Geriatric considerations - Hearing impairment: Nursing

Hearing impairment is a common condition in older adults that can negatively impact their quality of life through communication difficulties, social isolation, decreased self esteem, cognitive decline, and even depression.

As the nurse, you'll recognize age related hearing changes and provide patient centered care for your patient with a hearing impairment.

Now, the ear is divided into three parts, the external middle and inner ear and each part contains structures that can be affected by age related changes.

The external ear consists of the pinna or the outer part of the ear and the external auditory canal, which is a passageway connecting the outer ear to the tympanic membrane, commonly called the eardrum.

The external auditory canal narrows with age due to decreased tissue elasticity. Additionally, ceruminous glands that produce cerumen or earwax tend to atrophy over time resulting in drier earwax.

These conditions put individuals at higher risk for cerumen impactions which can cause a type of hearing loss called conductive hearing loss where cerumen blocks the external auditory canal, impairing the conduction of sound waves.

Another type of conductive hearing loss can occur due to age related changes in the middle ear, which is the air filled space that consists of the tympanic membrane and the auditory ossicles.

The auditory ossicles consist of three tiny bones that transmit sound waves collected by the tympanic membrane to the inner ear.

Now, these ossicles are prone to otosclerosis or stiffening. When this happens, they're unable to transmit sound waves as effectively.

Now, moving on to the inner ear, this includes the cochlea which converts sound waves into electrical impulses for the brain to process.

And a set of structures called the vestibular system which helps maintain balance over time. The cochlear structures including hair cells and conductive membrane can deteriorate or become damaged, causing a type of hearing loss called sensory neural hearing loss, which can happen when there is a problem with any of the structures in the inner ear or the neural pathways to the brain.

The most common type of sensory neural hearing loss is presby qis, which is a progressive age related hearing loss that often affects both ears.

Other age related changes within the inner ear can result in decreased vestibular sensitivity. This along with decreased sensory input from hearing and vision impairment and other factors that occur with age like slowed motor responses can impair balance and increase the risk of falls.

All right. So older adults often experience tinnitus or ringing in the ears which can accompany either conductive or sensory neural hearing loss.

Tinnitus is a subjective sensation of sound in one or both ears and individuals typically describe it as ringing buzzing, clicking or humming, even though no external sound is present.

Tinnitus is associated with head and neck trauma, cardiovascular or neurologic disease. Prolonged exposure to loud noises, middle or inner ear infections, impacted cerumen and substances like aspirin, caffeine, alcohol and cigarettes which are ototoxic or toxic to the ear.

As the nurse, you'll provide patient centered care for your patient with a hearing impairment by using strategies that enhance hearing and communication and promote auditory health.

Begin by clearly identifying yourself when you enter or leave your patient's room and make sure you have their attention before speaking.

Next, enhance your patient's hearing by adapting your communication techniques. Be sure to face your patient instead of looking down at paperwork or facing a computer and position yourself appropriately.

If your patient's hearing is better in one ear than the other. Also, be sure to know if any non verbal signs of hearing impairment are present such as turning the head to one side, cupping the ear or misunderstanding questions.

If your patient uses hearing aids or other assistive devices, make sure they are turned on and functioning properly, then use a normal or lower tone of voice to speak at a moderate pace and articulate clearly.

This is especially helpful for patients with presbycusis that have difficulty distinguishing consonants like SP TG and K also remember to avoid shouting or placing your hands near your mouth when speaking.

Since these make it more difficult for your patient to understand you. You can also incorporate non verbal communication techniques like gestures, visual aids, and written materials to reduce background noise.

Remember to turn off radios and televisions, close the door or move to a quieter location. Next, provide strategies to promote auditory health.

Teach your patient to avoid exposure to loud noises by wearing hearing protection when loud noises are unavoidable. Other strategies include eating healthy foods, maintaining healthy BP and cholesterol levels, avoiding ototoxic substances and reducing the risk of injury and cerumen impaction by not using cotton tipped applicators in the ear canal.

Finally emphasize the importance of regular hearing exams to determine if they would benefit from a hearing aid or other assisted devices and instruct them to contact their health care provider if they experience any ear pain discharge or new or worsening tinnitus or hearing loss.

Alright, as a quick recap, hearing impairment is a common condition in older adults that can negatively impact their quality of life.

As the nurse, you'll recognize age related hearing changes and provide patient centered care for your patient with a hearing impairment by using strategies that enhance hearing and communication and promote auditory health.