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Chapter 16: Hearing

Terms in this set (41)

Cerumen
earwax; natural substance that is genetically determined to be either dry or wet; function is to cleanse, protect, and lubricate the ear canal; naturally expelled, but age-related changes (like increased concentration of keratin, growth of longer and thicker hair, and thinning and drying of skin lining canal) can cause it to build up
Age related diminution in sweat gland activity causes:
further increase in potential for cerumen to accumulate by making the cerumen drier and more difficult to remove
Noise-induced hearing loss (NIHL)
preventalbe type of hearing loss; prolonged exposure to high-intensity noise is associated with the following: damage to sensory hair cells of inner ear, permanent shift in hearing threshold, impaired speech discrimination, tinnitus; could be impacted by occupation
Increased risk for NIHL
farmers, miners, construction workers, musicians, bar employees, and casting and forging industry workers
Impacted cerumen
common in older adults as leading cause of hearing loss (up to 57% of older nursing home residents experience this)
Causes of impacted cerumen
age-related changes, which make the cerumen dryer and more concentrated, increase risk; use of hearing aids increases possibility
Ototoxic Medications
adverse med effects can cause/contribute to hearing loss; aminoglycosides, aspirin, loop diuretics, quinine
Disease processes influencing hearing loss
otosclerosis, Meniere disease, acoustic neuromas, diabetes, renal failure, hypothyroidism, cerebrovascular disorders (incl HTN), virus, radiation to head/neck, head injury, high fever, Paget's disease
Most prevalent risk factor for impaired hearing
exposure to noise
Impacted cerumen can cause
pain, otitis, tinnitus, dizziness, fullness, or coughing; it is preventable and treatable
Otosclerosis
hereditary disease of auditory ossicles that causes ankylosis of the footplate of the stapes to the oval window; may begin in youth/early adulthood, but hearing loss may not be detected until middle or later adulthood when age-related changes compound the disease-related changes
Otosclerosis primarily causes
conductive hearing loss, but some sensorineural loss also may occur; initially: difficult to hear soft and low-pitched sounds, as hearing worsens: dizziness, tinnitus, or balance problems
Conductive Hearing Loss
results from abnormalities of the external and middle ear that interfere with sound conduction
Sensorineural hearing loss
caused by abnormalities of the sensory and neural structures of the inner ear, which usually are age related or noise induced
Mixed hearing loss
involves both conductive and sensorineural impairments
Presbycusis
the sensorineural hearing loss associated with an age-related degeneration of the auditory structures; usually occurs in both ears, but degree of impairment in each ear can vary
Early functional consequence of presbycusis
loss of ability to hear high-pitched sounds and sibilant consonants; can cause words to become distorted or jumbled
Psychosocial consequences
depression, social isolation, declines in cognitive function, diminished quality of life
Tinnitus
persistant sensation of ringing, roaring, blowing, buzzing, or other types of noise that don't originate in external environment; symptom of underlying condition
Underlying conditions that could cause tinnitus
impacted cerumen, Meniere disease, traumatic brain injury, or temporomandibular joint disfunction, associated w/ ototoxic meds and hearing loss
Risk factors most commonly associated with tinnitus
same ones associated with hearing loss: older age and increased exposure to noise; caffeine, alcohol, or nicotine can exacerbate tinnitus
Ceruminolytics
ear drop solutions whose primary purpose is to soften cerumen; commonly used to soften it before it can be removed
Assistive Listening Device
any device that amplifies or replaces sounds for individuals or group communication without being individualized
Examples of Assistive Listening Devices
stethoscope, megaphone/microphone, closed-captioned tv, personal listening system (small battery-powered amplifier and headphones), small amp device attached to telephone, cell phones that accommodate ppl with hearing aids/to amplify, visual cues for a doorbell, vibratory stimuli for alarm clock
Hearing Aid
Battery-operated device which consists of an amplifier, microphone, and receiver
Auditory Rehabilitation
services that improve communication for people who are learning impaired; they provide: counseling, education, amplification aids, communication methods, and management of the environment; low compliance
Sound above ___ dangerous to health
80 decibels
Frequency determines:
pitch
Intensity or amplitude reflects:
loudness or softness of sound, measured in decibels
Hearing begins with
external ear
External Ear
Pinna (cartilaginous structure, does not effect the change in conduction of sound), auditory canal (covered w/ skin, lined w/ hair follicles, and cerumen-producing glands); increases potential for cerumen accumulation
Middle Ear
tympanic membrane, three auditory ossicles; middle ear muscles and ligaments become weaker and stiffer w/ age; high pitch hearing will go first
Tympanic membrane
separates outer and middle ear; primary function: transmit sound energy and protect middle and inner ear; sound vibrations pass through here to 3 auditory ossicles
Three Auditory Ossicles
malleus, incus, stapes
Inner Ear
vibrations transmitted to cochlea; age related changes: loss of hair cells and neurons, reduction of blood supply, diminution of endolymph production, decreased basilar membrane flexibility, few neurons and hair cells, degeneration of spiral ganglion; these are primary physiologic cause of the age related hearing impairments that affect older adults
Things affected by age-related changes
degenerative changes in inner ear, narrowing of auditory meatus from bone apposition, diminished blood supply, CNS changes
Risk factors for hearing loss
male, smoking, second hand smoke, ototoxic meds, education level less than/equal to high school
Nursing Assessment of Hearing
otoscopic exam for impacted cerumen, tuning fork tests for hearing (looking at tympanic membrane), family history w/ past and present risks, attitudes about hearing aids, impact of hearing impairment on communication and QOL, behavioral cues
Screening tool to assess hearing
Hearing Handicap Inventory for the Elderly (HHIE-S) - 10 item questionnaire
Use and care of hearing aids
remove the hearing aid in areas with a lot of background noise
Letters of the alphabet that become distorted as hearing loss progresses
b, d, k, p, t (explosive consonants)
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