Hearing

Loss 
• Hearing- transduction of sound
to neural impulses and its
interpretation by the CNS •
Hearing loss- defect at any level
from sound transduction to
interpretation.
 •  Conductive- sound is not conducted efficiently through the outer

TYPES OF ear canal to the eardrum and the tiny bones (ossicles) of the middle
ear . usually results from an external ear disorder, such as impacted
cerumen, or a middle ear disorder.
HEARING • sensorineural loss involves damage to the cochlea or
vestibulocochlear nerve. 
LOSS  • mixed hearing loss has conductive loss and sensorineural loss,
resulting from dysfunction of air and bone conduction. 
• functional (or psychogenic) hearing loss is nonorganic and unrelated
to detectable structural changes in the hearing mechanisms; it is
usually a manifestation of an emotional disturbance.

• Congenital hearing loss is a hearing loss present at birth. It can

include hereditary hearing loss or hearing loss due to other
factors present either in-utero (prenatal) or at the time of birth.
 Etiology 

• Damage to the inner ear

Aging and exposure to loud noise may cause wear and
tear on the hairs or nerve cells in the cochlea that send
sound signals to the brain.
• Gradual buildup of earwax. Earwax can block the ear
canal and prevent conduction of sound waves
• Gradual buildup of earwax. Earwax can block the ear
canal and prevent conduction of sound waves
• Ruptured eardrum (tympanic membrane
perforation).
Risk Factors
• Family history of sensorineural impairment
•  Congenital malformations of the cranial
structure (ear) 
• Low birth weight (<1500 g) 
•  Use of ototoxic medications (eg, gentamicin,
loop diuretics)
•  Recurrent ear infections
•  Bacterial meningitis 
•  Chronic exposure to loud noises
•  Perforation of the tympanic membrane
ANATOMY AND
PHYSIOLOGY
 • Early manifestations of hearing impairment and loss may include tinnitus,
signs and increasing inability to hear in groups, and a need to turn up the volume of
the television. 
symptoms • Hearing impairment can also trigger changes in attitude, the ability to
communicate, the awareness of surroundings, and even the ability to protect
oneself
• A person at home may feel isolated because of an inability to hear.
 Prevention
• The Occupational Safety and Health Administration requires that workers wear
ear protection to prevent noise-induced hearing loss when exposed to noise
above the legal limits.
•  There are no medications that protect against noise-induced hearing loss;
hearing loss is permanent because the hair cells in the organ of Corti are
destroyed.
• Ear protection against noise is the most effective preventive measure available.
medical management

• If a hearing loss is permanent or

untreatable with medical or surgical
intervention or if the patient elects not
to have surgery, aural
rehabilitation may be beneficial.
• Hearing aids
 • TYMPANOPLASTY
Tympanoplasty, also called
eardrum repair, refers to
surgery performed to
reconstruct a perforated
tympanic membrane
(eardrum) or the small bones
of the middle ear. 

SURGICAL MANAGEMENT
 STAPEDECTOMY

•  A surgeon removes all

or part of the original
stapes bone and
replaces it with an
artificial device. The
result allows sound
waves to be sent once
again to the inner ear
for hearing. 
OSSICULAR RECONS
TRUCTION
• is a small electronic device that
electrically stimulates
the cochlear nerve (nerve for
hearing). The implant has
external and internal parts. The
external part sits behind the ear. It
picks up sounds with a
microphone. It then processes the
sound and transmits it to the
internal part of the implant.
 •  is the reconstruction of the middle ear ossicular
OSSICULAR chain which has been disrupted or destroyed, by
the use of some interpositioned devices which
RECONSTRUCTION helps in regaining the original mechanics of the
ossicular chain to transfer the sound energy to
the inner ear.
 FAMILY HISTORY ASSESSMENT

• Assess for other family members in several generations

with hearing loss (autosomal dominant hearing loss) 
NURSING
ASSESSMENTS • Inquire about genetic relatedness (eg, individuals who
are related, such as first cousins, have a higher chance to
share the same recessive genes—autosomal recessive
hearing loss)

• Inquire about age at onset of hearing loss 

• PHYSICAL ASSESSMENT 
• Assess for related genetic conditions, such as vision impairment (eg,
retinitis pigmentosa in Usher syndrome; thyroid disorder in Pendred
syndrome) 
• Assess for iris, pigmentary, and hair alterations (white forelock) seen
in Waardenburg syndrome 
Nursing Management

• The nurse who understands the different

types of hearing loss will be more successful
in adopting a communication style to fit the
patient’s needs. 
• Trying to speak in a loud voice to a person
who cannot hear high-frequency sounds only
makes understanding more difficult.
• using gestures and facial expressions can
help 
•  Providing the services of interpreters or those who can communicate through sign language is
essential in many situations so that the practitioner can effectively communicate with the patient. 
• During health care and screening procedures, the practitioner (eg, dentist, physician, nurse) must be
aware that patients who are deaf or hearing impaired are unable to read lips, see a signer, or read
written materials in dark rooms required during some diagnostic tests.