Deafness Is the leading cause of todays's world. This topic deals to understand about the types, causes etc if deafness. It is useful to the nursing students

1. Title Goes Here
Deafness
Presented By: Ms. Reshma Tamang
Asst. Professor,KIHS

2. Definition
• Deafness, Hearing impairment or hearing loss refers to
the total or partial inability to hear.

3. Types
1. Conductive hearing loss (CHL)
2. Sensorineural hearing loss (SHL)
3. Mixed hearing loss (MHL)
4. Others
1. Central hearing loss
2. Functional hearing loss
• Malingering

4. Conductive hearing loss
• Conductive hearing loss is any interference with the
conduction of sound impulses through the external auditory
canal, the eardrum, or the middle ear.

5. • Conductive hearing loss can be caused by anything that
interferes with the ability of the sound wave to reach the inner
ear such as
• cerumen
• foreign bodies
• infection.

6. Sensorineural hearing loss
• Sensory hearing loss originates in the cochlea and involves the
hair cells and nerve endings.
• Sensorineural hearing loss results from disease or trauma to the
sensory or neural components of the inner ear.

7. • Presbycusis is hearing loss caused by the aging process that
results from degeneration of the organ of Corti.
• This degenerative process usually begins at 50 yrs of age.

8. Mixed hearing loss
• Mixed hearing loss occurs when an individual has both
conductive and sensorineural hearing loss.
• This can be caused by a combination of any of the disorders

9. Central hearing loss
• Central hearing loss occurs when the central nervous system
cannot interpret normal auditory signals.
• This condition occurs with such disorders as cerebrovascular
accidents and tumors.

10. Functional hearing loss
• Functional hearing loss is a hearing loss for which no organic cause
or lesion can be found.
• Also called psychogenic hearing loss.
• Precipitated by emotional stress.
• Malingering is a type of psychogenic hearing loss.
• In Malingering, there is no organic or psychological cause. The
patient is pretending to be deaf for personal gains.

11. Severityof hearing loss
Loss in Decibels Interpretation
0–15 Normal hearing
>15–25 Slight hearing loss
>25–40 Mild hearing loss
>40–55 Moderate hearing loss
>55–70 Moderate to severe hearing loss
>70–90 Severe hearing loss
>90 Profound hearing loss

12. Etiology
• Age: increasing age
• Exposure to loud noise
• Genetic
• Head injury
• Ototoxic drugs
• Illness

13. • Illness
– Ear infections
– Measles may cause auditory nerve damage
– Meningitis may damage auditory nerve or cochlea
– Auto immune disease
– Mumps
– Otosclerosis
– Medulloblastoma or other brain tumors
– Syphilis from pregnant woman to fetus
– Premature birth
– Fetal alcohol syndrome in infants of alcoholic
mothers
– Neurological disorders
• Multiple sclerosis
• Stroke

14. RiskFactors
• Family history of sensorineural impairment
• Congenital malformations of the cranial structure (ear)
• Low birth weight (1500 g)
• Use of ototoxic medications (eg:gentamycin,
loop diuretics)
• Recurrent ear infections
• Bacterial meningitis
• Chronic exposure to loud noises
• Perforation of the tympanic membrane

15. Causes of Conductivedeafness
EXTERNAL EAR:
• Impacted Wax
• Otitis Externa
• Foreign Bodies
• Polyps
• Tumours
• Fluid in the ear
MIDDLE EAR
• Congenital defects of the ear drum and
ossicles.
• Perforation of the tympanic membrane
• Traumatic: Barotrauma, rupture of ear drum,
skull fracture
• Inflammation: AOM, COM,
• Neoplasms
• Otosclerosis

16. Causes of sensorineural deafness
• INNER EAR
• Congenital
• Trauma: Head injury, surgical
injury to labyrinth, loud sounds
producing concussion.
• Infections: mumps, syphilis,
tuberculous meningitis, enteric
fever, labyrinthitis.
• Presbycusis
• Tumours: Acoustic neuroma
• Meniere’s disease
• Ototoxic drugs: streptomycin,
Kanamycin, neomycin,
salicylates, frusemide and
quinine.

17. Causes of Central hearingloss
• Cerebrovascular accidents
• Brain tumors
• Multiple sclerosis

18. Pathophysiology
Disorders of external or middle ear
Interruption in the transmission of sound by air to the
inner ear
Conductive deafness

19. Disorders of inner ear or vestibulocochlear nerve or
aging
Interruption in neural transmission of sound to brain
Sensorineural deafness

20. Clinicalmanifestations
• Tinnitus
• Increasing inability to hear when in a group
• Need to turn up the volume of the television
• Failure to respond or In appropriate response to oral communications
• Excessively loud speech
• Strained facial expression
• Constant need for clarification of conversation
• Social withdrawal

21. Diagnostic measures
• History
• Physical examination
– Rinne’s test
– Weber’s test
• Audiometry
• Tympanogram

22. COMPARISON OF WEBER AND RINNE TESTS
Hearing Status Weber Rinne
Normal hearing Sound is heard equally in
both ears.
Air conduction is audible
longer than bone
conduction.
Conductive hearing loss Sound is heard best in
affected ear (hearing loss).
Sound is heard as long or
longer in affected ear
(hearing loss).
Sensorineural hearing loss Sound is heard best in
normal hearing ear.
Air conduction is audible
longer than bone
conduction
in affected ear.

23. Prevention
• Minimize the exposure to trauma, infection, ototoxic drugs.
• Avoid the risk factors.
• Wear ear protection to prevent noise-induced hearing loss when
exposed to loud noise.

24. Management
Medical management
• Restore hearing
– Antibiotics: to treat infections
– Remove impacted wax or foreign bodies
– Ceruminolytics for impacted wax
– Corticosteroids for inflammation
– Treat underlying disorders

25. • Assist hearing
– Hearing aids
– Implantable middle ear hearing devices
– Cochlear implants
– Sign language
– Auditory rehabilitation

26. • Hearing aids: Hearing aid is designed to amplify
sound
• Implantable middle ear hearing devices: Implantable middle ear hearing aids
are implanted surgically, can improve sound perception for patients with
moderate-to-severe sensorineural hearing loss.

27. • Cochlear implants: Cochlear implants are
surgically placed electrical devices that
receive sound and transmit the resulting
electrical signal to electrodes implanted in the
cochlear of the ear.
• Sign language: It involves hand
shapes, movement of hands, arms,
body and facial expressions

28. AURAL REHABILITATION

29. • Aural rehabilitation refers to services and procedures for
facilitating adequate receptive and expressive communication in
individuals with hearing impairment.
• If a hearing loss is permanent or untreatable, aural rehabilitation
may be beneficial.

30. Purpose
• To maximize the communication skills of the person
with hearing impairment.

31. Components
• Auditory training: Auditory training emphasizes listening skills, so
the person who is hearing-impaired concentrates on the speaker.
• Speech reading: Also known as lip reading. Speech reading can
help fill the gaps left by missed or misheard words.
• Speech training: The goals of speech training are to conserve,
develop, and prevent deterioration of current communication
skills.

32. • Hearing Aids: A hearing aid is a device through which speech and
environmental sounds are received by a microphone, converted to
electrical signals, amplified, and reconverted to acoustic signals.

33. • Hearing Guide Dogs: Specially trained dogs (service dogs) are available to
assist the person with a hearing loss.
• People who live alone are eligible to apply for a dog trained by International
Hearing Dog, Inc.
• The dog reacts to the sound of a telephone, a doorbell, an
alarm clock, a baby’s cry, a knock at the door, a smoke alarm, or an intruder.
The dog alerts its master by physical contact; the dog then runs to the source
of the noise.
•In public, the dog positions itself between the person with hearing impairment
and any potential hazard that the person cannot hear, such as an oncoming
vehicle or a loud, hostile person.

34. Surgicalmanagement
• Surgery is indicated for conductive or mixed hearing loss.
• To restore conductive hearing
– Myringotomy
– Stapedectomy
• Assisted hearing in profound deafness
– Cochlear implants
– Middle ear implants (Semi-implantable hearing
device)
• Tumour excision for acoustic neuroma

35. Nursing Diagnosis
• Disturbed sensory perception: hearing related to altered sensory reception and
transmission
• Impaired verbal communication related to impaired hearing
• Impaired social interaction related to impaired
hearing and decreased communication skills
• Disturbed body image related to impaired hearing and use of assistive hearing
devices
• Ineffective coping related to difficult
communication
• Deficient knowledge related to care of hearing aid due to lack of prior experience

36. Nursinginterventions
• Inspect ear canals for mechanical obstruction.
• Remove mechanical obstructions like cerumen or foreign bodies.
• Assess hearing by use of a tuning fork, or verbal cues to determine auditory ability
at various distances.
• Speak slowly with careful pronunciation of words.
• Add hand gestures, speak face to face and adjust pitch downward without increasing
volume.
• Introduce assistive devices such as hearing aids, written communication, and sign
language.
• Allow patient to verbalize feelings and grieving about hearing loss.