Lecture 11: Sensory Impairment

Question 1

How common are visual/auditory dysfunction?

Answer 1

75% have dysfunction not reported to their physicians

Question 2

What are the 6 types of functional vision changes that can occur?

Answer 2

1. Visual acuity: rods/cones malfunction
2. Extraocular motion (difficulty looking upward and maintaining convergence)
3. Intraocular pressue
4. Refractive power (all the opias)
5. Tear secretion (irritation, less tear secretion)
6. Corneal function (endothelium loses integrity)

Question 3

What are the key clinical points regarding vision/hearing problems?

Answer 3

1. Increased incidence with age but most causes are treatable
2. Hearing impairment increases with age and some types can be corrected
3. Combination of vision and hearing impairment may predispose one to falls and development of dependence.

Question 4

What is presbyopia and what causes it?

Answer 4

• Inability to focus sharply for near vision due to age.
• Sclerosis of the lens and atrophy of the ciliary muscle
• Can affect balance

Question 5

What is considered legally blind?

Answer 5

> = 20/200 OR a total visual field < 20deg

Question 6

What are the 4 MCC of age-related vision changes?

Answer 6

• Cataracts (sunlight, diabetes, steroids, smoking)
• Glaucoma
• Macular degeneration (wet is MC in age-related)
• Diabetic retinopathy

Dry MD is MC overall.

Question 7

What two medication classes are known for ototoxicity?

Answer 7

• Aminoglycosides (micins/mycins)
• Macrolides (ACE mycins)

Question 8

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What kind of hearing loss is usually due to age?

Answer 8

High frequency (presbycusis)

Question 9

What are the screening tools for hearing loss?

Answer 9

• Standard test
• Binaural tests
• Difficult speech tests

Question 10

What 3 hearing loss tests are required in the initial medicare annual wellness visit?

Answer 10

• Weber
• Rinne
• Whisper

Question 11

What are some ways to improve communication with someone with hearing loss?

Answer 11

• Decrease BKG noise
• Voice amplifier
• Speak SLOWER not louder
• Teach back

Question 12

What should everyone with communication difficulties caused by permanent hearing loss receive?

Answer 12

• ENT evaluation
• Audiological evaluation

Question 13

What noise level is a hearing aid best at helping?

Answer 13

55-80 dB loss. >80 is eh.

Question 14

When is surgery indicated for sensorineural hearing loss?

Answer 14

Severe hearing loss not corrected with hearing aids

Question 15

What ear surgeries may help with hearing?

Answer 15

• Middle ear implant
• Cochlear implant (inner ear damage)

Question 16

How does a cochlear implant work?

Answer 16

1. Sound processing that bypasses the ear to send signals straight to the nerve.
2. Receiver under the skin behind the ear receives signals.
3. Takes about a year for someone to make considerable gains in understanding speech

Brain must adapt to the signals sent by the implant