Hearing Loss PAINT

What is hearing loss?

Reduced hearing due to:

• Conductive causes → obstruction of sound wave transmission in external/middle ear

• Sensorineural causes → damage to inner ear or CN VIII (auditory nerve)

What are common risk factors for hearing loss?

• Family history of hearing loss

• Prescribed drugs: NSAIDs, aminoglycosides, loop diuretics, quinine-based meds, some chemo

• Prolonged exposure to loud noise

• Occupations involving machine operation

• Head trauma or ear surgery

What history cues suggest hearing loss?

• Difficulty hearing; asking for repetition

• Leaning forward/tilting head when listening

• Head trauma or surgery

• Withdrawal from groups/social interactions

• Shouting in conversation, inappropriate responses

What physical exam cues indicate hearing loss?

• Difficulty hearing high-frequency consonants (s, sh, f, th, ch)

• Abnormalities of pinna (redness, scaling, nodules, pain)

• Canal: cerumen, foreign bodies, edema, inflammation

• Tympanic membrane: intact? edema? fluid? inflammation?

• Mastoid: should be free from pain, redness, swelling

What functional ability cues suggest hearing loss?

• Frequently asking others to repeat statements

• Incorrectly answering questions

• Not responding when not facing sound source

• Social withdrawal/isolation

Which patients should NOT receive an otoscopic exam?

Patients unable to hold their head still or those who are confused (injury risk).

What diagnostic tests assess hearing loss?

• Tuning fork test (Weber/Rinne): distinguishes conductive vs. sensorineural loss

• Otoscopic exam: visualizes canal, TM, middle ear inflammation/blockage

• Audiometry: gold standard; measures sound frequencies & intensities

What are nonsurgical interventions for hearing loss?

• Remove cerumen buildup (ear irrigation if safe)

• DO NOT irrigate if: TM perforated, otitis media present, or object is vegetable matter (expands when wet)

• Experienced provider removes vegetable matter

How should the nurse communicate with hearing-impaired patients?

• Stand directly in front of patient, face well lit

• Avoid backlighting

• Gain attention before speaking

• Move closer to better-hearing ear

• Speak slowly/clearly, DO NOT shout

• Keep hands away from mouth

• Quiet room with minimal distractions

• Have patient repeat back statements

• Use gestures, write messages, use interpreters if needed

What are pre-op considerations for tympanoplasty?

• Baseline hearing assessment

• Administer antibiotics

• Teach: hearing loss normal immediately postop due to packing

• Encourage patient to wash hair before surgery

What are post-op nursing priorities after tympanoplasty?

• Monitor iodoform gauze packing & dressing (do not remove; reinforce & notify surgeon if bleeding)

• Keep dressing clean & dry, sterile technique for changes

• Position: flat, head turned to side, operative ear up for ≥12 hrs

• Administer prescribed antibiotics

• Observe for vertigo, tinnitus, infection

• Direct conversation to unaffected ear

What are key nursing considerations for hearing loss?

• Screen hearing at annual health assessments

• Teach patients to avoid using hairpins, ear candles, cotton swabs, toothpicks in ear canal

What are psychosocial impacts of hearing loss?

• Social withdrawal

• Communication frustration

• Depression, decreased quality of life

• Nurse role: support, connect to resources, teach coping strategies

How should a patient care for hearing aids?

• Keep dry

• Clean ear mold with mild soap & water (avoid excess wetting)

• Clean debris with soft toothbrush/brush provided

• Turn off when not in use

• Replace batteries frequently, keep extras on hand

• Store safely, avoid temperature extremes & drops

• Adjust volume to lowest effective setting

• Avoid hairspray, cosmetics, oils near receiver

• Some aids water-resistant, others waterproof → check with audiologist

• Troubleshooting if not working: change battery, check connections, switch, clean sound hole, adjust volume, seek service if unresolved

How is ear irrigation performed safely?

• Position: sit/lie with affected ear up

• Adults/children >3: pull pinna up & back; children <3: pull down & back

• Use warm solution (37°C / 98.6°F) with bulb syringe or Water Pik (low setting)

• Direct stream to superior ear canal, not directly at TM

• Ask about pain, nausea, vertigo during irrigation → indicates solution too hot/cold or too forceful

• After: wipe moisture, inspect canal