Three Classifications of Auditory Dysfunction
1. Conductive Hearing Loss
- Occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny
bones (ossicles) of the middle ear.
- Usually involves a reduction in sound level or the ability to hear faint sounds. This type of hearing loss can
often be corrected medically or surgically.
Causes:
o Blockage in the ear canal caused by impacted wax or foreign bodies
o Perforated eardrum maybe from infection or loud explosion
o Otitis media
o Otosclerosis
A. Assessment Findings
a. Clinical Manifestations
i. Cerumen impaction – often visible; client demonstrate some degree of hearing loss
ii. External otitis media – results in itching, pain and watery or purulent discharge
iii. Otosclerosis – maybe marked by mixed hearing loss or sensorineural hearing loss, and
tinnitus.
B. Laboratory and Diagnostic Findings
a. In Otitis Media, the otoscope findings depend on the stage of disease.
i. In the First stage – the tympanic membrane is retracted
ii. In Second Stage – the tympanic membrane’s blood vessels dilate and appear red.
iii. In the third stage – the tympanic membrane becomes red, thickened and bulging.
b. In Otosclerosis, reduced air conduction compared with bone conduction is noted in Rinne’s test.
C. Nursing Responsibility
a. Instruct the client the correct way to remove impacted cerumen
i. Soften cerumen with instilled peroxide
ii. Instruct the client to irrigate the ear in 2 to 3 days to remove the wax.
iii. Instruct the client to keep otic solution in the ear for 15 minutes by tilting the head sideways
or by putting cotton in the ear.
b. Treat Otitis media with topical antibiotics and steroids.
2. Sensorineural Hearing Loss
- Impaired function of the inner ear, which includes the auditory connections to the brain.
- Caused by defects in the inner ear, in the acoustic nerve, or in areas of the brain.
- The loss is noticed more in high frequency pitches, and the patient appears to have more difficulty hearing
in noisy environments.
- Results from damage or deformities of the inner ear, the area where the sound is identified by the cochlea
and sent to the brain via the acoustic nerve
- It is permanent and therefore cannot be corrected or treated, just managed.
Causes:
o Congenital and hereditary factor
o Noise trauma
o Meniere’s Disease
A. Assessment Findings
a. Clinical Manifestations
i. Inappropriately loud voice
ii. Tinnitus
iii. Speech sounds distorted
iv. Background noise makes listening more difficult
B. Diagnostic Test
a. Rinne’s test
b. Weber test
C. Nursing Responsibility
a. See Auditory dysfunction Implementation
3. Mixed Conductive and Sensorineural Hearing Loss
- Occur when hearing loss results from a combination of both conductive and sensorineural factors.
Causes:
a. Cerumen production
b. Foreign bodies
c. Trauma
d. Ear infection
Nursing Diagnosis:
1. Disturbed sensory perception, auditory related to obstruction of ear canal, damage to inner ear.
2. Anxiety related to inability to communicate
3. Impaired social interaction related to inability to hear others
4. Meniere’s Disease
- A degenerative condition of unknown etiology, which leads to progressive hearing loss predominantly on
middle age
Cause:
Unknown
Phathophysiology:
Meniere’s disease appears to involve overproduction or decreased absorption of endolymph, with resultant
degeneration of vestibular and cochlear hair cells. Recurrent attack results in progressive sensorineural hearing
loss, usually unilateral in nature.
A. Assessment
a. Clinical manifestations
i. Sudden episodes of severe whirling vertigo, with an inability to stand or walk; an episode
may last for several hours.
ii. Buzzing tinnitus
iii. Nausea, vomiting and diaphoresis
B. Diagnostic findings
i. Audiometry testing reveals sensorineural hearing loss
C. Nursing Management
a. Provide nursing care during acute attack.
i. Provide a safe, quiet and dimly lit environment, and enforce bedrest.
ii. Provide emotional support and reassurance to alleviate anxiety.
iii. Administer prescribed medications which may include antihistamine and antiemetics.
