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Hearing and Vision (HEARING PORTION) Flashcards

Exam 2

1
Q

What happens to the external ear?

A

Auricle wrinkles and sags
Increased cerumen production

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2
Q

Hearing:

What does a dry canal lead to?

A

Pruritis

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3
Q

Hearing:

Increased cerumen production with age: What kind? Why does increased cerumen occur?

A

Hard cerumen

Decreased apocrine gland activity –> accumulation

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4
Q

Hearing:

Internal ear:
What occurs?

A

Atrophy of organ of Corti and cochlear neurons

Loss of sensory hair cells

Degeneration of the stria vascularis

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5
Q

Age-Related Changes That Affect Hearing

How are sounds coded?

A

Sounds are coded according to intensity and frequency

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6
Q

Age-Related Changes That Affect Hearing

Intensity or amplitude reflects what? How is it measured?

A

Intensity or amplitude reflects loudness or softness of sound; measured in decibels (dB)

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7
Q

Age-Related Changes That Affect Hearing

Sounds at what levels are considered ototoxic?

A

Sounds louder than 80 to 85 (dB) are considered potentially ototoxic

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8
Q

Age-Related Changes That Affect Hearing

What determines pitch?

A

Frequency determines the pitch: high or low

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9
Q

Age-Related Changes That Affect Hearing

The human auditory system is most sensitive to what frequencies?

A

The human auditory system is most sensitive to frequencies between 2,000 and 5,000 Hz. ( but is able to hear lower or higher frequencies as well)

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10
Q

Age-Related Changes That Affect Hearing

When are people diagnosed with high frequency hearing loss? How is it measured?

A

People are diagnosed with high frequency hearing loss if they are unable to hear sounds between 2,000 Hz and 8,000 Hz, which is measured on an audiogram

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11
Q

Structure of the Ear and age-related changes

Where does hearing begin?

A

Hearing begins with external ear

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12
Q

Structure of the Ear and age-related changes

What are the three main parts of the ear?

A

External ear

Middle ear

Inner ear

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13
Q

Structure of the Ear and age-related changes

External ear: Pinna

A

Pinna: cartilaginous structure

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14
Q

Structure of the Ear and age-related changes

External ear: Pinna- what does it not do?

A

Does not affect the change in conduction of sound

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15
Q

Structure of the Ear and age-related changes

External ear: Auditory canal- what is it made up of?

A

Auditory canal: covered with skin, lined with hair follicles, and cerumen-producing glands

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16
Q

Structure of the Ear and age-related changes

External ear: Cerumen

A

Aging increases the potential for cerumen accumulation—complaint is hearing loss No additional s/s, painless.

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17
Q

Structure of the Ear and age-related changes

Middle ear: What is included in it?

A

Tympanic membrane:

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18
Q

Structure of the Ear and age-related changes

Middle ear:

Tympanic membrane: What is it?

A

separates outer and middle ear

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19
Q

Structure of the Ear and age-related changes

Middle ear:

Tympanic membrane: What does it do?

A

transmit sound energy and protect middle and inner ear

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20
Q

Structure of the Ear and age-related changes

Middle ear:

Tympanic membrane: How do sound vibrations pass?

A

Sound vibrations pass through tympanic membrane to three auditory ossicles

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21
Q

Structure of the Ear and age-related changes

Middle ear:

What can interfere with transfer of sound vibrations?

A

Calcification of the bones can interfere with transfer of sound vibrations.

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22
Q

Structure of the Ear and age-related changes

Middle ear:

Sound vibrations pass through tympanic membrane to three auditory ossicles. Calcification of the bones can interfere with transfer of sound vibrations.

What are the three things?

A

Malleus

Incus

Stapes

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23
Q

Structure of the Ear and age-related changes

Middle ear:

With age, what happens?

A

Middle ear muscles and ligaments become weaker and stiffer with age -weakens protection from loud noises

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24
Q

Structure of the Ear and age-related changes

Inner ear:

Where are vibrations transmitted?

A

vibrations transmitted to cochlea

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25
Structure of the Ear and age-related changes Inner ear: Age-related changes: What is there a loss of?
Loss of hair cells and neurons Few hair cells and neurons
26
Structure of the Ear and age-related changes Inner ear: Age-related changes: What is there reduction of?
Reduction of blood supply
27
Structure of the Ear and age-related changes Inner ear: Age-related changes: What is there a decrease in? What is a degeneration of?
Decreased basilar membrane flexibility Degeneration of spiral ganglion
28
Structure of the Ear and age-related changes Inner ear: Age-related changes: What is there a diminution of?
Diminution of endolymph production
29
Structure of the Ear and age-related changes Any degeneration of the inner ear structures will lead to what?
Any degeneration of the inner ear structures will lead to hearing loss
30
Structure of the Ear and age-related changes Ototoxic medication: What do they do?
Affect the sensory cells in the inner ear that detect sound and motion
31
Auditory Nervous System What is it affected by?
Affected by age-related changes
32
Auditory Nervous System Affected by age-related changes like?
Degenerative changes in inner ear Narrowing of auditory meatus from bone apposition Diminished blood supply Central nervous system changes
33
Risk Factors That Affect Hearing Wellness: What is hearing loss associated with?
Hearing loss associated with lifestyle, heredity /genetic* non modifiable environmental factors, medications, impacted cerumen, disease conditions
34
Risk Factors That Affect Hearing Wellness: Risk factors for hearing impairment:
male gender, increased age, genetic predisposition, exposure to loud noise(NIHL-Noise Induced Hearing Loss), impacted cerumen, smoking, exposure to secondhand smoke, ototoxic medications (NSAID’s) and certain medical conditions
35
Risk Factors That Affect Hearing Wellness: What are modifiable risk factors for hearing loss?
*Modifiable and preventable risk factors for hearing loss include noise, medications and impacted cerumen
36
Exposure to Noise Noise-induced hearing loss (NIHL): How is it viewed?
Noise-induced hearing loss (NIHL): preventable
37
Exposure to Noise Noise-induced hearing loss (NIHL): How does it occur?
Prolonged or intermittent exposure to noise Associated with occupations (OSHA, NIOSH) and recreational activities Exposure to toxic chemicals: risk factor for loss
38
Which is the most prevalent risk factor for impaired hearing? A. Use of ototoxic medications B. Exposure to noise C. Age-related changes of the ear D. Genetic factors
B. Exposure to noise The most prevalent risk factor for impaired hearing is exposure to noise, which can be viewed as both a lifestyle choice and an environmental factor. Prolonged or intermittent exposure to noise during occupational or leisure activities is a common and usually avoidable risk factor for damage to the auditory system
38
Exposure to Noise What is the leading cause of hearing loss? How is it viewed?
Impacted cerumen/impacted wax: leading cause of hearing loss which is preventable and treatable
39
Ototoxic Medications: What can cause or contribute to hearing loss?
Adverse medication effects can cause or contribute to hearing loss
40
Ototoxic Medications: What do these meds do specifically?
These medication damage the sensory cells in the inner ear that detect sound and motion.
41
Ototoxic Medications: These medication damage the sensory cells in the inner ear that detect sound and motion. What is included?
Aminoglycosides ( Gentamicin, Neomycin) Aspirin *not 81mg –higher doses Loop diuretics (Furosemide, Bumetanide) Chemotherapy
42
Ototoxic Medications: What does not increase the risk of ototoxicity alone?
*Age alone does not increase the risk for Ototoxicity
43
Ototoxic Medications: *Older adults are more likely to have conditions that increase the risk for medication related ototoxicity such as:
*Older adults are more likely to have conditions that increase the risk for medication related ototoxicity such as renal failure, dehydration and for interaction between two ototoxic medications.
44
Ototoxic Medications: How can ototoxicity be potentially viewed?
*Ototoxicity is potentially reversible; .
45
Ototoxic Medications: Why may meds be overlooked as a causative factor of hearing loss?
medications may be overlooked as a causative factor if the hearing loss is mistakenly ascribed to inevitable and irreversible degenerative changes
46
Disease Processes: How can disease processes be?
Hereditary : Auditory System Disease: Medical conditions and systemic diseases:
47
Disease Processes: Hereditary: like?
Otosclerosis
48
Disease Processes: Auditory System Disease: like?
Ménière’s disease Acoustic neuromas
49
Disease Processes: Medical conditions and systemic diseases: like?
Diabetes Cerebrovascular disorders Hypothyroidism Radiation to the head or neck Hypertension Viral infections Head injury Meningitis Hyperthermia
50
Hearing impairment by site Conductive hearing loss- Where is the problem occurring?
External and Middle ear
51
Hearing impairment by site Conductive hearing loss- What is exactly the problem?
Physical obstruction of sound wave
52
Hearing impairment by site Sensorineural hearing loss - What exactly is the problem?
defect in the cochlea. eight cranial nerve or the brain
53
Hearing impairment by site Sensorineural hearing loss - Where is the problem?
Sensory and neural structures of the inner ear causing sound distortion
54
Hearing impairment by site Mixed conductive: What kind of hearing loss is this?
Mixed conductive-sensorineural hearing loss and conductive hearing loss
55
Hearing impairment by site Hearing impairment types include:
Conductive hearing loss Sensorineural hearing loss Mixed hearing loss
56
Hearing impairment by site Hearing impairment types include: Conductive hearing loss
abnormalities of external and middle ear interfering with sound conduction
57
Hearing impairment by site Hearing impairment types include: Sensorineural hearing loss:
abnormalities of sensory and neural structures of inner ear, usually age related or noise induced
58
Hearing impairment by site Hearing impairment types include: Mixed hearing loss:
involves both conductive and sensorineural impairments
59
Effects on Communication Presbycusis: What is it?
sensorineural hearing loss as a result of aging, bilateral
60
Effects on Communication Presbycusis: What is there a diminished ability to do?
Diminished ability to hear high-pitched sounds, especially in the presence of background noise Diminished speech discrimination (difficult with consonants)
61
Effects on Communication Presbycusis: What is a nursing intervention for this?
*Nursing -Ensuring that the patient can directly visualize you when you provide instructions speak with a low tone/low pitch voice Presbycusis -has huge quality of life implications. Helping the client develop coping strategies and find social support systems is the most important thing that the nurse can do.
62
Effects on Communication Cerumen impaction: What kind of hearing loss is it?
Conductive Hearing Loss
63
Effects on Communication Cerumen impaction: What kind of hearing loss is it?
Reduced intensity of sounds and difficulty hearing low pitched tones.
64
Effects on Communication Interventions include:
Hygiene Cerumen removal
65
Effects on Communication Cerumen removal Contra-indications:
Tumors, Perforated TM, ear trauma otitis externa, ear surgery
66
Effects on Communication Cerumen removal How is it done?
Lavage or irrigation-with bulb syringe (Curette- by APN)
67
Effects on Communication Why may people not be aware of hearing change?
One in 3 adults over age 65 has hearing loss. Because of the gradual change in hearing, some people are not aware of the change at first.
68
Effects on Communication Hearing loss often effects what kind of hearing? What is not effected?
Most often, it affects the ability to hear high-pitched noises such as a phone ringing or beeping of a microwave. The ability to hear low-pitched noises is usually not affected.
69
Nursing Assessment of Hearing
Interviewing question Behavioral cues related to hearing Otoscopic examination for impacted cerumen Tuning fork tests for hearing Screening tool: Family history with past and present risks Attitudes about hearing aids if impairment is present Impact of hearing impairment on communication and quality of life
70
Assessment Tool: (HHIE-S) Hearing Handicap Inventory for the Elderly: How many questions is it? How long does it take to administer?
Ten questions Administered in 5 minutes
71
Assessment Tool: (HHIE-S) Hearing Handicap Inventory for the Elderly: What does it assess? What is interpreted?
Interpretation of the raw score
72
Care of the Person with a Hearing Disability What should you encourage?
Encourage audiometric testing
73
Care of the Person with a Hearing Disability Encourage audiometric testing- Why?
Problem may not be age-related and could be readily treatable
74
Care of the Person with a Hearing Disability What should patient learn?
Learning to live with a hearing deficit (safety, home adaptation)
75
Care of the Person with a Hearing Disability Nursing interventions include?
adequate light, low pitched tone, reduce background noise(turn TV off ) face the person, low tone voice.
76
Care of the Person with a Hearing Disability What can seriously be effected for patient?
Physical, emotional, and social health can be seriously affected
77
Hearing Aids: How does it impact hearing? How do you get hearing aids?
Hearing can improve but will not return to normal Purchase only by prescription
78
Hearing Aids: How does someone obtain hearing aids?
Need for complete audiometric examination by an audiologist

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