Disturbance in Auditory Functions

HEARING LOSS
Description

Genetic syndromes associated with hearing impairment include Waardenburg syndrome, Usher
syndrome, Pendred syndrome, and Jervell and Lange-Nielsen syndrome
• There are also acquired causes of hearing loss which may be caused by TORCH
infections (TOxoplasmosis, Rubella, Cytomegalovirus, Herpes) during pregnancy as well
as trauma or chronic exposure to loud noise
• Hearing loss occurs in men more often than women.
• Adults between the ages of 45 and 54 years have disabling hearing loss.

Conductive hearing loss usually results from an external ear disorder. the efficient transmission
of sound by air to the inner ear is interrupted.

A sensorineural hearing loss involves damage to the cochlea or vestibulocochlear nerve.

Assessment
Deafness is the partial or complete loss of the ability to hear
The nurse should be alert to the following:
• Speech deterioration
• Fatigue
• Indifference
• Social withdrawal
• Insecurity
• Indecision and procrastination
• Suspiciousness
• False pride
• Loneliness and unhappiness
• Tendency to dominate the conversation

Gerontologic Considerations
With aging, changes occur in the ear that may eventually lead to hearing deficits.
• A familial predisposition to sensorineural hearing loss is also seen, manifested by
inability to hear high-frequency sounds, followed in time by the loss of middle and lower
frequencies.
• The term presbycusis is used to describe this progressive hearing loss.
• Depression, isolation, and a decrease in cognitive function can have a negative impact on
quality of life in the older adult with hearing loss.
Nursing Management
Early detection of hearing loss is one of the objectives of Healthy People 2020, and nurses are in
a position to assist in meeting this goal.
• Questions used to assess for hearing loss may include:
• Have you experienced any hearing loss in the past?
• Are you experiencing any hearing loss now?
• Do your family members think that you are having difficulty hearing
• and/or experiencing any hearing loss?

Communicating with People Who Are Hearing Impaired

For the Person Who is Hearing Impaired Whose Speech is Difficult to Understand
• Determine how the person prefers to communicate with others. Do not assume that
writing, gestures, or other means are the best or preferred technique.
• Consider if the person uses sign language. Interpreters are available from American Sign
Language Services, Inc. (ASLI). These specialists provide the best means of
communication, providing accurate, professional services.
• Devote full attention to what the person is saying. Look and listen do not try to attend to
another task while listening.
• Engage the speaker in conversation when it is possible for you to anticipate the replies.
This enables you to become accustomed to any peculiarities in speech patterns.
• Try to determine the essential context of what is being said; you can often fill in the
details from context.
• Do not try to appear as if you understand if you do not.
• If you cannot understand at all or have serious doubt about your ability to understand
what is being said, have the person write the message rather than risk misunderstanding.
Having the person repeat the message in speech, after you know its content, also aids you
in becoming accustomed to the person’s pattern of speech.
• Written communication is an excellent resource. Material should be written at a third-
grade level so that the majority of people can understand it.
For the Person Who is Hearing Impaired Who Speech Reads
• When speaking, always face the person as directly as possible.
• Make sure that your face is as clearly visible as possible. Locate yourself so that your
face is well lighted; avoid being silhouetted against strong light. Do not obscure the
person’s view of your mouth in any way; avoid talking with any object held in your
mouth.
• Be sure that the patient knows the topic or subject before going ahead with what you plan
to say. This enables the person to use contextual clues in speech reading.
• Speak slowly and distinctly, pausing more frequently than you would normally.
Ménière Disease
Description
Ménière disease is an abnormality in inner ear fluid balance caused by a malabsorption in the
endolymphatic sac or a blockage in the endolymphatic duct

Endolymphatic hydrops (dilation of the endolymphatic space) develops, and either increased
pressure in the system or rupture of the inner ear membrane occurs, producing symptoms of
Ménière disease.

Clinical Manifestation
Ménière disease is characterized by a triad of symptoms: episodic vertigo, tinnitus (unwanted
noises in the head or ear), and fluctuating sensorineural hearing loss.
• Feeling of pressure or fullness in the ear
• Incapacitating vertigo
• Nausea
• Vomiting

Cochlear Ménière disease is recognized as a fluctuating, progressive sensorineural hearing loss

associated with tinnitus and aural pressure in the absence of vestibular symptoms or findings

Vestibular Ménière disease is characterized as the occurrence of episodic vertigo associated

with aural pressure but no cochlear symptoms.

Assessment
• Physical examination findings are usually normal, with the exception of those of cranial
nerve VIII.
• Sounds from a tuning fork (Weber test) may lateralize to the ear opposite the hearing
loss.
• An audiogram typically reveals a sensorineural hearing loss in the affected ear. This can
be in the form of a “Pike’s Peak” pattern, which looks like a hill or mountain.
• A sensorineural loss in the low frequencies occurs as the disease progresses.

Dietary Guidelines for Patients with Ménière Disease

The nurse instructs the patient to:
• Limit foods high in salt or sugar. Be aware of foods with hidden salts and sugars.
• Eat meals and snacks at regular intervals to stay hydrated. Missing meals or snacks may
alter the fluid level in the inner ear.
• Eat fresh fruits, vegetables, and whole grains. Limit the amount of canned, frozen, or
processed foods with high sodium content.
 • Drink plenty of fluids daily. Water, milk, and low-sugar fruit juices are recommended.
Limit intake of coffee, tea, and soft drinks. Avoid caffeine because of its diuretic effect.
• Limit alcohol intake. Alcohol may change the volume and concentration of the inner ear
fluid and may worsen symptoms.
• Avoid monosodium glutamate (MSG), which may increase symptoms.
• Pay attention to the intake of foods containing potassium (e.g., bananas, tomatoes,
oranges) if taking a diuretic that causes potassium loss.
• Avoid aspirin and aspirin-containing medications. Aspirin may increase tinnitus and
dizziness.

Pharmacologic therapy

Ménière disease consists of antihistamines, such as meclizine, which shortens the attack.
Tranquilizers such as diazepam (Valium) may be used in acute instances to help control vertigo.
Antiemetic agents such as promethazine (Phenergan) suppositories help control the nausea and
vomiting and the vertigo because of their antihistamine effect.

Surgical Management

Endolymphatic sac decompression, or shunting, theoretically equalizes the

pressure in the endolymphatic space.
A shunt or drain is inserted in the endolymphatic sac through a postauricular incision.

Vestibular nerve sectioning provides the greatest success rate in eliminating the attacks of
vertigo.
Cutting the nerve prevents the brain from receiving input from the
semicircular canals