both ears Normal aging of the ears can lead to drier cerumen, tinnitus, auditory nerve damage, and atrophy of the tympanic membrane. As people age, the ability to hear high-pitched sounds decreases.

The nurse conducting an auditory assessment documents which abnormal finding as subjective? Select all that apply. A. geeling of fullness B. skin polyp in ear canal C. bulging tympanic membrane D. tinnitus E. light yellow exudate

A. geeling of fullness D. tinnitus Subjective assessment findings are those an individual experiences that the nurse cannot verify. During the auditory/ear assessment these include such items as tinnitus and a feeling of fullness in the ear. Bulging of the tympanic membrane is visible to the nurse when a visual examination is completed using an otoscope. Light yellow exudate and a skin polyp can also be verified by the nurse during the examination.

When teaching a group of older adults living with hearing loss, which instructions to improve communication should the nurse include? Select all that apply. A. Exaggerate facial expressions. B. Assure your face is well lit and visible. C. Over enunciate speech. D. Face the individual when speaking. E. Write out names or difficult words. F. Raise the voice to a higher pitch. G. Speak normally and slowly.

B. Assure your face is well lit and visible. D. Face the individual when speaking. E. Write out names or difficult words. G. Speak normally and slowly. The nurse should include these factors to when teaching the family and friends of individuals living with hearing loss how to communicate more clearly.​

When discussing the options to improve hearing loss due to otosclerosis, a common cause of conductive hearing loss, the nurse shares that _____ is the initial treatment option. A. stapedectomy B. a hearing aid C. cochlear implant

B. a hearing aid During the early stages of otosclerosis the auditory ossicles have not yet become fixed. Since vibrations occur, a hearing aid can amplify the waves to improve hearing. Hearing aids become less effective as otosclerosis progresses due to increased fixation of the stapes. Stapedectomy surgery replaces the fixed stapes with a device that vibrates, restoring hearing. A cochlear implant is an electronic device that partially restores hearing. It can be an option for people who have severe hearing loss from inner-ear damage who are no longer helped by using hearing aids.​

A client with Meniere's disease is experiencing severe vertigo. Which instruction would the nurse give to the client to assist in controlling the vertigo? A. Increase sodium in the diet. B. Increase fluid intake to 3000 ml a day. C. Avoid sudden head movements. D. Lie still and watch the television.

C. Avoid sudden head movements. The nurse instructs the client to make slow head movements (avoiding sudden head movements) to prevent worsening of the vertigo. Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid sometimes are prescribed. Lying still and watching television will not control vertigo.

During a hearing assessment, the nurse notes that the sound lateralizes to the clients left ear with the Weber test. The nurse accurately documents this result as which finding? A. a normal finding B. a sensorineural or conductive loss C. a conductive hearing loss in the right ear D. the presence of nystagmus

C. a conductive hearing loss in the right ear In the Weber tuning fork test the nurse places the vibrating tuning fork in the middle of the client's head, at the midline of the forehead, or above the upper lip over the teeth. Normally, the sound is heard equally in both ears by bone conduction. If the client has a sensorineural hearing loss in one ear, the sound is heard in the other ear. If the client has a conductive hearing loss in one ear, the sound is heard in that ear.

After the health care provider assesses Debbie, the nurse notes she has been diagnosed with severe otosclerosis. Which explanation should the nurse provide to explain the diagnosis to Debbie? A. nystagmus that occurs with aging B. tinnitus that occurs with aging C. a conductive hearing loss that occurs with aging D. a sensorineural hearing loss that occurs with aging

C. a conductive hearing loss that occurs with aging Otosclerosis usually causes a conductive hearing loss, a hearing loss caused by a problem in the outer or middle ear. Presbycusis, a type of sensorineural hearing loss associated with aging, includes the loss of peripheral auditory sensitivity, a decline in word recognition ability, and associated psychologic and communication issues. Tinnitus is associated with damage to the hairs of the inner ear, chronic health conditions, and injuries or conditions that affect the nerves in the ear or the hearing center in of the brain. Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements.

The nurse discussing treatment options with a client diagnosed with Meniere's disease should include information about which diet? A. low-fat diet B. low-cholesterol diet C. low-sodium diet D. low-carbohydrate diet

C. low-sodium diet A client with Meniere's disease accumulates endolymphatic fluid in the inner ear that can result in dizziness. A low-sodium diet will help reduce the amount of endolymphatic fluid that contributes to the client's symptoms. The symptoms of the disease are not impacted by the level of cholesterol, carbohydrates, or fat in the diet.

The nurse is performing a whisper test to assess hearing. Which statement best describes the accurate procedure for performing this test? A. Stand 4 feet away from the client to ensure that the client can hear at this distance. B. Whisper a statement with the examiners back facing the client. C. Whisper a statement while the client blocks both ears. D. Whisper a statement and ask the client to repeat it.

D. Whisper a statement and ask the client to repeat it. The examiner stands 1-2 feet behind the client and asks the client to block one external ear canal. The nurse whispers a statement and asks the client to repeat it. Each ear is tested separately. If the patient responds correctly, hearing is considered normal and no further screening is necessary on that ear. To assure the whispered statement is as quiet as possible, the examiner should exhale before speaking.

When discussing the causes of hearing loss with a community group the nurse shares that nerve deafness would most likely result from an injury or infection that damaged which nerve? A. vagus nerve B. vestibular nerve C. trigeminal nerve​ D. cochlear nerve

D. cochlear nerve

A client is diagnosed with a disorder involving the inner ear. Which factor is the most common client symptom associated with a disorder in this part of the ear? A. burning of the ear B. hearing loss C. pruritus D. tinnitus

D. tinnitus Tinnitus is the most common complaint of clients with otologic disorders, especially disorders involving the inner ear. Symptoms of tinnitus range from mild ringing in the ear, which can go unnoticed during the day, to a loud roaring in the ear, which can interfere with the client's thinking process and attention span.

The hearing aids did not help Debbie's hearing. She underwent a fenestration procedure for the treatment of otosclerosis. Which statement by Debbie should indicate to the nurse that discharge teaching was effective? A. "It's ok to take a shower and wash my hair." B. "I should drink liquids through a straw for the next 2-3 weeks." D. "I can resume my tennis lessons starting next week." E. "I will take stool softeners as prescribed by my doctor."

E. "I will take stool softeners as prescribed by my doctor." Following ear surgery, the client needs to avoid straining while having a bowel movement. The client needs to be instructed to avoid drinking through a straw for 2-3 weeks, air travel, and coughing excessively. The client needs to avoid getting his or her hair wet, washing hair, showering for 1 week, and rapidly moving the head, bouncing, and bending over for 3 weeks.

Sensorineural Hearing Loss: Treatment

a hearing aid may help some patients, but it only makes sounds and speech louder, NOT clearer

Presbycusis

a type of sensorineural hearing loss associated with aging, includes the loss of: ● peripheral auditory sensitivity ● a decline in word recognition ability ● associated psychological and communication issues

Menière's Disease

an alteration of the inner ear

Functional Hearing Loss

an emotional or a psychological factor can cause functional hearing loss

Menière's Disease: Audiogram

assess for mid- or low-frequency sensorineural hearing loss in the affected ear or ears

Cochlear Nerve

because the organ of hearing is the organ of Corti, located in the cochlea, nerve deafness would most likely happen

Rinne Test: Sensorineural Hearing Loss Results

both AC and BC are reduced, but AC remains longer

Menière's Disease: Nursing Care

the client with Menière's disease is at risk for injury; therefore, nursing care should focus on: ● maintaining client safety ● minimizing the symptoms of the attack

Mixed Hearing Loss​: Treatment

careful evaluation is needed because the sensorineural hearing loss will still be present even after the corrective surgery for conductive loss is completed

Menière's Disease: Speech Discrimination Test

confirm suspected infection, identify the organism, and guide selection of antibiotic

Congenitally Deaf

deaf since birth with a hearing loss of 90 dB or greater

Menière's Disease: Electronystagmography

discover mastoid or temporal bone destruction or masses

X-rays, CT, or MRI​

discover mastoid or temporal bone destruction or masses​

Mixed Hearing Loss​

due to a combination of conductive and sensorineural causes: ● impacted cerumen ● otitis media with effusion ● tympanic membrane (TM) perforation ● otosclerosis ● narrowing of the external auditory canal ● congenital and hereditary factors ● noise exposure ● aging (presbycusis) ● Menière's disease ● trauma ● ototoxicity

Auditory Subjective Abnormal Findings

during the auditory/ear assessment these include such items as: ✹tinnitus ✹feeling of fullness in the ear

Menière's Disease: Glycerol Test

establish hearing loss

Audiogram

establish hearing loss​

Menière's Disease: Patho

excess endolymph (fluid in the inner ear) gradually accumulates and can lead to a ruptured membrane

Stapedectomy Surgery: Post Op

following ear surgery, the client needs to AVOID: ● straining while having a bowel movement ● drinking through a straw for 2-3 weeks ● air travel ● coughing excessively ● getting his or her hair wet, washing hair, showering for 1 week ● rapidly moving the head ● bouncing ● bending over for 3 weeks

Menière's Disease: Discharge Teaching

highlight lifestyle adjustment in your discharge teaching with the client. Key points include: ● maintain safety at home following discharge ● avoid stimulants, such as coffee, nicotine, and alcohol ● teach client to maintain a low-sodium diet (2,000mg/day or less) to prevent the buildup of endolymph in the inner ear ​ ● discuss techniques to reduce stress

Weber Test: Conductive Hearing Loss Results

in one ear, the sound will be heard louder (lateralizes) in that ear

Rinne Test: Conductive Hearing Loss Results

the relationship is reversed; BC is longer than AC

Deafness: Communication Barriers

interference in communication and interaction with others can be the source of many problems for the deaf client and caregiver: ● the client may refuse to admit to or may be unaware of impaired hearing ● irritability is common because the client must concentrate so hard to understand speech ● the loss of clarity of speech in the client with sensorineural hearing loss is most frustrating ● the client may hear what is said but not understand it ● withdrawal, depression, and accelerated cognitive decline are often associated with advancing hearing loss

Central Hearing Loss

involves an inability to interpret sound, including speech because of a problem in the central nervous system (CNS)

Sensorineural Hearing Loss

is caused by impairment of function of the inner ear or the vestibulocochlear nerve (CN VIII), such as: ● congenital and hereditary factors ● noise exposure ● aging (presbycusis) ● Menière's disease ● trauma ● ototoxicity

Medical History

like otitis media, many factors affecting the client's ear are a result of their early childhood health problems and therefore, the nurse needs to assess the client's: ● past medical history ● history of frequent middle ear infections as a child ● the use of medications that may cause damage to the ears​

Auditory System

major function of this system focuses on balance, hearing, amplification of sound waves, and reception and perception of sounds, consists of: ● external ● middle ● inner

AOM: Complication

mastoiditis because the mucous membrane of the middle ear is continuous with the air cells of the mastoid bone, both the mucous membrane and mastoid bone can be involved in the chronic infectious process

Ear infections

may be caused by viruses or bacteria and can affect the ear canal or the middle ear, such as: ● acute otitis externa (AOE) ● otitis media ● mastoiditis *when not properly treated, the client may experience recurrent occurrences that can lead to chronic otitis media and serious complications such as tympanic membrane perforation and hearing loss* ​

Non-Syndromic Heredity Hearing Loss

most persons have non-syndromic hearing impairment, in which hearing loss is the only primary problem: ● GJB2 gene mutations are one of the most common causes of non-syndromic hearing loss, these result in changes in the production of the protein Connexin 26, which has a role in the cochlear function ● other genetic mutations increase the risk for ototoxicity or result in malformations of structures in the middle and/or inner ear

Age-Related Hearing Changes

normal aging of the ears can lead to: ● drier cerumen ● tinnitus ● auditory nerve damage ● atrophy of the tympanic membrane ● ability to hear high-pitched sounds decreases

Conductive Hearing Loss

occurs when conditions in the outer or middle ear impair the transmission of sound through air to the inner ear, common of causes conductive hearing loss in adults include: ● impacted cerumen ● otitis media with effusion ● tympanic membrane (TM) perforation ● otosclerosis ● narrowing of the external auditory canal

Deafness

often called the "unseen handicap" because you may not realize the difficulty in communication with a deaf person until you begin a conversation with them

Presbycusis: Clinical Manifestations

older adults with presbycusis gradually lose: ● the ability to understand speech because their recognition of consonants (high-frequency sounds) is decreased, consonants enable individuals to recognize spoken words ● while older adults can hear vowels, they cannot distinguish consonants in the high-frequency range ● may lead to confusion and embarrassment due to the discrepancy in what was said and what was heard

Decibel Level (dB)

or loss as recorded on the audiogram can classify hearing loss

Menière's Disease: Complication

permanent hearing loss

Stapedectomy Surgery

replaces the fixed stapes with a device that vibrates, restoring hearing

Mixed Hearing Loss​: Clinical Manifestations​

sound is heard being both softer and more difficult to understand

Otosclerosis​: Patho

spongy bone develops from the bony labyrinth, preventing movement of the footplate of the stapes in the oval window; this reduces the transmission of vibrations to the inner ear fluids and results in conductive hearing loss

Symptom Relief​

there are ways to relieve symptoms associated with ear infections, like ear pain, whether antibiotics are needed or not: ● consider using acetaminophen or ibuprofen to relieve pain or fever ● antibiotics, such as amoxicillin, are used to treat severe ear infections or ear infections that last longer than 2-3 days ● if the client has a fever of 102.2°F (39°C) or higher, discharge or fluid coming from the ear, symptoms are much worse, or symptoms last for more than two or three days for AOM, the client should contact their provider

Hearing Aid Care​: How to Clean

these tips apply to all hearing aid models and styles: ● turn the hearing aid upside down while cleaning ports and openings; then any debris dislodged will fall out instead of in​ ● open the battery compartment at night; it will extend the life of the battery and allow the compartment to air out​ ● when changing the battery, brush the battery compartment clean​ *remember to check with the client for information specific to their make and model*

Delayed Prescribing

this means that your provider may give your client an antibiotic prescription but ask them to wait 2-3 days to see if fever, ear pain, or other symptoms still remain before filling the prescription

Whisper Test

to complete a general test of hearing, the nurse stands 1-2 feet behind the client and asks the client to block one external ear canal. The nurse whispers a statement and asks the client to repeat it: ● if the client responds correctly, hearing is considered normal and no further screening is necessary on that ear ● a client who does not understand what was said should be assessed by an audiologist to determine the extent of hearing loss ● each ear is tested separately ● to assure the whispered statement is as quiet as possible, the examiner should exhale before speaking

Menière's Disease: Prochlorperazine

to decrease N/V

Menière's Disease: Mild Diuretics

to decrease the pressure from the excess accumulation of endolymph

Menière's Disease: Meclizine

to reduce vertigo

Central Hearing Loss: Clinical Manifestations​

usually have poor scores on the portions of the audiogram: ● speech reception threshold (SRT) ● word recognition scores (WRS)

Otoscopic Examination​

visualize tympanic membrane​

Acute Otitis Media (AOM)

● It occurs when fluid builds up in the middle ear and is often caused by bacteria but can be caused by viruses ● may not need antibiotics in many cases because the body's immune system can fight off the infection without help from antibiotics, but sometimes antibiotics are needed

Otitis Media with Effusion (OME)

● It occurs when fluid builds up in the middle ear without pain, pus, fever, or other signs and symptoms of infection ● usually goes away on its own ● DOES NOT benefit from antibiotics, but sometimes antibiotics are needed

Hearing Aid Care​: Be Careful​

● NEVER get water on the hearing aid device; it can damage the sensitive electronics​ ● NEVER use chemical solutions or wipes that are not made for use with hearing aids​ ● NEVER insert anything into the microphone or receiver ports and be careful not to push wax or dirt into the opening

Contributors to Hearing Loss

● age ● recurrent ear infections ● certain medications ● certain diseases ● diabetes ● environmental or occupational exposure to loud noises *excessive hair in the ears and a history of tobacco use are more likely to contribute to infection than hearing loss*

Common Early Signs of Hearing Loss

● answer questions inappropriately and have no responses when not looking at the speaker ● strain to hear ● cup the hand around the ear ● read lips ● have an increased sensitivity to slight increases in noise level *often the patient is unaware of minimal hearing loss, family and friends who get tired of repeating or talking loudly are often the first to notice the hearing loss; pressure exerted by significant others is a significant factor in whether the patient seeks help for hearing impairment*

Hearing Aid Care​: Weekly Detail​

● approximately once per week, spend a little more time carefully removing additional dirt and buildup on the ear molds ● use a wax pick/wire loop to gently remove any stubborn deposits or wax buildup ● DO NOT use the pick around the microphone or receiver ports​ ● for models with wax guards, check and replace the wax guard as needed​

Central Hearing Loss: Treatment

● careful history is helpful because there are usually cases of deafness in the family ● refer the patient to a qualified hearing and speech service if indicated

Menière's Disease: Causes

● cause is unknown, but can be triggered by a combination of health problems, such as: ➥ allergies ➥ viruses ➥ trauma ➥ genetic predisposition ● common in adult clients between the ages of 40-50 years

Inner Ear

● cochlear (associated with hearing) ● semicircular canal (associated with balance) ● vestibule (associated with balance)

Culture & Sensitivity​

● confirm suspected infection ● identify the organism ● guide selection of antibiotic​

Deafness: Keys for Communicating

● confirm the deaf client's understanding of your health teaching consistently ● use descriptive visual aids as needed ● if the significantly hearing-impaired person uses sign language to communicate, the Americans with Disabilities Act requires providing an interpreter when presenting significant information such as for patient consent or discharge teaching

Presbycusis: Causes

● degenerative changes in the inner ear ● noise exposure

Otosclerosis​: Interprofessional Care ​

● diagnostic assessment​ ● history and physical examination​ ● otoscopic examination​ ● Rinne test​ ● Weber test​ ● audiometry​ ● tympanometry

Communicating With Clients With Hearing Impairment​: Nonverbal Aids​

● draw attention with hand movements ● have speaker's face in good light ● avoid light behind the speaker ● maintain eye contact ● avoid covering mouth or face with hands ● avoid chewing, eating, or smoking while talking ● remove background noise ● move close to better ear

Menière's Disease: Interventions

● during an acute attack, provide safety and comfort by: ➥ placing the client in a quiet and dark environment ➥ raising the side rails up ➥ bed in the lowest position ● provide emotional support ● address psychosocial problems, such as: ➥ anxiety ➥ depression

Hearing Aids

● during the early stages of otosclerosis the auditory ossicles have not yet become fixed, since vibrations occur, a hearing aid can amplify the waves to improve hearing ● become less effective as otosclerosis progresses due to increased fixation of the stapes

AOM: Clinical Manifestations

● fever ● ear pain ● sometimes general malaise ● assessment findings may reveal a bulging and painful tympanic membrane

Otosclerosis​: Management

● hearing aid​ ● surgery (stapedectomy or stapes prosthesis)​ ● drug therapy ​➥ calcium carbonate​ ➥ sodium fluoride with vitamin D​

Otosclerosis​

● is a hereditary autosomal dominant disease ● it is the most common cause of hearing loss in young adults ● typically bilateral, one ear may show faster progression of hearing loss ● client is often unaware of the problem until the loss becomes so severe that communication is difficult

Cochlear Implant

● is an electronic device that partially restores hearing ● it can be an option for people who have severe hearing loss from inner-ear damage who are no longer helped by using hearing aids

Syndromic Heredity Hearing Loss

● is associated with other clinical abnormalities, such as malformations of the external ear or problems involving other organs ● there are more than 400 syndromes that include hearing loss

Tinnitus and Hearing Loss

● is the perception of sound in the ears where no external source is present ● "ringing in the ears" or "head noise" ● sometimes the first symptom of hearing loss, especially in older adults ● may be soft or loud, high-pitched, or low-pitched ● occurs because of noise exposure ● also can be a drug side effect

Acute Otitis Externa (AOE)

● is the scientific name for an infection of the ear canal, which is also called swimmer's ear ● is usually treated with antibiotic ear drops

Rinne Test

● is to compare hearing by bone conduction (BC) and air conduction (AC) ● normally, sound is heard twice with the same time length, for both in front of the ear and on the bone

Prescribe After Watchful Waiting

● mild AOM will often get better on its own without antibiotic treatment, so your provider may recommend watchful waiting before prescribing antibiotics ● this means that your provider may wait a few days before deciding whether to prescribe antibiotics, while treating the symptoms of AOM ● watchful waiting gives the immune system time to fight off the infection first before starting antibiotics ● if your client does not get better in 2-3 days or get worse, antibiotics will be administrated

Hearing Aid Care​: Daily Basics​

● morning is best because the hearing aid has had time to dry overnight, making wax and buildup easier to remove ● gently brush the microphone cover to remove wax or debris​ ● wipe down the entire hearing aid gently with a soft cloth​

Sudden Hearing Loss

● occurs as an unexplained, rapid loss of hearing (usually in one ear) either at once or over several days ● it is a medical emergency, and the client should see a healthcare provider (HCP) at once

AOM: Chronic Otitis Clinical Manifestations

● purulent exudate may drain from the affected ear ● the surrounding mastoid bone can become infected ● the client may also complain of nausea and dizziness

Menière's Disease: Nursing Diagnoses

● risk for injury related to an altered mobility​ ● anxiety related to the effects of vertigo​

Presbycusis: Treatment

● sound amplification with the right device is often helpful in improving the understanding of speech ● an audiologic rehabilitation program can be valuable

Communicating With Clients With Hearing Impairment​: Verbal Aids​

● speak normally and slowly ● do not shout ● do not exaggerate facial expressions ● do not over enunciate ● use simple sentences ● rephrase sentence ● use different words ● write name or difficult words ● speak in normal voice directly into better ear

Menière's Disease: Clinical Manifestations

● sudden onset dizziness ● ear fullness ● tinnitus (ringing in the ears) ● muffled hearing ● hearing loss ● N/V ● feel as if the room is spinning (vertigo) ● may suddenly fall without any LOC

Client Teaching

● take vaccinations ● avoid putting foreign objects ● avoid smoking ● keep ears dry

Conductive Hearing Loss: Clinical Manifestations​

● the audiogram shows better hearing through bone than through air (air-bone gap) ● the patient often speaks softly because hearing his or her own voice (which is conducted by bone) seems loud ● this patient hears better in a noisy environment

Sensorineural Hearing Loss: Clinical Manifestations​

● the client CAN hear sounds but CANNOT understand speech ● lack of the ability to understanding others ● their ability to hear high-pitched sounds (including consonants) diminishes ● sounds become muffled and hard to understand ● an audiogram shows a loss in decibel levels of the 4000-Hz range and eventually the 2000-Hz range

Conductive Hearing Loss: Treatment

● the first step is to identify and treat the cause if possible ● if correction of the cause is not possible, a hearing aid may help if the loss is > 40 to 50 dB

Presbycusis: Emotional or Psychological Factors

● the older adult is often reluctant to use a hearing aid for sound amplification, reasons cited most often include: ➥ cost ➥ appearance ➥ insufficient knowledge about hearing aid ➥ amplification of competing noise ➥ unrealistic expectations ● most hearing aids and batteries are small, and neuromuscular changes such as: ➥ stiff fingers ➥ enlarged joints ➥ decreased sensory perception ● often the care and handling of a hearing aid frustrating for an older person ● some older adults may also tend to accept their losses as part of getting older and believe there is no need for improvement

Functional Hearing Loss: Clinical Manifestations​

● the patient DOES NOT seem to hear or respond to pure-tone subjective hearing tests ● NO physical reason for hearing loss can be found

Menière's Disease: Vertigo Patient Teaching

● turning the entire body, not the head ● dizziness is expected but can be prevented ● shouldn't drive ● turning the client in bed slowly and smoothly will be helpful ● make slow head movements (avoiding sudden head movements) to prevent worsening ● dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid sometimes are prescribed

Health Promotion: Healthy Hearing

● wear ear protection during recreational and work activities involving high noise levels ● monitor your audio level and how long you use personal listening devices ● avoid exposure to excessively loud noise whenever possible ​ ● undergo audiometric screening to detect hearing loss before it progresses ● avoid injury from cotton-tipped applicators and other cleaning materials ● immunizations ● individuals receiving ototoxic drugs or who are exposed to ototoxic agents should be monitored for signs and symptoms of ototoxicity, including: ➥ tinnitus ➥ diminished hearing ➥ balance problems

Auditory Objective Abnormal Findings

✹bulging of the tympanic membrane is visible to the nurse when a visual examination is completed using an otoscope ✹light yellow exudate and a skin polyp can also be verified by the nurse during the examination