Deafness

DEAFNESS/HEARING LOSS
AND REHABILITATION
PRESENTED BY :-
LITHATHOMAS
M.Sc(N)
By:-Ms.LithaThomas,AsstProf,Sumandeep
NursingCollege,SVDU

INTRODUCTION:-
 Hearing impairment ranges from minor
difficulty in understanding words or hearing
certain sounds to total deafness.
 Someone who has hearing loss might be able
to hear some sounds or nothing at all.
 People also may use the words deaf, deafness,
or hard of hearing when they're talking about
hearing loss.
By:-Ms.LithaThomas,AsstProf,
SumandeepNursingCollege,SVDU

DEFINITION
 Deafness refers to the partial
complete loss of hearing in one or
both ears.
 Hearing impairment refers to both
complete and partial loss of the
ability to hear.

INDCIDENCE :-
 1 in 15 Americans are affected
 More than 26 million people in the United
States have some form of hearing impairment.
 Approximately 10 million persons in the United
States have irreversible hearing loss.
 It is estimated that more than 30 million
people are exposed to noise levels that
produce hearing loss on a daily basis.

TYPES OF HEARING LOSS :-
 Hearing loss can be classified into three main categories :-
 Conductive hearing loss :- it results from the interference
of the sound transmission through the external ear and
middle ear
 Sensorineural hearing loss:- it is caused by the
impairment of the function of the function of the inner
ear, the eighth cranial nerve or the brain.
 Mixed hearing loss :- in this both conductive and
sensorineural hearing components are present
simultaneously.

CAUSES OF HEARING LOSS :-
 Conductive Hearing loss :-
 Ear Obstruction
 Infection
 Otosclerosis
 Tympanosclerosis
 Trauma to the Tympanic membrane

 Sensorineural Hearing Loss :-
 Presbycusis
 Aging and degenerative process
 Congenital Hearing Loss
 Noise Induced Hearing loss
 Benign and Malignant Tumours
 Meniere’s Disease
 Systemic disorders like autoimmune disease, syphilis, diabetes
 Cigarette smoking and tobacco exposure
 Central auditory Dysfuction
 Mixed Hearing Loss :-
Some causes of hearing impairement can result in
both sensorineural and conductive hearing loss

SYMPTOMS OF HEARING LOSS
 Failure to respond to oral communication
 Inappropriate response to oral communication
 Excessive loud speech
 Abnormal awareness of sound
 Strained facial expressions
 Tilting of head when listening
 Constant need for clarification of conversation
 Faulty speech articulation
 Listening to radio or television at increased volume
 Diplacusis
 Recruitement
 Tinnitus

Sound is perceived as faint or distant, but it remains
relatively clear.
the normal movement of sound vibrations through the
ear canal, tympanic membrane or ossicles is impeded
Due to etiological factors
PATHOPHYSIOLOGY :-
A ) Conductive Hearing Loss :-

Normal reception and transmission of sound wave are
disrupted sound is distorted and faint.
leading to the brain stem injury or damage
Due to etiology there is trauma or damage to the organ
of corti or auditory nerve pathway of the inner ear
CONTI……
A ) Sensorineural Hearing Loss :-

DIAGNOSIS
•Otoscopic examination
•Rinne’s test
•Weber’s test
•Audiometry

MANAGEMENT :-
1. Restore hearing :-
 Administration of antibiotics for blockage due to infection
 Oral corticosteroids
 Antiviral drugs
2. Assist Hearing
 Hearing aids and listening Devices
3. Manage Tinnitus :-
 Biofeedback
 Electrostimulation
 Hypnosis
 Hearing aids
 Tinnitus maskers
4.Improve aural rehabilitation :-
 Teaching the client to use other sense more effectively
 Speech reading
 Maximize the use of the remaining hearing ability

SURGICAL MANAGEMENT :-
 Myringotomy
 Stapedectomy :- in this
procedure the damaged
stapes is removed and is
replaced with a plastic or
stainless steel prosthesis.
 Tumour excision
 Cochlear implants
 Temporal bone
stimulators
 Middle ear implants

NURSING MANAGEMENT :-
 Impaired verbal communication related to
effects of hearing loss
 Ineffective coping related to recent loss of
hearing
 Impaired social interaction related to perceived
inability to interact with others
secondary to hearing loss.
 Deficiet knowledge of managing hearing loss
related to lack of previous exposure to a
hearing aid

GUIDELINES FOR COMMUNICATING WITH THE
HEARING-IMPAIRED PERSON WHOSE SPEECH IS
DIFFICULT TO UNDERSTAND:
 Devote full attention to what the person is saying. Look and
listen
 Engage the speaker in conversation when it is possible for you to
anticipate the replies.
 Try to determine the essential context of what is being said;
 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.

 For the hearing-impaired person who speech reads:
 When speaking, always face the person as directly as
possible.
 Make sure your face is as clearly visible as possible
 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.
 Speak slowly and distinctly, pausing more frequently.
 If for any reason your mouth must be covered (as with
a mask) and you must direct or instruct the patient,
write the message.

REHABILITATION
 All hearing impaired
individuals need
some sort of
rehabilitation for
communication to
lead a near to normal
life. The various
means available to
them are :-

Instrumental device :-
•Hearing aids
•Cochlear implants
•Assistive devices
Training :-
•Speech reading
•Auditory reading
•Speech conversation
• Listening Stratergies
•Manual or total Commnication

INSTRUMENTAL DEVICES :-
Hearing aids :-
A hearing aid is a device to amplify sounds
reaching the ear. It consists of three parts:
(a) microphone, which picks up sounds and converts
them into electrical impulses.
(b) an amplifier, which magnifies electrical impulses
and
(c) a receiver, which converts electrical impulses
back to sound.
Types of hearing aids :-
Air conduction hearing aid
Bone conduction hearing aid

BODY-WORN TYPES :-
 The microphone and
amplifier along with
the battery are in one
case worn at the
chest level while
receiver is situated at
the ear level.
 High degree of
amplification
 Useful in severely
deaf persons or
children with
congenital deafness

BEHIND THE EAR TYPE :-
 Microphone,
amplifier, receiver
and battery are all in
one unit which is
worn behind the ear.
 Coupled to the ear
canal with a tubing
and an earmould
 Useful for slight to
moderate cases of
hearing loss

SPECTACLE TYPE :-
 Modification of
behind the ear type
 Unit is housed in the
auricular part of the
spectacle frame
 Useful for persons
who need both eye
glasses and an
hearing aid.
 Not very popular now

IN THE EAR TYPE :-
 Entire hearing aid is
housed in an
earmould which can
be worn in the ear.
 Useful for mild to
moderate hearing
loss with flat
configuration
 Very popular now due
to its cosmetic
appearance

CANAL TYPES :-
 The hearing aid is so
small that the entire
hearing aid can be worn
in the ear canal without
projecting into the
concha.
 Ear canal should be large
and wide
 Used for mild to moderate
hearing loss of high
frequency
 Two types :- in the canal
type (ITC) and completely
in the canal (CIC)

Indications :-
Any individual who has a hearing problem that cannot be
helped by medical or surgical means is a candidate for hearing aid.
 Sensorineural hearing loss
 Deaf children
 Conductive deafness
Fitting a hearing aid :-
 When fitting a hearing aid, consideration is given to :-
 Degree of hearing loss
 Configuration of hearing loss
 Type of hearing loss
 Presence of recruitment
 Uncomfortable loudness level
 Age and dexterity of patients
 Condition of outer and middle ear
 Cosmetic appearance of the aid
 Type of ear mold
 The type of fitting i.e monoaural, binaural. With y connection or CROS type.

IMPLANTABLE HEARING AIDS:-
 To avoid the objection of cosmetically visible
aids, attempts are being made to develop
implantable hearing devices which can be
totally or partially concealed under the
tissues round the ear. The transducer of the
aid is coupled directly to the ossicular chain.
They are useful in conductive hearing loss,
congenital or acquired and also for
sensorineural hearing loss.

BONE ANCHORED HEARING AID :-
 In BAHA an ostoe integrated implant with a
titanium abutment is fixed to the skull. The
hearing aid is then coupled to the abutment to
carry sound directly to the cochlea via bone
conduction eliminating the soft tissues between
the skull bone and bone vibrator of the
conventional bone aid. It eliminates pressure,
pain and local irritation and has better efficiency
and fidelity. It is used for conductive or mixed
hearing loss and also where air conducting
devices cannot be used like discharge of ear,
aural atresia, canal stenosis.

HEARING AID PROBLEMS
 Whistling Noise
 Loose ear mold
 Improperly made
 Improperly worn
 Worn out
 Inadequate Amplification
 Dead batteries
 Wax in ear
 Wax or other material in mold
 Wires or tubing disconnected from aid
 Aid turned off or volume too low
 Improper mold
 Improper aid for degree of loss

 Improper Aid Selection
Too much power required in aid, with
inadequate separation between microphone
and receiver
Open mold used inappropriately
 Pain from Mold
Improperly fitted mold
Ear skin or cartilage infection
Middle ear infection
Ear tumor
Unrelated conditions of the temporo
mandibular joint, throat, or larynx

PATIENT EDUCATION
Cleaning
Malfunctioning
Recognizing Complications

COCHLEAR IMPLANTS :-
 They are electronic devices which convert
sound signals to electrical impulses which
directly stimulate the fibers of Cranial
nerve VIII.
Components of cochlear implant :-
There are two main components :-
 External component :- it remains outside
the body and consists of a microphone, a
speech processor and a transmitter
 Internal component :- it is surgically
fitted inside the body and consist of a
receiver/stimulator and an electrode
array.

 Microphone:- picks up the sound and passes it on to the
speech processor.
 Speech processor:- converts the sound to digital electric
signal
 Transmitter:- sends the signal from the speech
processor to the internal receiver/ stimulator by
radiofrequency
 Receiver/stimulator:- is implanted under the skin,
receives the signal from the transmitter, decodes it and
then transmits it to electrode array, which stimulates the
cochlear nerve.
 Electrode array:- consist of multiple electrodes and is
implanted in the scala tympani of the cochlea.

COCHLEAR IMPLANTS :-

 Selection of candidates for cochlear implants :-
 Age :- 18 years or more
 Bilateral severe to profound hearing loss
 Limited or no benefit from hearing aid
 No medical contraindication for surgery
 Willingness and support of the family.
 Surgery for cochlrear implantation :-
 Similar to mastoid surgery
 First a site is prepared for location of
reciever/stimulator
 Cortical mastoidectomy is performed
 Round window niche is exposed
 Cochleostomy opening is made in the basal turn of
cochlea
 Electrode array is passed into the scala tympani and
receiver/stimulator is fixed.
 Wound is closed in layers.

ASSISTIVE DEVICES :-
These devices help the person to listen in
special difficult situation, warn him of danger signals
and to communicate with his family and friends
who are far away from him.
These devices can thus be divided into three
groups :-
 Assistive Listening devices and systems :-
 Alerting Devices :-
 Telecommunication devices :-

TRAINING :
 Speech Reading
 Auditory Training
 Speech Conversation

Deafness

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