Learning Outcomes: Students should be able to: 1) Define deafness2) State the etiology of hearing loss 3) Explain the pathophysiology of hearing loss 4) State the clinical manifestation of hearing loss 5) Explain the types of hearing loss 6) Discuss the investigations of hearing loss 7) Describe the treatment of hearing loss patient 8) Carried out nursing care plan for the patient

1. BSCN 3052 EYE & ENT
“DEAFNESS”
Nur Amira Binti Ahmad
3067141001
Bachelor Of Science In Nursing (Hons)
KPJ HEALTHCARE UNIVERSITYCOLLEGE
Lecturer:
Madam Salida Binti Johari

2. Learning Objectives
AT the end of this lesson, students should be able to:
1) Define deafness
2) State the etiology of hearing loss
3) Explain the pathophysiology of hearing loss
4) State the clinical manifestation of hearing loss
5) Explain the types of hearing loss
6) Discuss the investigations of hearing loss
7) Describe the treatment of hearing loss patient
8) Carried out nursing care plan for the patient

3. ANATOMY AND PHYSIOLOGY OF EAR
When sound waves enter the ear, it goes down the ear canal (
auditory), and hit the eardrum, which vibrates.
The vibrations from the eardrum pass to the three ossicles (bones called the
malleus (hammer), incus (anvil) and stapes) in the middle ear.
These occicles amplify the vibrations, which are then picked up by small
hair-like cells in the cochlea;
they move as the vibrations hit them, the movement data is sent through the
auditory never to the brain

4. DEFINITION OF DEAFNESS
■ Hearing impairment, deafness, or hearing loss refers to the inability to hear things,
either totally or partially. In a simple definition hearing loss is the reduced ability to
hear sound. Deafness is the complete inability to hear sound. Deafness and hearing
loss have many causes and can occur at any age. (Introduction to Audiology, 8th
Edition)

5. INCIDENCE
■ 360 million people worldwide have disabling hearing loss
■ Hearing loss may result from genetic causes, complications at birth, certain infectious
diseases, chronic ear infections, the use of particular drugs, exposure to excessive noise and
ageing.
■ Half of all cases of hearing loss are avoidable through primary prevention.
■ Current production of hearing aids meets less than 10% of global need.

6. ETIOLOGY
■ Many different conditions lead to partial and total deafness. Ear infections, fluid buildup behind the
eardrum, holes in the eardrum, and problems with the middle ear bones can cause deafness from
conductive hearing loss.
■ Presbycusis, or age-associated hearing loss, also has a genetic component. It is a condition that makes
someone deaf over time as they age due to the slow decay of sensitive hair cells lining the inner ear.
■ Exposure to loud noise in certain occupations from sources such as construction machinery, heavy
equipment, or amplified music can cause sensorineural hearing loss in people of all ages and is the
most common cause of hearing loss.To prevent this type of hearing loss it is important to wear proper
hearing protection and avoid exposure to loud noise whenever possible.
■ Some kinds of sensorineural hearing loss or deafness may be caused by infectious diseases, such as
shingles, meningitis, and cytomegalovirus. In childhood, the auditory nerve can be damaged by
mumps, meningitis,German measles (rubella), or inner ear infections.

7. PATHOPHYSIOLOGY
Damage to the outer, middle & inner ear, aging
process, exposure to loud sounds
Cause wear and tear on the hairs or nerve cells in
the cochlea that send sound signals to brain.
Electrical signal cannot be transmitted efficiently
Symptom of hearing loss such as asking the other
person to repeat back, "Hah", leaning forward

8. TYPES OF DEAFNESS
1. Conductive Hearing Loss
2. Sensorineural Hearing Loss
3. Mixed Hearing Loss
4. Prelingual Deafness
5. Post-lingual Deafness

9. • Caused by any condition or disease that impedes the
conveyance of sound in its mechanical form through the
middle ear cavity to the inner ear.
• A conductive hearing loss can be the result of a
blockage in the external ear canal or can be caused by
any disorder that unfavorably effects the middle ear's
ability to transmit the mechanical energy to the stapes
footplate.
• This results in reduction of one of the physical attributes
of sound called intensity (loudness), so the energy
reaching the inner ear is lower or less intense than that
in the original stimulus.
CONDUCTIVE HEARING LOSS

10. SENSORINEURAL HEARING LOSS
■ Sensorineural hearing loss results from inner ear or auditory nerve dysfunction.
■ The sensory component may be from damage to the organ of Corti or an inability of
the hair cells to stimulate the nerves of hearing or a metabolic problem in the fluids of
the inner ear.
■ The neural or retrocochlear component can be the result of severe damage to the
organ of Corti that causes the nerves of hearing to degenerate or it can be an inability
of the hearing nerves themselves to convey neurochemical information through the
central auditory pathways.

11. MIXED HEARING LOSS
■ A mixed hearing loss can be thought of as a sensorineural hearing loss with a conductive component
overlaying all or part of the audiometric range tested.
■ So, in addition to some irreversible hearing loss caused by an inner ear or auditory nerve disorder,
there is also a dysfunction of the middle ear mechanism that makes the hearing worse than the
sensorineural loss alone.
■ The conductive component may be amenable to medical treatment and reversal of the associated
hearing loss, but the sensorineural component will most likely be permanent. Hearing aids can be
beneficial for persons with a mixed hearing loss, but caution must be exercised by the hearing care
professional and patient if the conductive component is due to an active ear infection.

12. PRELINGUAL DEAFNESS
■ Prelingual deafness refers to the inability to hear properly or at all before the patient learnt how to
utter or understand speech. In such cases the individual was born with a congenital condition or lost
their hearing very early in life, during infancy. People with prelingual deafness have never acquired
speech with sound.
■ In the majority of cases, people with prelingual deafness have hearing parents and siblings, and
were born into families who did not know sign language.Consequently, they also tend to have slow
language development.The very few who were born into signing families tend not to have delays in
language development. If cochlear implants are placed in prelingual deaf children before they are
four years old, they will usually acquire oral language successfully.

13. POST-LINGUAL DEAFNESS
■ Most people with some kind of hearing loss have post-lingual deafness.They
had acquired spoken language before their hearing was diminished. Losing
their sense of hearing may have been caused by a medication side-effect,
trauma, infection, or a disease.
■ In most cases, the person lost their hearing gradually; household members,
friends and teachers may have noticed something was wrong before they
themselves acknowledged the disability. Depending on the severity of hearing
loss, the patient may have had to use hearing aids, had a cochlear implant
inserted, or learnt how to lip-read.

14. UNILATERAL AND BILATERAL DEAFNESS
■ Unilateral deafness (single-sided deafness or SDD) refers to just one ear, while bilateral means a
hearing impairment in both. People with unilateral hearing impairment may find it hard to carry on a
conversation if the other person is on their "deaf" side. P
■ inpointing where a sound is coming from may be more difficult, compared to those who can hear well
with both ears. Understanding what others are saying when there is a lot of noise about may be hard.
When there is no background noise, or very little, a person with unilateral deafness has virtually the
same aural communicative abilities as somebody with normal hearing in both ears.
■ Babies born with unilateral deafness tend to have speech developmental delays.They may find it
harder to concentrate when they go to school. Social activities may be more challenging than it is for
children with no hearing problems.

15. CLINICAL MANIFESTATION
Signs and symptoms of hearing loss may include:
1. Muffling of speech and other sounds
2. Difficulty understanding words, especially against background noise or in a crowd
of people
3. Trouble hearing consonants
4. Frequently asking others to speak more slowly, clearly and loudly
5. Needing to turn up the volume of the television or radio
6. Withdrawal from conversations
7. Avoidance of some social settings

16. INVESTIGATION
INVESTIGATION EXPLAINATION
PHYSICAL
EXAMINATION
The doctor will look in the ear for possible causes of hearing loss, such as earwax or inflammation from an
infection.
GENERAL SCREENING
TEST
The doctor may ask the patient to cover one ear at a time to see how well the patient’s hear words spoken at
various volumes and how doctor respond to other sounds.
TUNING FORKTESTS A tuning fork evaluation may also reveal whether hearing loss is caused by damage to the vibrating parts of
your middle ear (including eardrum), damage to sensors or nerves of inner ear, or damage to both.
THE RINNETEST A Rinne test evaluates hearing loss by comparing air conduction to bone conduction. Air conduction hearing
occurs through air near the ear, and it involves the ear canal and eardrum. Bone conduction hearing occurs
through vibrations picked up by the ear’s specialized nervous system.
THE SCHWABACHTEST It compares the hearing sensitivity of a patient with that of an examiner. The tuning fork is set into vibration,
and the stem is placed alternately againts the mastoid process (the bony protusion behind the ear).
AUDIOMETER TESTS During these more-thorough tests conducted by an audiologist, the patient wear earphones and hear sounds
directed to one ear at a time.The audiologist presents a range of sounds of various tones and asks the
patient to indicate each time they hear the sound.

17. MANAGEMENT
HEARINGAIDS
■ Sound amplification with a hearing aid helps people who have either conductive or
sensorineural hearing loss. Unfortunately, a hearing aid does not restore hearing to
normal.A hearing aid should, however, significantly improve a person's ability to
communicate and enjoy sounds. Many people are reluctant to wear hearing aids
because of social stigma. Doctors should discuss such issues and encourage people to
meet with an audiologist to evaluate the array of different hearing aid designs
available. Some older people and those with arthritis or neurologic problems find it
difficult to manipulate the smallest hearing aids and should consider slightly larger
devices.

18. o Behind-the-ear (BTE) hearing aids - these consist of a dome (earmold)
and a case, with a connection from one to the other. The case is behind the
pinna (outer ear, the part that sticks out); the connection to the dome comes
down the front of the ear. The sound from the device is routed to the ear
either electrically or acoustically. BTE hearing aids tend to last longer than
other devices because the electrical components are located outside the
ear (less moisture and earwax damage). These devices are more popular
with children who need a sturdy and easy-to-use device.
o In-the-canal (ITC) hearing aids - these fill the outer part of the ear canal
and can be seen, but only just. Soft ear inserts, usually made of silicone,
are used to position the loudspeaker inside the ear. These devices fit most
patients straight away, and have better sound quality.
o Completely-in-the canal (CIC) hearing aids - these are tiny devices, but
are not recommended for people with severe hearing loss.
o Bone conduction hearing aids - for patients with conductive hearing loss,
as well as those unable to wear conventional type hearing aids. The
vibrating part of the device is held against the mastoid with a headband.
The vibrations go through the mastoid bone, to the cochlea. These devices
can be painful or uncomfortable if worn for too long.

19. EARWAX REMOVAL

20. COCHLEAR IMPLANT
■ Most profoundly deaf people who cannot hear sounds even with a hearing aid benefit from a
cochlear implant.Cochlear implants provide electrical signals directly into the auditory nerve by
means of multiple electrodes inserted into the cochlea, which is the inner ear structure
containing the auditory nerve. A cochlear implant is needed when people with a hearing aid do
not understand more than half the words in sentences. An external microphone and processor
pick up sound signals and convert them to electrical impulses.The impulses are transmitted
electromagnetically by an external coil through the skin to an internal coil, which connects to the
electrodes.The electrodes stimulate the auditory nerve

21. SIGN LANGUAGE
■ Sign language is a visual language, not a written language like English, Malaysia, French and Duthc.
Teaching a visual language is completely different from teaching a written language. Sign language
itself has its own and unique grammar rules and foundation because it is strongly influenced by Deaf
community’s cultural attributes such as facial expressions, gestures, usage of space, and many
more.The language itself may seem superficial from the outside but if we sink deeper, there’s much
more to the language itself.That goes well to any sign language in any country all over the world.

22. ASSISTIVE DEVICE
■ Several types of assistive devices are available for people who have significant hearing loss.
Light alerting systems enable people to know when the doorbell is ringing or a baby is crying.
Special sound systems help people hear in theaters, churches, or other places where there is
competing noise. Many television programs carry closed captioning, with the dialog shown as
visible text.Telephone communication devices are also available.

23. LIP READING
■ is an important skill for people who have decreased hearing. It is particularly important for people
who can hear but have trouble discriminating sounds, typically those with age-related hearing loss.
■ Observing the position of a speaker's lips allows people to recognize which consonant is being
spoken. Because people whose hearing loss affects high frequencies are unable to understand
consonant sounds, lip reading can significantly improve the comprehension of speech.
■ Lip reading and other strategies for coping with hearing loss are sometimes taught by hearing
professionals in a program called aural rehabilitation. In addition to training in lip reading, people
are taught to gain control over their listening environment by learning to anticipate difficult
communication situations and modifying or avoiding them.

24. PREVENTION OF HEARING LOSS
TV, Radio, Music
Players AndToys
Do not set the volume too high. Children especially are very sensitive to the
damaging effects of loud music. Researchers found that noisy toys put
children's hearing at risk.
Headphones Focus on isolating what you want to hear; block out all outside noise as much as
possible, instead of drowning it out with high volume.
The workplace If you work in a noisy environment, wear ear plugs or ear muffs. Even in discos,
nightclubs, and pubs - ear plugs are discreet and hardly noticeable.
Leisure venues If you go to pop concerts, motor racing, drag racing and other noisy events,
wear ear plugs.

25. Role of nurse in communicating with the hearing
impaired and muteness
■ Speak clearly and naturally.
■ Move closer to the listener.
■ Face the listener while speaking.
■ Restate your message, if needed.
■ Do not cover your mouth.
■ Be patient.
■ Encourage to use hearing aid
■ Encourage client to read lips, if that helps

26. NURSING CARE PLAN
■ Ineffective communication
■ Knowledge deficit

27. Nursing Diagnosis
Supporting Data
ImpairedVerbal Communication related to auditory impairment as evidence by absent of speech to verbal responses and inattention to noise.
Goal Patient will be able to give response in conversation after intervention and throughout hospitalization.
Nursing Intervention 1. Asses the level of hearing impaired of the patient (mild, moderate, severe)
As a baseline data for further intervention
2. Provide conducive environment (calm and quiet)
To encourage effective communication between the patient and the nurses and patient’s relatives
3. Communicate using clear and simple word
To ensure patient can understand and interprete the message. Long sentences may cause the patient to misinterprete
the message.
4. Phrase questions to be answered simply by yes or no
To reduce the confusion in patient to process a lot of information
5. Speak in normal tones and avoid talking too fast. Avoid pressing for response.
Pressing for response may result in frustration in patient
6. Provide alternative methods of communication: pen, paper, pictures.
To assist patient in communication
7. Assist patient to choose the best hearing aids according to the severity of the condition
To help the patient to have a better life style in communicating with the people around
8. Encourage family members to use the alternative methods in communication with the patient and take part in the
activities
To give the patient moral support and to help the patient to be assertive
9. Inform doctor
For further intervention
10. Documentation
To record all the nursing interventions

28. Nursing
Diagnosis
Supporting Data
Knowledge deficit related to home care management secondary to hearing impairment
Goal Patient will be given informations of home care management and demonstrate understanding after intervention and
throughout hospitalization.
Nursing Intervention 1. Asses patient’s ability to hear to determine the severity of the hearing impairment
As a baseline data for further intervention
2. Minimize environmental noise when giving the information to the patient
To encourage effective communication between the nurse and the patient
3.Teach patient or caregiver to administer ear medications by showing the position of the head to allow the medication flow into the ear canal (in
case of hard cerumen or infection)
To ensure the effectiveness of the medication taken
4. Instruct patient or caregiver in safe techniques for cleaning ears.Thin wahclothes and fingers are best for cleaning ears. Cotton-tipped
applicators should be avoided to prevent inadvertent injury to eardrum.
To minimize the injury to the ear which may worsen the condition of the patient
5.Teach patient or caregiver to use and care of the hearing aid or other assistive hearing devices.
To promote hygiene and effectiveness of using the hearing aid
6. Explore technology such as amplifiers, modifiers for telephones, and services for the hearing impaired such as telephone hearing-impaired
assitance)
To help the patient function and participate in meaningful activities
7. Emphasize to patient the importance of routine examination by an audiologist.
Frequent examinations detect changes in hearing or need for change in hearing aid.
8. Encourage family members to take part in the activities
To provide moral support
9. Inform doctor
For further intervention
10. Documentation
To record all the nursing interventions

29. CONCLUSION
■ Hearing impairment, deafness, or hearing loss refers to the inability to hear things, either
totally or partially. In a simple definition hearing loss is the reduced ability to hear sound
meanwhile deafness is the complete inability to hear sound. there are types of hearing
impairment and each of the type has it owns management to overcome the problem so
that the patient will have a better living and improve quality of life in engaging with all
people in their surrounding. Hearing loss also can be preventable and more health
campaign of taking care of the ear should be reinforce to create the awareness of the
people outside especially young people nowadays who loved to listen to loud musics, those
who worked in construction site and many more who are at risk to get hearing impairment
caused by the noise pollution.As the saying goes, ‘prevention is always better than cure’
thus people should be made aware of the importance of taking care of oneselves from the
noise pollution made by the human being

30. REFERENCES
■ Book
1. Martin, F. andClark, J. (2003). Introduction to audiology. 1st ed. Boston: Allyn and Bacon.
2. Bull, P., Clarke, R. and Bull, P. (2007). Diseases of the ear, nose and throat. 1st ed. Oxford: Blackwell.
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31. Thank you for “LISTENING”