Hearing and Vision (HEARING PORTION) Flashcards
Exam 2
What happens to the external ear?
Auricle wrinkles and sags
Increased cerumen production
Hearing:
What does a dry canal lead to?
Pruritis
Hearing:
Increased cerumen production with age: What kind? Why does increased cerumen occur?
Hard cerumen
Decreased apocrine gland activity –> accumulation
Hearing:
Internal ear:
What occurs?
Atrophy of organ of Corti and cochlear neurons
Loss of sensory hair cells
Degeneration of the stria vascularis
Age-Related Changes That Affect Hearing
How are sounds coded?
Sounds are coded according to intensity and frequency
Age-Related Changes That Affect Hearing
Intensity or amplitude reflects what? How is it measured?
Intensity or amplitude reflects loudness or softness of sound; measured in decibels (dB)
Age-Related Changes That Affect Hearing
Sounds at what levels are considered ototoxic?
Sounds louder than 80 to 85 (dB) are considered potentially ototoxic
Age-Related Changes That Affect Hearing
What determines pitch?
Frequency determines the pitch: high or low
Age-Related Changes That Affect Hearing
The human auditory system is most sensitive to what frequencies?
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)
Age-Related Changes That Affect Hearing
When are people diagnosed with high frequency hearing loss? How is it measured?
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
Structure of the Ear and age-related changes
Where does hearing begin?
Hearing begins with external ear
Structure of the Ear and age-related changes
What are the three main parts of the ear?
External ear
Middle ear
Inner ear
Structure of the Ear and age-related changes
External ear: Pinna
Pinna: cartilaginous structure
Structure of the Ear and age-related changes
External ear: Pinna- what does it not do?
Does not affect the change in conduction of sound
Structure of the Ear and age-related changes
External ear: Auditory canal- what is it made up of?
Auditory canal: covered with skin, lined with hair follicles, and cerumen-producing glands
Structure of the Ear and age-related changes
External ear: Cerumen
Aging increases the potential for cerumen accumulation—complaint is hearing loss No additional s/s, painless.
Structure of the Ear and age-related changes
Middle ear: What is included in it?
Tympanic membrane:
Structure of the Ear and age-related changes
Middle ear:
Tympanic membrane: What is it?
separates outer and middle ear
Structure of the Ear and age-related changes
Middle ear:
Tympanic membrane: What does it do?
transmit sound energy and protect middle and inner ear
Structure of the Ear and age-related changes
Middle ear:
Tympanic membrane: How do sound vibrations pass?
Sound vibrations pass through tympanic membrane to three auditory ossicles
Structure of the Ear and age-related changes
Middle ear:
What can interfere with transfer of sound vibrations?
Calcification of the bones can interfere with transfer of sound vibrations.
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?
Malleus
Incus
Stapes
Structure of the Ear and age-related changes
Middle ear:
With age, what happens?
Middle ear muscles and ligaments become weaker and stiffer with age -weakens protection from loud noises
Structure of the Ear and age-related changes
Inner ear:
Where are vibrations transmitted?
vibrations transmitted to cochlea
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
Structure of the Ear and age-related changes
Inner ear:
Age-related changes: What is there reduction of?
Reduction of blood supply
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
Structure of the Ear and age-related changes
Inner ear:
Age-related changes: What is there a diminution of?
Diminution of endolymph production
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
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
Auditory Nervous System
What is it affected by?
Affected by age-related changes
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
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
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
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
Exposure to Noise
Noise-induced hearing loss (NIHL): How is it viewed?
Noise-induced hearing loss (NIHL): preventable
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
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
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
Ototoxic Medications:
What can cause or contribute to hearing loss?
Adverse medication effects can cause or contribute to hearing loss
Ototoxic Medications:
What do these meds do specifically?
These medication damage the sensory cells in the inner ear that detect sound and motion.
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
Ototoxic Medications:
What does not increase the risk of ototoxicity alone?
*Age alone does not increase the risk for Ototoxicity
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.
Ototoxic Medications:
How can ototoxicity be potentially viewed?
*Ototoxicity is potentially reversible;
.
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
Disease Processes:
How can disease processes be?
Hereditary :
Auditory System Disease:
Medical conditions and systemic diseases:
Disease Processes:
Hereditary: like?
Otosclerosis
Disease Processes:
Auditory System Disease: like?
Ménière’s disease
Acoustic neuromas
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
Hearing impairment by site
Conductive hearing loss- Where is the problem occurring?
External and Middle ear
Hearing impairment by site
Conductive hearing loss- What is exactly the problem?
Physical obstruction of sound wave
Hearing impairment by site
Sensorineural hearing loss - What exactly is the problem?
defect in the cochlea. eight cranial nerve or the brain
Hearing impairment by site
Sensorineural hearing loss - Where is the problem?
Sensory and neural structures of the inner ear causing sound distortion
Hearing impairment by site
Mixed conductive: What kind of hearing loss is this?
Mixed conductive-sensorineural hearing loss and conductive hearing loss
Hearing impairment by site
Hearing impairment types include:
Conductive hearing loss
Sensorineural hearing loss
Mixed hearing loss
Hearing impairment by site
Hearing impairment types include:
Conductive hearing loss
abnormalities of external and middle ear interfering with sound conduction
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
Hearing impairment by site
Hearing impairment types include:
Mixed hearing loss:
involves both conductive and sensorineural impairments
Effects on Communication
Presbycusis: What is it?
sensorineural hearing loss as a result of aging, bilateral
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)
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.
Effects on Communication
Cerumen impaction: What kind of hearing loss is it?
Conductive Hearing Loss
Effects on Communication
Cerumen impaction: What kind of hearing loss is it?
Reduced intensity of sounds and difficulty hearing low pitched tones.
Effects on Communication
Interventions include:
Hygiene
Cerumen removal
Effects on Communication
Cerumen removal
Contra-indications:
Tumors,
Perforated TM,
ear trauma otitis externa,
ear surgery
Effects on Communication
Cerumen removal
How is it done?
Lavage or irrigation-with bulb syringe (Curette- by APN)
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.
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.
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
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
Assessment Tool: (HHIE-S)Hearing Handicap Inventory for the Elderly:
What does it assess? What is interpreted?
Interpretation of the raw score
Care of the Person with a Hearing Disability
What should you encourage?
Encourage audiometric testing
Care of the Person with a Hearing Disability
Encourage audiometric testing- Why?
Problem may not be age-related and could be readily treatable
Care of the Person with a Hearing Disability
What should patient learn?
Learning to live with a hearing deficit (safety, home adaptation)
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.
Care of the Person with a Hearing Disability
What can seriously be effected for patient?
Physical, emotional, and social health can be seriously affected
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
Hearing Aids:
How does someone obtain hearing aids?
Need for complete audiometric examination by an audiologist
