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 ear wax, tend to atrophy over time, resulting in drier ear wax.

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 sensorineural hearing loss, which can happen when there’s a problem with any of the structures in the inner ear or the neural pathways to the brain.

The most common type of sensorineural hearing loss is presbycusis, 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.

Alright, so older adults often experience tinnitus, or “ringing in the ears”, which can accompany either conductive or sensorineural 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,