Chapter 37

1. Chapter 37 Hearing and Vision Problems

2. Hearing and Vision Problems • Sight and hearing: • Allow communication and learning • Are important for most activities • Are important for safety and security needs • Many people have some degree of hearing or vision loss. • Common causes are: • Birth defects • Accidents • Infections • Diseases • Aging

3. Ear Disorders & Hearing Problems • The ear is needed for hearing and balance. • Problems range form slight hearing impairment to complete deafness. • Problems may occur suddenly, but usually are gradual in onset. • One or both ears may be affected.

4. Otitis Media • Otitis media is infection of the middle ear. • Common in infants and children • Viruses and bacteria are causes. • Otitis media is acute or chronic. • Chronic otitis media can damage the • Eardrum • Bones of the middle ear that conduct sound • Permanent hearing loss can result from chronic otitis media.

5. Otosclerosis • A hereditary condition in which the ossicles in the middle ear begin to harden • A common cause of hearing loss in adults • Gradual and progressive hearing loss • Accompanied by tinnitus ( ringing in the ear) • Surgery can often restore some hearing.

6. Ménière’s Disease • An increase of fluid in the inner ear causing pressure in the middle ear • Usually only one ear is affected. • Symptoms include: • Vertigo (dizziness) • Tinnitus • Hearing loss • Pain or pressure in the affected ear • Sever dizziness may cause nausea and vomiting. • Safety is needed during vertigo. • The person must lie down. • Falls are a major concern.

7. Hearing Loss • Hearing loss is not being able to hear the range of sounds associated with normal hearing. • Losses are mild to severe. • Deafness is hearing loss in which it is impossible for the person to understand speech through hearing alone. • Hearing loss occurs in all age groups. • Common causes of hearing loss are: • Damage to the outer, middle, or inner ear • Damage to the auditory nerve

8. Dominant Progressive Hearing Loss • Impairment of nerves used to hear • Hearing loss is progressive. • Usually starts in early or middle adulthood • Sometimes starts in early childhood

9. Presbycusis • Gradual hearing loss associated with aging • Occurs after age 50 • No cure • Hearing aids and speech reading are helpful.

10. Temporary Hearing Loss • Blockage of the ear canal with earwax • Common in older adults • Hearing improves when wax is removed. • Earwax is usually removed by doctor or nurse.

11. Effects of Hearing Problems • Signs/symptoms vary – hearing loss may not be obvious. • A client’s behaviour, attitude may change due to hearing problems – frustration, anger. • May deny that they have a hearing problem • Signs of hearing problems • Speaking too loudly • Leaning forward to hear • Turning and cupping the unaffected ear toward the speaker • Responding inappropriately • Asking for words to be repeated

12. Effects of Hearing Problems • Hearing loss can affect all aspects of a person’s heath • Physical • Emotional • Social • Intellectual • Spiritual • Hearing is needed for speech. • Hearing loss may result in slurred speech. • Words may be pronounced wrong. • Some have monotone speech or drop word endings. • It may be hard to understand what the person says. • Canadian Hearing Society is an excellent resource.

13. Aids for Hearing Loss • Hearing aids are electronic devices that fit inside or behind the ear. • They make sounds louder. • They do not correct, restore, or cure hearing problems. • The person hears better because the device makes sounds louder. • Background noise and speech are louder. • If a hearing aid does not seem to work properly, try these measures: • Check if the hearing aid is on. It has an on/off switch. • Check the battery position. • Insert a new battery, if needed. • Clean the hearing aid.

14. Care of Hearing Aids • Hearing aids are expensive – handle with care. • Look for visual signs of damage, cracks, or clogged openings. • Insert battery, turn on – check for whistling sound which indicates battery is working. • Apply correctly – incorrect insertion may cause the aid to fall out, or whistling sound may occur. • Keep hearing aid in dry place, avoid getting the device wet. • When not in use – turn hearing aid off and keep the battery door open. • Report missing or damaged hearing aid.

15. Technology Devices • Special telephone system • Uses typed messages back and forth • Signalling devices • The device makes a sound, vibrates, or flashes a light to alert the person. • E-mails • Computer software • Dogs • Alert to ringing phone, baby crying, door bell • Closed captioning • TV screen over 13 inches have built-in decoder.

16. Caring for Client with Hearing Problems • Alert client of your presence. • Adjust the lighting. • Reduce background noise. • Focus your attention on the client. • Speak in a normal tone. • Check communication aid. • Adjust your language. • Use other communication methods. • Watch for signs of fatigue.

17. Eye Disorders & Vision Problems • Vision loss occurs at all ages. • Problems range from mild vision loss to complete blindness. • Blind is the absence of sight. • Vision loss is sudden or gradual in onset. • One or both eyes are affected. • The legally blind person sees at 6 m (20 ft) what a person with normal vision sees at 60 m (200 ft).

18. Age-Related Macular Degeneration • Also called AMD or ARMD • A disease that blurs central vision and causes damage to the macula located in the centre of the retina • The disease is usually gradual in onset. • Central vision becomes fuzzy, shadowy. • Client may lose central vision but have some peripheral vision. • It is the leading cause of blindness in persons 50 years of age and older; for which there is no cure. • The two types of AMD are: • Wet AMD • Dry AMD

19. Retinal Detachment • Separation of the retina from its supporting tissue • Can result in permanent blindness • Vision may be saved by surgical reattachment.

20. Diabetic Retinopathy • A complication of diabetes, it is a leading cause of blindness. • Tiny blood vessels in the retina are damaged. • Usually both eyes are affected. • Everyone with diabetes is at risk. • Blood can leak from the blood vessels creating scar tissue that pulls the retina away from the back of the eye.

21. Glaucoma • An eye disease that causes pressure within the eye, which damages the optic nerve • Vision loss with eventual blindness occurs. • Usually age-related, onset sudden or gradual • Can develop in one or both eyes • Peripheral vision (side vision) is lost – tunnel vision (can only see straight ahead) • Blue green halos around lights • Glaucoma has no cure. • Prior damage cannot be reversed. • Medications and surgery can control glaucoma and prevent further damage to the optic nerve.

22. Cataract • A clouding of the lens in the eye that prevents light from entering the eye. • A cataract can occur in one or both eyes. • Signs and symptoms include: • Sensitive to light and glares • Cloudy, blurry, or dimmed vision • Surgery is the only treatment. • Removal of cloudy lens and implantation of new lens

23. Presbyopia • Gradual inability to focus on close objects • Associated with aging – usually occurs after age 40 • Corrective lenses/contact lenses can help

24. Effects of Vision Problems • Vision loss affects physical, emotional, social, intellectual, and spiritual health. • Clients can learn to move about, complete activities of daily care, and learn new reading methods. • Guide dog and white cane with a red tip are recognized worldwide. • Canadian National Institute for the Blind (CNIB) has good resources. • Talking books • Different types of aids • Support to clients and families

25. Aids for Vision Problems • Eyeglasses – correct vision problems • Expensive – keep in case when not worn. • Plastic lenses scratch easily. • Use special cleaning solutions/soft cloth to dry. • Contact lenses – hard or soft • Fit directly on the eye • Proper cleansing/soaking solution is important. • May be worn for 12–24 hours – usually removed for swimming and sleeping. • Report any eye redness or drainage, eye pain, or blurred vision.

26. Aids for Reading • Braille is a touch reading and writing system that uses raised dots for each letter of the alphabet. • The first 10 letters also represent the numbers 0 through 9. • Communication aids • Large print clocks, oral clocks, large letters for playing cards • Talking prescription devices

27. Artificial Eyes • Removal of an eyeball is sometimes necessary because of injury or disease. • The client is fitted with an ocular prosthesis. • Some prostheses are permanent implants. • If removable, the client may be taught to remove, clean, and re-insert it. • You need to protect the client’s prosthesis from loss or damage.

28. Caring for Clients with Vision Problems • Sense of hearing, touch, smell, taste may become more developed with loss of vision. • Client may be sensitive to the tone of a person’s voice. • Alert client to your presence. • Walk slightly ahead, allow client to hold onto your arm, inform of approaching obstacles. • Explain the location of food on a plate by relating to the time on a clock. • Keep area free of clutter. • Inform client if you close doors.