This document discusses hearing impairment, including definitions, types, tests used for diagnosis, and treatment options. It defines the main types of hearing loss as conductive, sensorineural, and mixed. Diagnosis involves a medical history, physical exam, and tests like pure tone audiometry, tympanometry, and auditory brainstem response testing. Treatment depends on the underlying cause but may include medications, surgery, hearing aids, or cochlear implants. Regular screening is important due to the high prevalence of hearing loss.

4. • Spinning Wheel Illusion
Stare at one of the 5 wheels. Whichever one you stare at
will appear to suddenly stop spinning. In reality - none of
the wheels are turning at all.

5. • Let’s see if
your vision
and mind
works hand in
hand
together..

8. Visual Impairment
Dr.Reza Parker (MD Romania)

9. THE EYE : PROCESS OF NORMAL
VISION
• The eye is a complex part of the human
body that no other organ can equal.
• The sense of vision is a complex and
intricate physiological system.
• There are 3 elements necessary for good
vision to take place. These are:
• A pair of healthy, intact and efficiently
functioning eyes with complete parts
• A well lighted objects
• A healthy brain

10. Anatomy and physiology
• Five physiological/physical
systems in visions:
• The Protective Structure
• The Refractive Parts
• The Muscles
• The Retina and Optic Nerves
• The Brain (where vision takes
place)

11. Definition
• Visual impairment (VI) refers to a
significant functional loss of vision
that cannot be corrected by
medication, surgical operation, or
ordinary optical lenses such as
spectacles.

12. Definitions
• Visual Acuity – the ability to clearly distinguish
forms or discriminate details at a specific
distance. Normal Visual Acuity is measured by
reading letters, numbers and others symbols
from a chart 20ft away.
• Legal Blindedness – condition where visual acuity
is 20/200 in the better eye after the best possible
correction with glasses or contact lenses. The
field of vision for this person is about less than
180 degrees to an area of 20 degrees.

13. Blindedness
• Total blindness – the person is absolutely without sight but may
have light and movement perception and travel vision.
– The degree of blindness include:
• Light perception (can differentiate light and dark/day and
night)
• Movement perception (can detect if an object or a person is
in motion or in still position)
• Travel vision (field of vision is enough to travel safely in
familliar area)

14. More Definitions
• Field of Vision – refers to the area that normal eyes
cover above, below and on both sides when looking
at an object or when gaziing straight ahead. The field
of normal vision covers approximately a range of 180
degrees.
– Central field of Vision – looking directly at an object
– Peripheral Vision – the outer ranges of the field of vision
– Tunnel Vision – results from an extremely restricted field
of vision.

15. • Low vision – a level of vision that with
standard correction hinders an
individual in the visual planning and
execution of tasks, but which permits
enhancements of the functional vision
through the use of optical or non-optical
aids and environmental modifications or
techniques.(Corn’s definition of Low
Vision)

16. Etiology
• The inability of the eyes to function efficiently
may be traced to:
1. Errors of Refraction
2. Imbalance of the Eye Muscles
3. Diseases
4. Trauma or Accidents

17. Loss of visual field
• Photophobia- inability to look at sight
• Diplopia- double vision
• Visual distortion or distortion of images
• Visual perceptual difficulties or difficulties of
perception
• Or any combination of the above features

18. Levels of Impairment
1. MILD VISUAL IMPAIRMENT
• Can read relatively larger characters
• No difficulty in identifying shapes, colours and
brightness contracts

19. 2. MODERATE VISUAL IMPAIRMENT
• Can tell shapes and colours of objects and can
distinguish between brightness and darkness.
•Can only read characters with larger size and
broader strokes.

20. 3. SEVERE VISUAL IMPAIRMENT:
•Can only distinguish more obvious changes in
brightness and darkness.
• May not see anything (completely blind).

21. Types
• Low visual acuity
• Blindness
• Legal blindness
• Visual acuity

22. 1. Inherited conditions of blindness and vision
impairment
2. Infections of the eyes
3. AIDS related visual impairment

23. Injury to Eyes Amblyopia
Cataract

24. Trachoma Diabetic retinopathy

25. Glaucoma Age Macular
degeneration

26. Symptoms
• Daily Activities: Squinting to get an object in
focus, Trouble locating familiar objects in a
familiar environment, Wearing mismatched
clothing.
• Mobility: Leaning against the wall when
walking , Running into objects, Difficulty
walking on uneven surfaces.

27. • Eating/Drinking: Difficulty getting
food onto a utensil and serving
from a platter, Frequently spilling
food
• Reading/Writing: Difficulty writing
on the lines of a piece of paper,
Frequent complaining that the
lighting is inadequate for reading or
writing

28. EPIDEMIOLOGY
• By age: More than 82% of all
people who are blind are 50
years of age and older. 1.4
million blind children below age
15.

29. • By gender: females have a significantly higher
risk of being visually impaired than males.
• By geography: . More than 90% of the world's
visually impaired live in developing countries.

30. COMMUNICATION BARRIERS:
Many people are uncomfortable with
communicating with the blind, and this can
cause communication barriers

31. .
• Lack of facial expressions, mimics, or body
gestures/responses
• Non-verbal gestures that could imply the
visually impaired individual not appearing
interested
• Speaking when not anticipated or not
speaking when anticipated
• Fear of offending the visually impaired
• Standing too close and invading the personal
comfort level

32. • Having to exercise or ignore feelings of pity
• Being uncomfortable with touching objects or
people.
• A look of detachment or disengagement.
• Dependency

33. Tests for visual impairment
1. Snellen test
• Also known as the visual acuity
test.
• Snellen’s chart is used.

34. 2. Visual field test
• a person can see without tilting or turning
one’s head.
• This measures the peripheral vision of the
eyes.

35. 3. Tonometry test
• uses specialized instruments to determine
fluid pressure inside the eye to evaluate for
glaucoma.

36. 4. Ocular Motility Assessment
• This tests if there is squint of other problems
in the movement of the eyeballs.

37. Other tests:
• Visually evoked potential
(VEP)
• Electroretinogram (ERG)
• Electro-oculogram (EOG)

38. • Control of diabetes
• Cotaract surgery
• Magnification systems
• Glaucoma
• Drugs: The drugs may include Beta-blockers
like betaxolol hydrochloride or carbonic
anhydrase inhibitors dorzolamide and
Sympathomimetics like brimonidine tartrate.

39. Optical aids
• -Improving far sight: TV,Theater,
Cinema
• -Improving near sight: Reading,
Writing, Crafts
• -Improving sensitivity
to contrast:Special
lights,Magnified
games,Watches,special phones,
etc.

40. What is IDEA?
• Three basic elements in educating visually impaired
children
-specialized services, books and materials in appropriate
media (including braille), as well as specialized equipment
and technology
-a full range of program options and support services so
that the Individualized Education Program (IEP) team can
select the most appropriate placement
-be adequate personnel preparation programs to train
staff to provide specialized services which address the
unique academic and non-academic curriculum needs

41. • COMPUTERS
• PHONICS
• ELECTRONIC AIDS

42. • Regular eye examinations:
Most people should have their eyes tested at
least once every two years.
It is very important for drivers and people
whose eyesight may be affected by their
occupation, such as those who use computer
monitors, to have regular eye examinations

43. There are several other ways to reduce the
risk of visual impairment:
• Protect your eyes from the sun. Ultra violet
(UV) rays from the sun can damage your
eyesight so in bright sunlight, wear a pair of
good-quality sunglasses that protect your eyes
from both UVA and UVB rays.

44. • Find out whether there is a history of
glaucoma or eye disease in your family.
• Hypertension-Hypertension is when the
pressure of the blood in your
bloodstream is regularly above 140/90
mmHG.
• Pain- Pain is an unpleasant physical or
emotional feeling that your body
produces as a warning sign that it has
been damaged.

45. CONCLUSION:
Visual impairment is increasing especially
among older people.
Communication and different ways of being able
to communicate with visually impaired clients
must be tailored to individual needs and
available at all times.

46. Hearing Impairment

47. Definitions
• Also called deafness or hearing loss, occurs when
there’s a problem with or damage to one or more
parts of the ear.
• Most prevalent impairment worldwide. Almost 600
million, an estimated 10% of people worldwide, have
mild or worse hearing impairment.
• 1 of every 10 people has a hearing loss
• Over age 65, 1 in every 3 persons has some
degree of hearing loss
• 80% of hearing people are in denial

49. Types of Hearing Loss
1. Conductive Hearing Loss (CHL)
• the conduction of sound to the cochlea is
impaired
• can be caused by external and middle ear disease
2. Sensorineural Hearing Loss (SNHL)
• due to a defect in the conversion of sound into
neural signals or in the transmission of those
signals to the cortex
• can be caused by disease of the cochlea, acoustic
nerve ( CN Vlll), brainstem, or cortex

50. Types of Hearing Loss
3. Mixed Hearing Loss
• the conduction of sound to the cochlea is
impaired, as well as transmission through the
cochlea to the cortex

51. Differential diagnosis of hearing loss

52. DIFFERENTIAL DIAGNOSIS OF HEARING LOSS

53. HISTORY
–Onset (sudden or gradual)
–Duration
–Unilateral/ bilateral
–Continuous / Intermittent

54. –Exposure- noise, drugs, viral illness
–History of ear of head trauma
–History of surgeries
–Associated symptoms- pain, discharge, tinnitus,
vertigo

55. • PMH:
– Chronic illness: DM, HTN, Hypothyroidism
– Previous surgeries
• Rx:
– Ototoxic drugs
• Amino glycosides, diuretics, quinine, aspirin
• Social history:
– Occupation
– Tobacco
– Alcohol
– Cocaine
– Marijuana

56. PHYSICAL EXAMINATION
• General assessment
• Ear exam:
– Deformities of Pinna & EAC
– Pre & post-auricular region
• Otoscopy
- EAC, TM
• Tuning Fork Test
- Rinne
- Weber
• Cranial Nerves

57. INVESTIGATIONS
• Specific hearing tests
Tuning Fork Tests
Pure tone audiometry
Impedance audiometry
Brain stem evoked response audiometry
• Radiology
- CT & MRI of skull & temporal bones

58. Hearing tests
• Subjective
– Tonic Fork test
– Pure tone audiometry (PTA)
• Objective
– Tympanometry (impedance audiometry)
– Electric response audiometry (ERA).

59. Tuning Fork Tests
• Test: Weber
• Technique: Tuning Fork
placed at midline forehead
• Normal: Sound radiates to
both ears equally
• Abnormal: Sound lateralizes
to one ear
– Ipsilateral Conductive Hearing
Loss OR
– Contralateral Sensorineural
Hearing Loss

60. Tuning Fork Tests
• Test: Rinne’s
– Technique
• First: Bone Conduction
– Vibrating Tuning Fork held on
Mastoid
– Patient covers opposite ear with
hand
– Patient signals when sound
ceases
– Move the vibrating tuning fork
over the ear canal
» Near, but not touching the ear
• Next: Air Conduction
– Patient indicates when the sound
ceases

61. Tuning Fork Tests
– Test: Rinne’s
– Normal: Air Conduction is better than Bone Conduction
• Air conduction usually persists twice as long as bone
• Referred to as "positive test"
– Abnormal: Bone conduction better than air conduction
• Suggests Conductive Hearing Loss
• Referred to as "negative test"

62. Pure tone audiometry (PTA)
• PTA is the key hearing test used to identify
hearing threshold level of an individual, enabling
determination of the degree, types and
configuration of hearing loss.
• Provides the basis for diagnosis and management.
• The symbols used on most audiograms are:
– x - left, air conduction
– o - right, air conduction
– ] - left, bone conduction
– [ - right, bone conduction

63. Normal audiogram

65. Tympanometry (impedance audiometry)
– Assess the function of middle ear and Eustachian
tube.
– Very useful when screening for middle ear
effusion.
– It is not a hearing test, but rather a measure of
energy transmission through the middle ear.
– It can also assess the integrity of stapedius reflux.

66. Normal tympanogram

67. Auditory brainstem response (ABR)
audiometry
• An objective neurologic test of auditory brainstem
function in response to auditory (click) stimuli.
• Procedure: The stimulus either in the form of click
or tone pip is transmitted to the ear via a
transducer placed in the insert ear phone or head
phone. The wave froms of impulses generated at
the level of brain stem are recorded by the
placement of electrodes over the scalp.

68. Auditory brainstem response (ABR)
audiometry
• These peaks are
considered to originate
from the following
anatomical sites:
• 1. Cochlear nerves - waves
I and II
• 2. Cochlear nucleus - wave
III
• 3. Superior olivary complex
- wave IV
• 4. Nulclei of lateral
lemniscus - wave V
• 5. Inferior colliculus -
waves VI and VII

69. Treatment
• Tailored to the pathology itself.
• corticosteroids to reduce cochlea hair cell
swelling and inflammation to improve healing
of these injured inner ear structures.
• Cochlear implants
• Surgical procedures
• drainage

70. Summary
• Patients with hearing loss may have conductive, sensorineural,
or mixed hearing loss.
• Patients with hearing loss should undergo a directed history
and examination.
• Weber and Rinne tests to distinguish conductive from
sensorineural hearing loss
• Patients with conductive hearing loss should undergo physical
examination of the auricle and external auditory canal (EAC)
looking for evidence of blockage to explain the hearing loss.
• Patients without an obvious etiology for hearing loss (such as
external otitis or cerumen impaction) should undergo formal
audiologic testing.

71. summary
• Otoscelerosis is the second most common cause of conductive
hearing loss in 15-50 years olds (eftar cerumen impation).
• Presbycusis is the most common cause of SNHL
• Short exposure to louder sounds can cause significant SNHL
• Features of Ménière disease; tinnitus, hearing loss, aural
fullness, and vertigo