Hearing Loss Nursing Care Plans Diagnosis and Interventions
Hearing Loss NCLEX Review and Nursing Care Plans
Hearing loss (HL) can be devastating, as it significantly impacts daily living. Normal communication is hampered, which leads to strained relationships and conflicts, especially if others are unaware of the disability.
The early onset of HL interferes with maturation by hindering the child’s self-image, social skills, and cognition. Meanwhile, age-related degeneration and loud noises are the most common causes of HL in adults.
The primary focus of preventative methods is the avoidance of damaging noise, ototoxic drugs, and, most importantly, the early management of HL and its associated clinical conditions.
Types of Hearing Loss
- Conductive Hearing Loss (CHL). CHL is a reversible form of HL that results from the cessation of sound moving through the outer ear or ossicles. Sounds may be muffled, garbled, or hollow-sounding. Medical interventions such as antibiotics, reconstructive, and stapes surgery are recommended for patients with this kind of HL.
- Sensorineural Hearing Loss (SNHL). SNHL is an irreversible type of HL characterized by damage to the sensorineural elements (e.g., nerve pathways, structures) of the ear. The principal interest of therapy and diagnosis is to ascertain the level of residual hearing and to medically correct or enhance it through auditory training and hearing aids.
- Mixed Hearing Loss. A mixture of both conductive and SNHL components.
Signs and Symptoms of Hearing Loss
- speech or sound distortion (e.g., muffled, garbled, hollow, tinny)
- trouble distinguishing between consonants
- difficulty understanding speech
- constant requests for the speaker to articulate more clearly or speak more loudly
- frequent misinterpretation of speech
- social isolation
- withdrawal from interactions
- watching tv or listening to music at a higher volume
- Trauma. Trauma-induced HL (such as head injury) is associated with damage to the structures of the ear. Contact sports and car accidents can cause severe bruising, dislocation of ossicles, and blood clots, obstructing blood circulation to the ear cartilage. Pressure changes from scuba-diving or flying can also cause barotrauma (partial loss of hearing) and pain.
- The buildup of earwax. Blocks the ear canal giving rise to temporary hearing loss
- Osteoma. Benign tumors that can prevent the conduction of sounds
- Cholesteatoma. Impacts the structures of the middle ear due to bone erosions
- Ear injury. Excessive noises and aging causes wear and tear to the external and internal ear since it damages the nerve cells in the cochlea or the chain of bones (ossicles), responsible for the transmission of electrical signals (sound vibrations). Perforation of foreign bodies or objects such as cotton buds can lead to infection or can penetrate the eardrums.
- Inflammation and infection of the ear. Nasal congestion due to bacterial or viral infections causes hearing loss due to inadequate ventilation of the Eustachian tube to the middle ear, causing fluid drainage, which promotes infection and inflammation.
- Otitis media (OM). OM is brought by fluid accumulation in the ossicles, affecting the efficient transmission of sound vibrations.
- Otitis externa (OE). OE is an ear inflammation of the external auditory tube affecting the function of the ear and may result in hearing loss upon the buildup of thick and dry skin in the ear canal.
Risk Factors To Hearing Loss
- Aging. The aging process affects the hearing function and speech range of individuals. Presbycusis or age-related HL often occurs as a result of degeneration of the inner ear structures, changes in afferent spiral ganglion neurons, loss of hair cells, and narrowing of stria vascularis.
- Heredity. Congenital defects in the anatomy of the ear can cause hearing deficits or loss. The genetic makeup of the ear may also make a person more susceptible to acoustic trauma or age-related degeneration. Autoimmune ear disorders and labyrinthitis predisposes the patient to hereditary progressive SNHL. Hereditary deafness and speech problems have been linked to defects in the organ of the Corti.
- Progressive noise. Frequent exposure to loud noises (high frequency) can cause acoustic trauma to the ear since it damages the cells of the cochlea. Individuals exposed to firearms and firecrackers have been shown to suffer from permanent hearing damage or loss.
- Occupational noises. Occupational deafness or HL often occurs when the environmental or industrial noises reach damaging levels.
- Recreational noises. Involves recreational noise exposure commonly seen in target practices, shooting, jet engines, power tool use, snowmobiling, and motorcycling
- Medications. Some medications, such as antibiotics, can cause ototoxicity (damage to the inner ear). This is also one of the major causes of congenital HL.
- Conditions. Infections such as mumps, encephalitis, meningitis, and scarlet fever put the patient at risk of uni or bilateral HL. Meniere’s disease, a condition of the inner ear, has been associated with tinnitus.
Complications of Hearing Loss
Hearing loss inflicts emotional trauma to the patient and substantially diminishes their quality of life. As a result of their disability, people who have hearing loss are likely to be pessimistic or confrontational. Its functional impact includes:
- Social isolation. The inability to convey feelings and sustain a conversation results in frustration and withdrawal from situations that require talking. Their failure to communicate effectively fosters introversion and insecurity.
- Poor self-concept. Children with hearing deficits will likely suffer from low self-esteem due to differences in communication skills with hearing peers.
- Risk For Injury. Inefficient and unsatisfactory methods of instruction can place the patient in a critical situation since their handicap interferes with proper retention and understanding of information. These may affect their ability to perform tasks and use assistive devices correctly, increasing their risk for injury or trauma.
Diagnosis of Hearing Loss
- Physical examination. Involves assessment of head, ear, nose, and neck, hearing ability, presence of dizziness or complaints of vertigo, and extraocular motion to determine the clinical cause of HL.
- Neurological assessment. This routine component of the otological examination is performed to identify the possible association with neurological disorders. Conditions such as neurofibromatosis and multiple sclerosis cause SNHL or hearing impairment. This test also focuses on cranial nerve involvement as it may indicate the potential conditions that may induce HL.
- Otological examination. This diagnostic procedure is also known as the ear examination. It evaluates the cause of hearing dysfunction and recognizes the condition or abnormality which may be disrupting the normal hearing. The use of an otoscope aids the examination of the external auditory canal, middle ear, and tympanic membrane and offers information regarding the presence of perforations, impaction of foreign objects, bulging, erythema, etc. Head mirrors also provide good visualization of the auricle and external canal.
Other more definitive screening tests:
- Hearing test applications. User-friendly, app-based test that allows patients to digitally screen their hearing ability and auditory processing.
- Tuning fork tests. Uses the principle of air and bone conduction via two prongs. The vibration of the tuning fork provides tactile stimulation to the ear, which aids with the identification of the degree of HL. The intensity of sounds gained and the unresponsiveness of one or both ears determine whether HL is due to sensorineural or conductive HL.
- Audiometer tests. A more thorough test to identify the cause of hearing dysfunction or loss.
Treatment for Hearing loss
- Hearing aids. Conventional therapy for chronic SNHL. This device amplifies sound vibrations by means of the residual hair cells, which transmit neural signals to the brain. However, substantial damage to the epithelium and hair cells inhibits its amplification and restricts the input it can provide. It is indicated in patients with presbycusis, tinnitus, osteosclerosis, uni or bilateral hearing loss, and older adults with impaired hearing. HL, due to the absence of the auditory nerve and a defective cochlea, may not be remedied by hearing aids.
- Removal of excessive earwax. Involves the use of a suction device or loop wire to remove the impacted earwax, which blocks the ear canal.
- Cochlear implants. Comparable in certain aspects with hearing aids since it is indicated for chronic cases of sensorineural hearing loss. Cochlear implants involve surgical implantation of a processor-controlled, multichannel electrode into the cochlea. It functions by transmitting electrical impulses to the acoustic nerve and recognizes these signals as true sounds. The surgical procedure is typically performed with the patient under general anesthesia with a one-day post-surgical hospitalization. Fitting occurs after four to six weeks, which is typically sufficient for the surgical site to heal. After the external device is fitted, the audiologist activates the implant.
- Surgical repair. This intervention may be warranted for certain cases of hearing loss, such as those with perilymph fistulas, otosclerosis, endolymphatic hydrops, tumors, or deformities in the ossicles or eardrum.
- Surgical debulking. Involves tumor removal with preservation of the facial nerve
- Surgical reconstruction. Indicated for conditions that cause hypertrophy, displacement, or distortion of the ear. This intervention aims to correct hearing loss and cosmetic defects.
- Stapedectomy. An invasive operation involving prosthesis placement, bypassing the ossification of the stapes footplate.
Nursing Diagnosis for Hearing Loss
Hearing Loss Nursing Care Plan 1
Disturbed Sensory Perception: Auditory
Nursing Diagnosis: Disturbed Sensory Perception (auditory) related to hearing loss, secondary to otosclerosis, as evidenced by changes in hearing with nose blowing, complaints of ringing, lack of response, and inability to hear.
Desired Outcome: The patient will experience an improvement in hearing.
|Hearing Loss Nursing Interventions||Rationale|
|Assess the patient’s hearing ability by observing how they respond to regular conversation. Determine the source of deafness by inquiring about muffled or absent sounds in one ear.||Provides baseline information regarding the degree of hearing impairment or hearing capacity. Difficulty responding to discussions or interrogations may indicate moderate or severe HL, which necessitates rapid medical attention due to its disruptive impact on daily living. The healthcare provider may ask pertinent questions to identify if hearing loss is psychogenic (a defensive mechanism) or triggered by a disease process.|
|Explain the condition and its potential effect on hearing and accommodate the patient’s inquiries. Assure the patient that HL and its associated problems (such as vertigo) are treatable and manageable.||Awareness of the underlying cause of HL reduces the patient’s anxiety over functional/sensory loss and prevents the precipitation of stress, which negatively impacts patient outcomes. Moreover, they may be unaware of its complications, prognosis, and causative factors (such as progressive noise).|
|Ensure that the intensity of environmental noises (e.g., medical equipment) is kept to a minimum or eliminated. Avoid abrupt or jarring noise peaks during the recuperation phase.||The distortion in hearing ability causes confusion and agitation. Although reducing background noise may seem impractical or difficult, the use of protective and muffling devices in the ear is an excellent technique to manage noise-induced hearing loss.|
|Encourage the patient’s family and significant others to communicate in a loud and clear voice.||Failure to communicate can lead to frustrations and friction between the patient and his/her significant other. Moreover, failure to relay instructions amidst HL might result in grave errors, mistakes, complications, and risk of injury or accidents.|
|Use simple and short sentences while speaking slowly.||Improves the patient’s ability to comprehend uttered sentences.|
Hearing Loss Nursing Care Plan 2
Nursing Diagnosis: Deficient Knowledge related to lack of information about hearing loss, secondary to Otitis media, as evidenced by inaccurate adherence to instructions, lack of comprehension of management initiatives, and frequent queries on the severity of hearing changes
Desired Outcome: The patient will verbalize knowledge and comprehension of the disease process and demonstrate sensible precautions for hearing loss progression.
|Hearing Loss Nursing Interventions||Rationale|
|Assess the patient’s understanding of the pattern and process of the disease. Identify the risk of smoking and illness exposure.||Enables the nurse to establish a stable environment favorable to the patient’s rehabilitation and to equip them with the necessary knowledge to combat the progression of HL.|
|Provide information regarding the potential sources of HL (e.g., exposure to infected individuals, irritants, infection).||The provision of information enables the patient or his/her family to be well-informed about the condition and its implications. Treatment of HL can be improved via management of the condition to improve its signs and symptoms, prevent its progression, or surgical therapy. These treatment options enable the patient to better prepare for routine diagnostic procedures and intensive therapy.|
|Provide adequate privacy during discussions and maintain a calm and nonjudgmental demeanor.||Helps build rapport and a trusting relationship|
|Use child-appropriate language and explain the condition with the help of an ear model. Request that the patient or their parents communicate their comprehension of the teaching.||The transmission of information may be compromised due to the patient’s hearing deficiencies. The goal of this intervention is to strengthen visual observation and interpretation as well as coordination of lip-reading, facial expressions, and body language. These measures also enhance their comprehension of conversational patterns and train residual hearing.|
|Refer the patient or their parents to special training programs, hearing conservation programs, caregiving, rehabilitative measures, smoking cessation, and parenting skills classes||The involvement of professional services and programs aids the patient in meeting their needs. It also encourages patient follow-ups and enhances their skills and knowledge.|
Hearing Loss Nursing Care Plan 3
Nursing Diagnosis: Impaired Verbal Communication related to hearing loss, secondary to traumatic brain injury, as evidenced by neck stiffness, tinnitus, dizziness, and impaired hearing.
Desired Outcome: The patient will demonstrate less frustration due to communication difficulties and effectively communicate their needs through other means of communication.
|Hearing Loss Nursing Interventions||Rationale|
|Determine the causality of impaired communication.||Early deafness can distort communication skills. Moreover, its impact varies depending on the degree of HL. The patient’s character (e.g., mental, spiritual, societal) and sources, including the availability of a support system, affect one’s reaction to the level of handicap the HL generates.|
|Assess the noise level of the care environment.||Prolonged exposure to intense sounds can precipitate HL.|
|Assess the patient’s ability to interpret spoken information.||It is possible that the cause of HL is not peripheral but rather a dysfunction of the central nervous system. This incapacity to perceive speech and process complex information is frequently the result of a central hearing loss.|
|Assess for cognitive alterations and note the presence of psychological disorders. Evaluate the patient’s reaction to the impairment and their willingness to seek alternative forms of communication.||Evaluation of the patient’s mental status allows the healthcare provider to determine speech discrimination and difficulties emanating from psychological origins.|
|Give special attention to nonverbal cues and use gestures when speaking to the patient.||The patient’s initiative to comprehend conversational trends is indicated by the use of gesture clues and purposeful gaze at the speaker’s face. Similarly, patients use nonverbal communication (such as facial expressions, tone, eye contact, and body language) as a communication channel to decipher words or information being conveyed.|
|Establish eye contact and use concrete terms and gestures in giving instructions such as “point to the affected site or pain” and “turn your head.”||Simple directions allow the patient time to process information and adhere to instructions.|
Hearing Loss Nursing Care Plan 4
Risk For Social Isolation
Nursing Diagnosis: Risk For Social Isolation related to hearing loss, secondary to tinnitus.
Desired Outcome: The patient will exhibit behaviors that enhance social interaction
|Hearing Loss Nursing Interventions||Rationale|
|Assess any contributing factors to social isolation.||Treatment compliance can be enhanced by identifying and correcting the variables that cause social isolation and negative emotions.|
|Identify the patient’s risk of social isolation.||HL puts the patient at risk of social isolation due to intensified emotional feelings such as grief reactions.|
|Approach the patient in a positive, accepting, and non-judgmental manner while establishing rapport and a supportive attitude.||Due to speech and communication difficulties, patients with HL may experience strained relationships as a result of their inability to communicate. The nurse should enrich the patient’s experiences with positive remarks and support to avoid being isolated and make them feel more connected.|
|Guide and assist the patient by utilizing all available forms of communication. Foster positive channels and ensure that the patient achieves emotional stability via the encouragement of counseling and referral groups with similar experiences.||Interactions decrease the patient’s sense of isolation. Since the patient’s inability to communicate may be the source of social isolation and low self-esteem, this intervention also expresses the view that the patient is valued.|
|Offer sustained support throughout individual and group activities that may be too challenging, frightening or grief-provoking for the patient.||The progressive decline of hearing often leaves emotional trauma. Although the patient’s hearing function cannot be restored in certain circumstances, it is still possible to reduce the psychological effects of HL. A supportive presence from a trusted individual helps decrease the patient’s fear and anxiety during rehabilitation.|
Hearing Loss Nursing Care Plan 5
Nursing Diagnosis: Chronic Low Self-Esteem related to hearing loss, secondary to acoustic neuroma, as evidenced by negative self-perceptions, incapacity to perform self-care, and negative reinforcement
Desired Outcome: The patient will elicit fewer negative reactions regarding their hearing handicap.
|Hearing Loss Nursing Interventions||Rationale|
|Assess the patient’s self-esteem levels.||Indications of decreased self-esteem include isolation, feelings of insecurity, inadequacy, self-care deficits, noncompliance with treatment, and withdrawal from social relationships.|
|Provide the patient time to perform personal care activities||Performing activities of daily living, such as eating, dressing, and grooming, is the first step in establishing a positive self-image.|
|Provide reinforcement or a reward system for each completed task.||Praise, rewards, and positive recognition encourage the repeat of desirable activities in response to pleasant or positive stimuli.|
|Enable the patient to partake in recreational activities while increasing their involvement in more complex, group-related tasks.||Patients may feel overwhelmed when introduced to a group setting; however, this can be minimized by exposing them to a series of simple, more manageable tasks before progressing to more complicated ones to build task mastery.|
|Include visualization techniques in the care plan that can assist with the replacement of negative thoughts and feelings (e.g., bad self-image, doubts, worries) with more positive ones.||Visualization training helps improve self-image by recreating and blocking out triggering negative images and feelings to achieve a state of peace and attunement with the reality of the condition.|
|Involve the patient in group therapy with members who share the same handicap, situation, or experience as they have.||Patients with a hearing handicap can benefit from group rehabilitation activities as it minimizes feelings of isolation, provides a realistic appraisal of the situation, and provide avenues to adopt communication strategies.|
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Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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