Chapter 9: Patient comfort and supporting personal hygiene
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Related theory
Hearing loss can develop over time and become less noticeable to the individual and those close to them, as they find alternative ways to cope. Hearing impairment can cause frustration, stress, social isolation, paranoia and depression (NHS England [145]).
There is a high overall incidence of hearing difficulties in people with learning disabilities (McClimens et al. [124]). These difficulties can be due to a variety of factors including genetic tendencies to deafness, fragile X syndrome, structural abnormalities within the organ and neural complications; this can further complicate communication difficulties for this population (McClimens et al. [124]).
Nurses should be aware of how ear problems occur so they are able to explore these with patients to identify problems early and provide appropriate patient education. All findings should be documented and handed over to the patient's doctor for further investigation, such as a hearing assessment (Box 9.5).
Box 9.5
Hearing tests for adults
Pure tone audiometry
Pure tone audiometry (PTA) tests the hearing of both ears. During PTA, a machine called an audiometer is used to produce sounds at various volumes and frequencies (pitches).
Speech perception
The speech perception test, sometimes known as a speech discrimination test or speech audiometry, involves testing the ability to hear words without using any visual information. The words may be played through headphones or a speaker, or spoken by the tester.
Tympanometry
The eardrum should allow as much sound as possible to pass into the middle ear. If sound is reflected back from the eardrum, hearing will be impaired. During tympanometry, a small tube is placed at the entrance of the ear and air is gently blown down it into the ear. The test can be used to confirm whether the ear is blocked, most commonly by fluid.
Whispered voice test
The whispered voice test is a very simple hearing test. It involves the tester blocking one of the patient's ears and testing their hearing by whispering words at varying volumes.
Tuning fork test
A tuning fork produces sound waves at a fixed pitch when it is gently tapped. It can be used to test various aspects of hearing. The tester will tap the tuning fork on their elbow or knee to make it vibrate, before holding it at different places around the patient's head.
Bone conduction test
A bone conduction test is often carried out as part of a routine PTA test in adults. A bone conduction test involves placing a vibrating probe against the mastoid bone behind the ear. It tests how well sounds transmitted through the bone are heard. Bone conduction is a more sophisticated version of the tuning fork test. When used together with PTA, it can help to determine whether hearing loss comes from the outer and middle ear, the inner ear, or both (NHS Direct Wales [143]).
