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1. HEARING LOSS
POOJA BHANDARI
ROLL NO :04
PBBN 3RD YEAR
Bhandari P

2. Sounds of Life
• Hearing connects us with:
 Family
 Friends
 Sounds in our environment
 Music we love
• When hearing loss is present it can put limits on your
life.
Bhandari P

3. Hearing is Important
 Personal Safety
• Driving
• Walking
• Public Places
 Environmental Awareness
• Phone calls
• Door bell
• Alarms and smoke detectors
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4. Communication Around You
• Radio and TV
• Telephone
• Meetings
• Religious Services
• Theaters
• Traveling
• Family and Friends
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5. How We Hear…
The ear is made up of 3 parts:
• Outer Ear
• Middle Ear
• Inner Ear
Each of these three parts has a
special function that allow us to hear.
Bhandari P

6. Outer Ear
Sound is:
• Picked up by the outer ear – pinna
• Sent down to ear canal to the eardrum
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7. Middle Ear
As sound is sent down the
canal to the eardrum
• Sound vibrations cause the eardrum
to rock back and forth.
• Three tiny bones in the middle ear
send the sound vibrations the inner ear.
Bhandari P

8. Inner Ear
The inner ear contains over 30,000 tiny hair cells
• Vibrations from the middle
ear cause hair cells to move.
• Hair cells are connected
to the hearing nerve and
send the hearing signal to
the brain
Bhandari P

9. Physiology Of Hearing
• Sound
1st enter 332m/s(travel) Sound (hear)
Ear Brain
sound wave strike 8th Cranial Nerve
Tympanic membrane impulse of sound
Vibration produce Endolymph
Middle Ear ( malleus) pressure
Strike & transfer Perilymph
Incus & Stapes Oval window( help in
Transfer to inner ear movement )
Bhandari P

10. Three Types of Hearing Loss
1. Conductive Hearing Loss
Sound is blocked in the outer or middle ear.
Causes:
• Excessive earwax
• Damaged eardrum
• Ear infection or fluid in the
middle ear
• Stiffness in the bones of the
middle ear (otosclerosis)
Solution:
• Most often medically treated with high success
• Hearing aids very successful if unable to treat medically
Bhandari P

11. Three Types of Hearing Loss
2. Sensorineural Hearing Loss
Inner ear hair cells or hearing nerve is
damaged and cannot send complete signals to the brain.
Causes:
• Aging
• Noise Exposure
• Hereditary factors
Solutions:
• Cannot be corrected with medicine or surgery
• Hearing aids can be very helpful
Bhandari P

12. Three Types of Hearing Loss
3. Mixed Hearing Loss
Both conductive and sensorineural hearing loss
occur simultaneously
Causes:
• Can be one or several causes
Solutions:
• May be possible to restore some
hearing with medicine or surgery
• Hearing aids can be very helpful
Bhandari P

13. Terms Used to
Describe Hearing Loss
Loudness: Decibel (dB)
Pitch: Frequency
Type of hearing loss:
Sensorineural (nerve);
Conductive (middle ear) or
mixed (both)
Severity of hearing loss:
Mild, Moderate, Severe, Profound
Shape of hearing loss:
Flat, Sloping, Ski-slope
Bhandari P

14. Incidence
• U.S. population 270+ million
–2 million Deaf
–26 million Hard of Hearing
• 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 hard of hearing people are in
denial
Bhandari P

15. Incidence of Hearing Loss
10% of Canadians
have a hearing loss.
• 1 in 10 people have some
degree of hearing loss.
• 1 in 3 Canadians over
the age of 65.
Hearing loss is reported as
the third most common health
problem in Canada today after hypertension & arthritis
Bhandari P

16. Signs of Hearing Loss
• People around you seem
to mumble
• You often ask others to repeat
themselves
• You can hear but cannot
understand
• Difficulty following
conversations when background
noise or when in groups
• Children and women's voices are difficult to hear
• Need to turn up TV or radio louder
• Cannot hear high pitched sounds such as birds, crickets and
bells
Bhandari P

17. Common Reactions to Untreated Hearing
Loss
• Denial
• Anxiety & Depression
• Search for a cure
• Feeling powerless
• Emotional detachment
• Isolation
• Withdrawal from communication situations
Bhandari P

18. Benefits of Improved Hearing
National Council on Aging Study
The majority of hearing aid wearers
reported significantly improved quality
of life including improvements in:
• personal relationships
• self-esteem
• overall health
Family members reported an average
of 15% greater benefit than the
hearing aid wearer.
Bhandari P

19. The Diagnostic Test
• Laboratory tests
- Blood test
- Culture of ear discharge
- Pathological Examination ( tissue biopsy)
• Radiological Test
- Plain Radiography (x-ray) to assess the condition of
mastoid air cells.
- Specialized Radiography ( CT scan , Tomogram,
Contrast radio opaque studies ) to diagnose
intracranial complication.
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20. Diagnostic test cont..
• Audiotory function test:
- Clinical test of hearing
. Finger friction tests
. Watch test
. Speech or voice tests
. Tuning fork test
• Audiometry tests
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21. Testing of Air Conduction and Bone
conduction
• Rinne test
- The Rinne test is a hearing test, primarily for
evaluating loss of hearing in one ear (unilateral
hearing loss).
- It compares perception of sounds transmitted by air
conduction to those transmitted by bone conduction
through mastoid.
- The Rinne test is done by first putting the vibrating
fork close to the ear canal and then putting the fork on
the mastoid region, to determine if sound is better
heard at the ear canal (air conduction) or
Bhandari P

22. Testing of Air Conduction and Bone conduction
cont..
when the fork is placed on mastoid region (bone
conduction).
- In normal circumstances, air conduction should
always be better than bone conduction.
- If normal , then Rinne’s test is positive.
- If bone conduction is better than air conduction then
Rinne’s test is negative.
Normal: Air conduction > bone conduction (positive
Rinne test)
Bhandari P

23. Testing of Air Conduction and Bone conduction
cont..
.Conductive deafness: A.C < B.C (Negative Rinne test)
.Sensorineural deafness : A.C > B.C , but in low volume
and shorter duration ( low positive Rinne test).
Bhandari P

24. Testing of Air Conduction and Bone conduction
cont..
• WEBER TEST :
- The weber test is done by placing a vibrating tuning
fork on the patients forehead.
- Either the sound will be heard equally well ( or not
heard).
- On both sides (which is normal) or the patient will
hear the sound louder on one side. This is known as
lateralizing.
Bhandari P

25. Testing of Air Conduction and Bone conduction
cont..
- When the sound lateralizes to one ear , this means that
either there is a conductive hearing loss on the same
side , or there is sensorineural deficit on the other
side.
- It compare the bone conduction of two ear. It is used
for testing unilateral or bilateral deafness.
Bhandari P

26. Testing of Air Conduction and Bone conduction
cont..
• PURE TONE AUDIOMETRY:
- Pure tone are delivered the client’s ear by earphone
for testing air condition.
- Vibrator applied to the mastoid area for testing bone
conduction.
- The hearing ability of each ear is recorded on the
audiogram according to air and bone conduction.
- The intensity of sound that heard is measured in unit
DECIBELS (db).
Bhandari P

27. Bhandari P

28. Degree Of Hearing Loss
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29. Digital Hearing Aids
Digital Technology
• changes speech & sounds
into numbers
• applies mathematical
calculations to the numbers
Benefits
• enhanced clarity
• more detail in the speech
• programmed using a computer
for optimal flexibility
• ability to do more advance sound
processing (e.g.. noise reduction, feedback
management)
Bhandari P

30. Digital Hearing Aids
– What Users Say
• Arlinger et al., 1996
– Better sound quality
– Better speech intelligibility
• Warland et al., 1997
– Improved overall hearing/
clearer sound
– Enhanced performance in noise
• Knebel & Bentler, 1998
– Crispness of sound
– Feeling more comfortable with the
accuracy of what was heard
– Improved ability to hear high pitched
sounds e.g.. bird sounds
Bhandari P

31. Assistive Devices
• Amplified Telephones
• Wireless headsets for TV
Bluetooth Technology
• Can use this technology to receive sounds from your
TV, telephone, or cell phone DIRECTLY to your
hearing aids without any cords
Bhandari P

32. Benefits of Improved Hearing
National Council on Aging Study
The majority of hearing aid wearers
reported significantly improved quality
of life including improvements in:
• personal relationships
• self-esteem
• overall health
Family members reported an average
of 15% greater benefit than the
hearing aid wearer.
Bhandari P

33. References
• www.lifesci.sussex.ac.uk/home/Chris_Darwin/Percep
tion/1pbAnatomy
• www.nchearingloss.org/hlintro
• Sharma M, Poudel K, Gautam R., Medical Surgical
Nursing ; Samikshya Publication , Page no: 538- 539
• Brunner and Suddarth’s Text book of Medical –
Surgical Nursing : Volume 1 , 13th edition , page no :
1887 - 1890
Bhandari P

34. Bhandari P