Hearing impairment

Listen to what two nurses with firsthand experience have to say.

Communication is your most important health care intervention. Chances are you sometimes care for patients whose ability to communicate is at risk because of hearing problems. As hearing-impaired nurses who wear bilateral hearing aids, we have special empathy for these patients. In this article, we'll tell you about the types of hearing loss, how hearing aids can help, and how you can improve communication with a hearing-impaired patient.

Catching a wave

Hearing involves capturing, recognizing, and accurately interpreting sound waves. Three types of hearing loss can impair the process:

Conductive hearing loss is a blockage of sound waves between the outer or middle ear and the inner ear that reduces the ability to hear faint sounds and distinguish between like sounds. Symptoms include muffled sounds, earache or discharge, and pressure or a sense of fullness in the ear. Common causes include otitis media due to infection, impacted wax, ruptured eardrum, and otosclerosis. A hearing aid won't help someone with this condition, but prompt medical or surgical intervention can generally reverse it.

In sensorineural hearing loss, sound waves are conducted normally but the inner ear can't detect the vibrations or can't send them to the auditory nerve. The person has trouble understanding normal conversations and hearing high-pitched frequencies. She may hear constant ringing or buzzing sounds or suffer from dizziness or nausea. German measles, mumps, cytomegalovirus, ototoxic medications, occupational noise, and aging can lead to sensorineural hearing impairment, which usually is permanent. A hearing aid can help with this type of problem.

Mixed hearing loss combines conductive and sensorineural disorders. Someone with this type may also benefit from a hearing aid.

A hearing aid helps hearing by capturing, amplifying, and funneling sound waves to the auditory nerve. Like the telephone, it has a microphone, amplifier, and earphone plus electrical current to connect the components. An otolaryngologist or audiologist should determine who's a candidate for a hearing aid, and the audiologist or a hearing aid specialist can help the patient determine which type is appropriate for her. (For the available types, see Hearing Aid Options.) All types should be made-to-order because too loose or too tight a fit interferes with sound wave detection.

Relying on more than a hearing aid

Wearing a hearing aid doesn't always restore normal hearing. Activate your facility protocol on caring for a hearing-impaired patient as soon as you learn that she has hearing loss. Ensure that all health care providers who might interact with her are put on notice. Place a notation such as Hearing Aid Wearer and a hearing-impaired communication tip sheet on her bedside table and in her chart. (See A Kit to Enhance Communication to learn about a tool with visual alerts and communication strategies.)

Here are some points to cover on the hearing-impaired communication tip sheet:

Ask the patient how she prefers to communicate. Encourage her to identify supportive adjuncts and services, such as speech reading (lip reading), writing, sign language, closed-captioned TV, listen aids, or telecommunication relay-services (TRS), which provide a simple means for deaf, hard-of-hearing, and speech-disabled persons to communicate with anyone by telephone. Consult your telecommunication and administration department regarding assistive devices and services.

Allow extra time to interact with the patient, especially when giving her special instructions. If she owns a hearing aid, make sure it's in her ear and working properly. If she wears glasses, make sure she's wearing them too. Speak with her away from noisy areas, open windows, or air conditioners. Eliminate background noise and turn off the radio or TV Remember, a hearing aid amplifies all sounds, which can interfere with her ability to hear you.

Get the patient's attention so she can make the most of gestures and speech reading. Stand close to her, make eye contact, and speak clearly and a little more slowly than usual. Make sure only one person speaks at a time. Use full sentences, a natural tone of voice, and universal hand gestures. Avoid exaggerating, which alters natural word formation and impairs speech reading, and shouting, which disrupts the hearing cycle by distorting sound waves. Never converse or conduct unexpected activity behind her.

To help the patient speech read, consider her view of your face. Make sure the lighting on your face is adequate so she can read your speech and facial expressions. Don't stand in front of a bright light or window. Don't chew gum or food while speaking and don't obscure your mouth with your hands or anything else. Even mustaches and beards obstruct the lips and might interfere with speech reading.

Always have your patient repeat your instructions, regardless of whether she's wearing her hearing aids. Especially while talking about critical issues such as pain management, be certain she understands. Don't be misled by "smiling and nodding"; if she doesn't respond appropriately, rephrase your communication or write it down.

Stay attuned to her emotional needs. Include her in all activities and conversations regarding her health care plan.

Advocate for her right to wear her hearing aid during tests and procedures whenever possible. In some cases, such as during magnetic resonance imaging, this isn't possible.

Keep in mind that pain, fatigue, and the effects of medications can impair your patient's communication abilities. Always include her hearing challenges and communication tips, along with her medical progress, in your end-of-shift report.

Prepare now

You and your facility can take steps now to help future hearing-impaired patients. Locate the facility's hearing aid policy and procedure; know what it says and make sure it reflects current practice. Ask the nursing educator to schedule a staff-development session on hearing aid maintenance. Contact the sign language interpreter and ask how he provides services. Learn how to use the TRS and how to get closed-captioning on the TV Make sure this information appears in the policy and procedure manuals.

Becoming familiar with the needs of a patient with a hearing impairment takes extra effort. But the effort will leave you better equipped to deliver her care and help her be a well-versed health care consumer who's able to participate in her own plan of care.

SELECTED REFERENCES

Bickley, L.: Bate's Guide to Physical Examination and History Taking, 8th edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2002.

Matthews-Flint, L., and Lucas, L.: "Telecommunication Relay Service: Linking Nurses to Patients with Communication Disorders," Home Healthcare Nurse. 17(5):300-305, May 1999.

By Linda J. Lucas, RN, CNS, PHN, MSN, and Lenora J. Matthews-Flint, RN, CNS, PHN, MSN

Linda J. Lucas is an independent nurse-consultant in Wilmington, Del., and Lenora J. Matthews-Flint is a clinical nurse specialist/staff-development specialist in the tricentral staff-education department at Kaiser Permanente Medical Center in Baldwin Park, Calif.

Copyright Springhouse Corporation Oct 2003
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