HearingSound vibrations traveling through air are collected by and

funneled through the external ear, causing the eardrum to

vibrate. Sound waves are then transmitted through auditory

oSsicles as the vibration of the eardrum causes the mal-

leus, the incus, and then the stapes to vibrate. As the stapes

vibrates at the oval window, the sound waves are passed to

the fluid in the inner ear. The movement of this fluid stimu-

lates the hair cells of the spiral organ of Corti and initiates

the nerve impulses that travel to the brain by way of the

acoustic nerve.The transmission of sound waves through the external

and middle ear is referred to as "conductive hearing," and the

transmission of sound waves in the inner ear is referred to as

perceptive or "senisorineural hearing." Therefore, a conductive

hearing loss would be related to a dysfunction of the exter-

nal or middle ear (eg., impacted earwax, otitis media, foreign

object, perforated eardrum, drainage in the middle ear, or oto

sclerosis). A sensorineural loss would be related to dysfunc-

tion of the inner ear (i.e., organ of Corti, cranial nerve VIII, or

temporal lobe of brain).In addition to the usual pathway for sound vibrations

detailed previously, the bones of the skull also conduct sound

waves. This bone conduction, though less efficient, serves to

augment the usual pathway of sound waves through air, bone

and finally fluid (Fig. 17-3).

HEALTH ASSESSMENTBeginning when the nurse first meets the client, assessment

 Of hearing provides important information about the client’s

Ability to interact with the environment. Changes in hearing

Are often gradual and go unrecognized by clients until a severe

Problem develops. Therefore, asking the client specific ques.

Tions about hearing may help in detecting disorders at an early

Stage.

Collecting Subjective Data:

The Nursing Health History

First it is important to gather data from the client about the

Current level of hearing and ear health as well as past and

Family health history problems related to the ear. During data

Collection, the examiner should be alert to signs of hearing

Loss such as inappropriate answers, frequent requests for rep-

Etition, and so on. Collecting data concerning environmental

Influences on hearing and how these problems affect the clent’s usual activities of daily living (ADLs) is
also important.

Answers to these types of questions help you to evaluate a client’s risk for hearing loss and, in turn,
present dways that the client may modify or lower the risk of ear and hearing

Problemns.nt

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