Hearing, speech, and vision allow communication, learning, and moving about. They are important for self-care, work, most activities, and safety and security needs. For example, you see dark clouds and hear tornado warning sirens. You know to seek shelter. With speech, you alert others.

Hearing, speech, and vision disorders occur in all age-groups. Common causes are birth defects, injuries, infections, diseases, and aging.

Ear Disorders

The ear functions in hearing and balance.

See Body Structure and Function Review: The Ear, p. 676.

Body Structure and Function Review

The Ear

A sense organ, the ear (Fig. 42-1) functions in hearing and balance. It has 3 parts: the external ear, middle ear, and inner ear.

Sound waves are guided through the external ear (outer part) into the auditory canal. Glands in the auditory canal secrete a waxy substance called cerumen. The auditory canal extends about 1 inch into the eardrum. The eardrum (tympanic membrane) separates the external and middle ear.

The middle ear contains the eustachian tube and 3 small bones called ossicles. The eustachian tube connects the middle ear and the throat. Air enters the eustachian tube so there is equal pressure on both sides of the eardrum. The ossicles amplify sound received from the eardrum and transmit the sound to the inner ear. The 3 ossicles are:

• The malleus—looks like a hammer.

• The incus—looks like an anvil.

• The stapes—is shaped like a stirrup.

The inner ear consists of semicircular canals and the cochlea. The cochlea looks like a snail shell. It contains fluid that carries sound waves from the middle ear to the acoustic nerve. The acoustic nerve then carries messages to the brain.

The 3 semicircular canals are involved with balance. They sense the head’s position and changes in position. They send messages to the brain.

Otitis Media

Otitis media is an infection (itis) of the middle (media) ear (ot). It often begins with sore throats, colds, or other respiratory infections that spread to the middle ear. Viruses and bacteria are causes.

Otitis media is acute or chronic. Chronic otitis media can damage the structures needed for hearing. Permanent hearing loss can occur.

Fluid builds up in the ear. Pain (earache), hearing loss, fever, and tinnitus occur. Tinnitus is a ringing, roaring, hissing, or buzzing sound in the ears or head. An untreated infection can travel to the brain and other structures in the head. The doctor orders antibiotics, pain-relief drugs, or drugs to relieve congestion.

See Focus on Children and Older Persons: Otitis Media.

Focus on Children and Older Persons

Otitis Media

Children

Otitis media is common in infants and children. Infants cannot tell you about an earache. The child may:

Older Persons

Persons with dementia cannot tell you about pain or when something is wrong. Be alert for behavior changes. The following may signal otitis media.

• Unusual irritability

• Problems sleeping

• Tugging or pulling at 1 or both ears

• Fever

• Fluid draining from the ear

• Balance problems

• Signs of hearing problems

Meniere’s Disease

Meniere’s disease involves the inner ear. Usually 1 ear is affected. Symptoms include:

• Vertigo (dizziness)

• Tinnitus

• Hearing loss

• Feeling of fullness or pressure in the ear

With Meniere’s disease, fluid builds up in the inner ear. The increased fluid causes swelling and pressure in the inner ear. Symptoms are sudden.

An attack usually involves vertigo, tinnitus, and hearing loss. Vertigo causes whirling and spinning sensations. The dizziness causes severe nausea and vomiting. An episode can last 20 minutes or 2 to 24 hours.

Drugs and a low-salt diet decrease fluid in the inner ear. Smoking, caffeine, and alcohol are avoided.

Safety is needed during vertigo.

• Have the person lie down.

• Prevent falls. Assist with walking and use bed rails according to the care plan.

• Remind the person to keep the head still. The person avoids turning the head. To talk to the person, stand directly in front of him or her.

• Avoid sudden movements. The person moves slowly.

• Prevent bright or glaring lights.

Hearing Loss

Hearing loss is not being able to hear the normal range of sounds associated with normal hearing. Losses are mild to deafness, the most severe form. Deafness is hearing loss in which it is impossible for the person to understand speech through hearing alone.

Common in older persons, hearing loss is more common in men than in women. Causes include damage to the outer, middle, or inner ear or to the acoustic nerve. Risk factors include:

Temporary hearing loss can occur from earwax (cerumen). Hearing improves after the earwax is removed.

Clear speech, responding to others, safety, and awareness of surroundings require hearing.

See Focus on Communication: Hearing Loss.

See Promoting Safety and Comfort: Hearing Loss.

Focus on Communication

Hearing Loss

The National Association of the Deaf (NAD) uses the terms deaf and hard-of-hearing to describe persons with hearing loss. Do not use the terms deaf and dumb, deaf-mute, or hearing-impaired. Such terms offend persons who are hard-of-hearing.

Promoting Safety and Comfort

Hearing Loss

Safety

Do not try to remove earwax. This is done by a doctor or a nurse. Do not insert anything, including cotton swabs, into the ear.

Effects on the Person.

A person may deny hearing loss or not notice gradual hearing loss. Others may see changes in the person’s behavior or attitude. They may not relate the changes to hearing loss. See Box 42-1 for signs and symptoms of hearing loss.

Box 42-1

Hearing Loss—

Signs and Symptoms

• Problems:

• Hearing on the phone

• Hearing with background noise or in noisy areas

• Following conversations when 2 or more people are speaking

• Understanding women and children

• Straining to understand a conversation

• Hearing voices as mumbled or slurred

• Misunderstanding what others are saying

• Answering questions or responding inappropriately

• Asking others to repeat themselves

• Speaking too loudly

• Leaning forward to hear

• Turning and cupping the better ear toward the speaker

• Turning up the TV, radio, music, or other sound sources so loud that others complain

Psychological and social changes may occur. People may give wrong answers or responses. Therefore they tend to shun social events to avoid embarrassment. Often they feel lonely, bored, and left out. Only parts of conversations are heard. They may become suspicious. They think others are talking about them or are talking softly on purpose. Some control conversations to avoid responding or being labeled “senile” because of poor answers. Straining and working hard to hear can cause fatigue, frustration, and irritability.

Hearing is needed for speech. Pronouncing words and voice volume depend on hearing yourself. Hearing loss may result in slurred speech or pronouncing words wrong. Some people have monotone speech or drop word endings. It may be hard to understand what the person says. Do not assume or pretend that you understand. Serious problems can result. See “Speech Disorders” on p. 681.

See Focus on Children and Older Persons: Effects on the Person.

Focus on Children and Older Persons

Effects on the Person

Children

Some babies are born with hearing problems. Others develop hearing problems as they grow older. Hearing is needed for language development. Children learn to talk by imitating sounds and voices.

Medical attention is needed if a child does not hear well or speak clearly. See Box 42-2. Items checked “No” may signal hearing loss. Report concerns about a child’s hearing to the nurse.

Box 42-2

Hearing Checklist for Children

Items marked “No” may signal hearing loss.

No	Yes	Birth to 3 Months
___	___	Reacts to loud sounds.
___	___	Calms down or smiles when spoken to.
___	___	Recognizes your voice and calms down if crying.
___	___	When feeding, starts or stops sucking in response to sound.
___	___	Coos and makes pleasure sounds.
___	___	Has a special way of crying for different needs.
___	___	Smiles when he or she sees you.
		4 to 6 Months
___	___	Follows sounds with his or her eyes.
___	___	Responds to changes in the tone of your voice.
___	___	Notices toys that make sounds.
___	___	Pays attention to music.
___	___	Babbles in a speech-like way and uses many different sounds, including sounds that begin with p, b, and m.
___	___	Laughs.
___	___	Babbles when excited or unhappy.
___	___	Makes gurgling sounds when alone or playing with you.
		7 Months to 1 Year
___	___	Enjoys playing peek-a-boo and pat-a-cake.
___	___	Turns and looks in the direction of sounds.
___	___	Listens when spoken to.
___	___	Understands words for common items such as “cup,” “shoe,” or “juice.”
___	___	Responds to requests (“Come here.”).
___	___	Babbles using long and short groups of sounds (“tata,” “upup,” “bibibi”).
___	___	Babbles to get and keep attention.
___	___	Communicates using gestures such as waving or holding up arms.
___	___	Imitates different speech sounds.
___	___	Has 1 or 2 words (“Hi,” “dog,” “Dada,” or “Mama”) by first birthday.
No	Yes	1 to 2 Years
___	___	Knows a few parts of the body and can point to them when asked.
___	___	Follows simple commands (“Roll the ball.”) and understands simple questions (“Where’s your shoe?”).
___	___	Enjoys simple stories, songs, and rhymes.
___	___	Points to pictures, when named, in books.
___	___	Acquires new words on a regular basis.
___	___	Uses some 1- or 2-word questions (“Where kitty?” or “Go bye-bye?”).
___	___	Puts 2 words together (“More cookie.”).
___	___	Uses many different consonant sounds at the beginning of words.
		2 to 3 Years
___	___	Has a word for almost everything.
___	___	Uses 2- or 3-word phrases to talk about and ask for things.
___	___	Uses k, g, f, t, d, and n sounds.
___	___	Speaks in a way that is understood by family members and friends.
___	___	Names objects to ask for them or to direct attention to them.
		3 to 4 Years
___	___	Hears you when you call from another room.
___	___	Hears the TV or radio at the same sound level as other family members.
___	___	Answers simple “Who?” “What?” “Where?” and “Why?” questions.
___	___	Talks about activities at day care, pre-school, or friends’ homes.
___	___	Uses sentences with 4 or more words.
___	___	Speaks easily without repeating syllables or words.
No	Yes	4 to 5 Years
___	___	Pays attention to a short story and answers simple questions about it.
___	___	Hears and understands most of what is said at home and in school.
___	___	Uses sentences that give many details.
___	___	Tells stories that stay on topic.
___	___	Communicates easily with other children and adults.
___	___	Says most sounds correctly except for a few (l, s, r, v, z, ch, sh, and th).
___	___	Uses rhyming words.
___	___	Names some letters and numbers.
___	___	Uses adult grammar.

Modified from National Institute on Deafness and Other Communication Disorders: Your baby’s hearing and communicative development checklist, NIH Publication No. 10-4040, Bethesda, Md, updated June 14, 2015, National Institutes of Health.

Communication.

Persons with hearing loss may wear hearing aids or lip-read (speech-read). They watch facial expressions, gestures, and body language. Some people learn American Sign Language (ASL) (Figs. 42-2 and 42-3). ASL uses signs made with the hands and other movements such as facial expressions, gestures, and postures. (Different sign languages are used in different countries. For example, British Sign Language is different from ASL.)

FIGURE 42-2 Manual alphabet. (Courtesy National Association of the Deaf, Silver Spring, Md.)

FIGURE 42-3 American Sign Language examples.

Some people have hearing assistance dogs (hearing dogs). The dog alerts the person to sounds. Phones, doorbells, smoke alarms, alarm clocks, babies’ cries, sirens, and on-coming cars are examples.

Hearing Aids.

Hearing aids fit inside or behind the ear (Fig. 42-4, p. 680). They make sounds louder. They do not correct, restore, or cure hearing problems. Hearing ability does not improve. The person hears better because the device makes sounds louder. Background noise and speech are louder. The measures in Box 42-3, p. 680 apply.