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Nursing Care for Disability Prevention (Audiology / Hearing Screening)

- Hearing Impairment

Introduction Early intervention services for children who are deaf or hard of hearing are of paramount importance. The first years of a child's life are crucial for learning essential skills and acquiring experiences necessary for subsequent developmental stages. This is known as the "critical period," during which a child is most receptive to environmental stimuli and can maximize their developmental potential.

The first years of life are critical for developing key skills for children who are deaf or hard of hearing. It is a vital phase for language development, making it essential to invest in this period to benefit the child and avoid future challenges. Furthermore, early intervention positively impacts academic performance. Research indicates that low academic achievement among the deaf and hard of hearing, especially in reading and writing, underscores the necessity of early intervention programs.

Hearing loss is categorized into two types:

  • Deafness (Deaf child): A child with a hearing loss of 70 dB or more, which impedes speech comprehension through hearing alone, with or without the use of a hearing aid.
  • Hard of Hearing (Hard of hearing child): A child with a hearing loss ranging between 35-69 dB, which causes difficulty—but not a disability—in speech comprehension through hearing alone, with or without the use of a hearing aid.

Classification of Hearing Loss

Hearing loss is classified based on three criteria:

  1. Age of Onset:
    • Pre-lingual hearing loss (before the development of speech and language).
    • Post-lingual hearing loss (after the development of speech and language).
  2. Site of Lesion:
    • Conductive Hearing Loss: Dysfunction in the outer or middle ear (pinna, ear canal, eardrum, or ossicles).
    • Sensorineural Hearing Loss: Dysfunction in the inner ear (cochlea, auditory nerve).
    • Mixed Hearing Loss: Dysfunction involving the outer, middle, and inner ear.
    • Central Hearing Loss: Dysfunction of the auditory pathways in the brainstem or the auditory centers in the brain.
  3. Degree of Hearing Loss (measured in decibels - dB):
    • Very Mild: 25–40 dB.
    • Mild: 41–55 dB.
    • Moderate: 56–70 dB.
    • Severe: 71–90 dB.
    • Profound: 91 dB and above.

Causes of Deafness and Hearing Loss

  • Hereditary factors: Chromosomal abnormalities or parental genes.
  • Prenatal and Perinatal factors: Maternal rubella, meningitis, Rh factor incompatibility, premature birth, maternal use of drugs/alcohol, mercury poisoning, and birth trauma or anoxia (oxygen deprivation) leading to nerve cell damage.
  • Other causes: Childhood diseases (measles, mumps, meningitis), outer ear obstructions (excessive wax), eardrum perforation (due to foreign objects, loud noises, or trauma), middle ear infections (otitis media), and congenital malformations.

Symptoms of Hearing Loss

  • Complaints of ear pain, frequently asking others to speak louder or repeat themselves, and tilting the head toward the speaker.
  • Ear discharge or excessive wax buildup.
  • Speech errors, inconsistent voice tone, and cupping the hand around the ear.
  • Preference for sign language, redness of the pinna, lack of response to loud sounds, or tinnitus.

Prevention

Prevention involves medical, psychological, and social measures:

  • Level 1 (Primary): Preventing causative factors (vaccination, prenatal care, ear hygiene, avoiding noise).
  • Level 2 (Secondary): Early detection, diagnosis, and medical treatment of ear conditions, and providing appropriate hearing aids.
  • Level 3 (Tertiary): Comprehensive rehabilitation (medical, educational, vocational) to achieve social and psychological integration.