MSRLE

• HEARING AIDS

  • Device design to improve hearing by making sounds audible to a person with hearing loss.
  • EAR TRUMPET, OR EAR HORS-were passive amplification cone design Ed to gather sounds energy and direct it into the ear canal.
• Risk Factors

  • Family Hx of sensorineural impairment.
  • Congenital malformation
  • Low birth weight(less 1500)
  • Use of ototonic medication (gentamicin,loop diuretics)
  • Recurrent ear infection
  • Bacterial meningitis
  • Chronic exposure to loud noises.
  • Perforation of the tympanic membrane.
• Whisper Test

  • Excluding the one ear from the testing, examine cover the untested ear with palm of hand. Then whisper softly from distance of 1-2 feet from the unoccluded ear and out of pt sight. Pt. Usually repeat what was whispered if have normal acuity.
• Weber Test

  • Use to test the lateralization of sounds.
  • Tuning fork (512Hz).
  • Grasping it firmly by its stem or tapping it ilon examiner's knee or hands ,then place on pt. Head or forehead.
  • CONDUCTIVE HEARING LOSS - Otosclerosis or otitis media (sounds heard better in affected ear.
  • SENSORINEURAL HEARING LOSS - results from the damage to the cochlear or vestibulocochlear nerves,the sound lateralized to the better hearing ears,
  • Useful to detecting unilateral hearing loss.
• Rinne Test

  • Examiners shift the stem of vibrating tuning fork between two positions 2 inches from the opening of ear canal (air conduction.)and Mastoid bone (bone conduction)
  • Conductive hearing Loss - ,bone conducted sounds heard as long as or longer than air conducted sounds.
  • Sensorineural hearing Loss - air conducted sounds is audible longer than bone conducted sounds.
  • In normal hearing the air conducted is louder than bone conducted sounds.
• DIAGNOSTIC EVALUATION

  1. Audiometry
  2. Tympanogram
  3. Auditory brain stem response
  4. Electronystagmography
  5. Platform posturography.
  6. Sinusoidal Harmonic acceleration.
  7. Middle Ear Endoscopy
• 1. Audiometry

  - Audie (to hear),metria(to measure).

  - branch of audiology and science of measuring hearing acuity for a variation in sounds intensity and pitch and for tonal purity.

  - determine the subject hearing level but may able to measure ability to discriminate different sounds intensities, recognize pitch and distinguished speech from background noise.

  - ACOUSTIC Reflex and OTOACOUSTIC Emissions also be measured.

  Often use the AUDIOGRAM.
• TYMPANOGRAM

  • Also called Impedance Audiometry
  • Measures middle ear muscle reflex to sounds stimulation and compliance of the tympanic membrane by changing the air pressure in sealed ear canal.
  • Compliance is impaired with middle ear disease.
• Auditory Brain Stem Response

  • Detectable electrical potential from cranial nerve VIII and ascending auditory pathways of brain stem in response to sound stimulation.
  • Electrodes places on pt.forehead. Acoustic stimuli- usually in form of clicks are made in the ear. Resulting electrophysiologic measurements can determine ,at which decibel level a patient hears and whether there are any impairment along the nerve pathways.(tumor or cranial nerve VIII)
• ELECTRONYSTAGMOGRAPHY

  • Measurements and graphic recording of the changes in electrical potentials created by eye movement during spontaneous,positional or calorically evoked nystagmus. it is also used to assess the oculomotor and vestibular system and corresponding actions.
  • Help to diagnose:MENIERE'S DS.and tumor in internal auditory canal or posterior fossa.
  • Any vestibular suppressant (sedative, tranquilizer, antihistamine and alcohol are withheld for 24 hours before testing, Prior to the test the procedure is explained to the patient.
• Platform Posturography

  • Used to investigate postural control capabilities
  • The integration of visual, vestibular and proprioception cues. With motor response output and coordination of the lower limbs is tested.
  • Pt stand in platform surrounded by screen and different condition such as moving platform, stationary platform with moving screen are presenting.
• Sinusoidal Harmonic Acceleration

  • Or Rotary Chair
  • Use to access the vestibulo- ocular system by analysing compensatory eye movement in response to clockwise or counterclockwise chair rotation.
  • It helps identify the disease and evaluate the course of recovery.
  • Preparation is the same as electronystagmography.
• Middle Ear Endoscopy

  • Ear examine with very small diameter and acute angles endoscopy.
  • Endoscopist in Ear: Otolaryngology.
  • This procedure has anesthesia for 10mins. Then external auditory canal is irritated with sterile normal saline sol.
  • Tympanotomy - created with laser beam or a myringotomy knife
• Consideration in hearing Aids

  1. Hearing impairment
  2. Lifestyle
  3. Level of activity
  4. Physical condition of the ears
  5. Appearance
  6. Budget
• Microphone:

  • Starts the process of hearing by picking up different sounds in the environment and converting them into an electric signal
  • Two types of microphones:
  • Directional microphone: picks up most of the sound in front of the wearer, helping to understand conversations in noisy environments
  • Omnidirectional microphone: picks up sounds in all directions, giving the user a better sense of where sound is coming from
• Processor / Amplifier:

  • Acts as the motherboard of the hearing aid
  • Takes the electric signal from the microphone and converts it into a digital signal that can be manipulated
• Receiver:

  • Creates and enhances soundwaves
  • Directs sound towards the wearer's inner ear
• Battery:

  • Serves as the power source for the hearing aid
• Earmolds (earpieces):

  • Direct the flow of sound into the ear
  • Enhance sound quality
• Types of Hearing Aids

  1. Air conduction Hearing Aids
  2. Bone conduction Hearing Aids
• Air conduction Hearing Aids

  1. Open fit hearing aid - ( with narrow tube)mini BTE design to hide behind the ear. Sound transmitted into ear canal via thin plastic tube that connect to a tip that sits within the ear canal. It doesn't block the ear canal like other traditional Hearing Aids so the air allowed to enter the ear naturally. amplified sounds from the hearing aids enters through the tip.
• 2. In the ear hearing aid

  • fits completely inside the hospital outer ear, they have plastic case that holds electronics.
  • Best for people with mild -severe hearing loss  buts they don't works as well in children whose ears are still growing.
• 3. Behind the ear hearing aid

  • sits in hard plastic case behind the ear.
  • Plastic ears mold fit inside the outer ear and direct sounds to the ear..
  • For mild to severe hearing loss but its not for everyone.
  • Uses small battery which have shorter life and can be difficult to handle.
  • Often doesn't have extra feature like volume control or directional microphone.
  • Is susceptible to ear wax clogging the speaker.
• 4 In the canal hearing aid.

  • custom made based on an impression taken of your ear canal and surrounding areas.
  • They are slightly larger than CIC hearing aid but still consider cosmetically appealing.
  • All components in an ITC are encased within a lightweight plastic shell.
  • In there medium size makes them a great choice for push control button.
  • ITC offer a secure fit, easy to insert and remove and have longer battery life. works best to mild to moderate hearing loss.
• 5. Completely in the canal hearing aid

  • molded to fit inside ear canal . It improves mild to moderate hearing loss in adults.
  • Smallest and least visible type. Is less likely to pick up wind noise.
  • Uses very small battery,which have shorter life and can be difficult to handle No extra feature  .
  • Susceptible to ear wax clogging the speaker.
• BONE CONDUCTED HEARING AIDS

  • Also known as (AUDITORY OSSEOINTERGRATED DIEVICE) transfer sound through bone conduction to the inner ears
  • Have SOUND PROCESSOR AND COUPLING MECHANISM
  • instead of a receiver,it has bone vibrator which snugly fit on the mastoid and directly stimulates the cochlea.
  • Useful in ot. With active draining ears,otitis external or atresia if the ears canal when ear inserts cannot be worn.
  • Pick up sound by microphone,they changes thee sounds to vibration and send it to the child's skull through an abutment,a magnet located just under thee skins or through bone a soft band.
• Headband Hearing aids

  • SPECTACLE TYPE - incorporated within the spectacle frames
  • It is useful fot those who use glasses with hearing aids.
• Implantable Hearing Aids

  • Work on direct drive principle.
  • Rather than delivering acoustic energy into the external auditory canal (like traditional aid system) direct drive middle ear implant system uses mechanical vibration delivered directly to ossicular chain, while leaving the ear canal open.
• Cochlear implant

  • Surgically implanted neuroprosthetic device to provide a person with moderate to profound sensorineural hearing loss a modified sense of sounds. CI bypassed the normal acoustic hearing process replace it with electric signal which directly stimulates the auditory nerve.
  • Pt. With CI receiving intensive auditory training may learn to interpret those signals as sounds and speech.
• BONE ANCHORED HEARING AIDS

  • suited to people who have conductive hearing losses, unilateral Hearing, loss single sided deafness, and people with mixed hearing losses who cannot otherwise wear in the ear or behind the ear hearing aids.
  • More expensive than conventional hearing aids, placement involved invasive surgery which carries a risk of complications.
• Auditory Brain stem implants

  • Doesn't store normal hearing
  • But it helps distinguished sound like telephone rings and car horns.
  • Combined with lip reading ,the cues can improve communication with others.
• Middle ear implant

  • Suitable for those with a mild to moderate mixed or conductive hearing loss or an sensorineural hearing loss.
  • Latest or more recent hearing implant.
  • Offer alternative to conventional hearing aid. Consider for those with earmould allergies,skin problems in there ears,outer ear infection,and malformed ears.
• Four types of Hearing Loss

  • Conductive Hearing Loss - caused by something that stops sounds from getting through the outer or middle ears. Can be often treated by medication or surgery.
  • Sensorineural hearing Loss - occurs when there is a problem in the way the inner ears or hearing nerves works.
  • Mixed hearing loss - including both conductive and sensorineural hearing loss.
  • Auditory Neuropathy Spectrum Disorder - occur when sounds enter the ear normally,but because of damage into inner ear or the hearing nerve,sounds isn't organized in a way that the brain can understand.
• Craniotomy involves the opening of the skull surgically to gain access to intracranial structures
• It is performed to remove a tumor, relieve elevated intracranial pressure, evacuate a blood clot, and control hemorrhage
• Surgeons cut the skull to create a bony flap, which can be repositioned after the surgery and held in place by periosteal or wire suture
• Purposes of Craniotomy:

  • To diagnose
  • To remove brain tumors
  • To treat brain tumors
• Indications for Craniotomy:

  • Surgical removal of tumor or blood clot or draining the abscess within the skull
  • Clipping an aneurysm to reduce its potential to burst
  • Removal of arteriovenous malformation to prevent bleeding
  • Surgery for epilepsy
  • Ventricular shunting to reduce pressure in the skull
  • Inserting deep brain stimulator for the treatment of brain tumors, Parkinson's disease, essential tremor, and dystonia
• 3. Transsphenoidal Craniotomy:

  Site: Sella turcica. Incision location: Beneath the upper lips to gain access into the nasal cavity

  • Nursing intervention: Maintain nasal packing in place, instruct the patient to avoid blowing the nose, provide frequent oral care, keep the head of the bed elevated
• Cranial Surgical Approaches:

  1. Supratentorial Craniotomy:

  • Site: Above the tentorium
  • Incision location: Usually behind the hairline
  • Nursing intervention: Maintain head of bed elevated 30-45 degrees, with neck in neutral alignment, position patient on either side or back

  2. Infratentorial Craniotomy:

  • Site of surgery: Below the tentorium, brain stem
  • Incision location: At the nape of the neck, around the occipital lobe
  • Nursing intervention: Maintain neck straight alignment, avoid flexion of the neck, position patient on either side