Question

Read the following case study while considering the questions below:

Beverly Jones is an 83-year-old retired nurse who lives independently in her home in Oak Creek. She was a flight nurse in the Korean War and would fly into combat to help evacuate injured soldiers. After the war, she worked at St. Luke’s hospital in the Emergency Department for 20 years and then at a clinic near the airport and close to home for 20 years before retiring. She has never been married and does not have children.

Ms. Jones feels healthy at her age. She has a past medical history of hypertension, hypothyroidism, and arthritis. She takes lisinopril 20 mg daily and Lasix 40 mg daily for her hypertension. This combination has well controlled her blood pressure for the past 30 years. About 10 years ago, her physician started her on aspirin for her heart and she takes 325 mg daily. She takes Synthroid 88 mg for her hypothyroidism and 600 mg of ibuprofen BID as needed for her arthritis. She does not drink but has smoked a pack a day for 70 years.

You meet Ms. Jones for the first time when she comes in for her annual check-up and flu shot. You notice she asks you to repeat yourself frequently and she turns her head as you move around the room. She does not answer all of your questions appropriately and has difficulty following some of your directions. You are concerned about Ms. Jones’ hearing and complete the HHIE-S. She scores a 28.

o   What age-related changes would you expect to find in the external, middle, and inner ear and nervous system?

o   What are Ms. Jones risk factors for hearing loss?

§ Age

§ Environmental noise: planes and guns in war, ambulances in the ER, living and working near the airport

§ Smoking

§ Medication: aspirin, Lasix, ibuprofen, especially for a long time

§ HTN, hypothyroidism

o   What behavior cues do you notice and expect to see that indicate a hearing deficit?

§ See Text

o   What is the HHIE-S and what does her score indicate?

§ Hearing Handicap Inventory for the Elderly: assesses the presence and functional consequences of hearing loss in cognitively intact older adults

§ 84% probability of hearing impairment- severe handicap- need to refer

o   What additional questions would you ask Ms. Jones to assess her hearing?

§ See Text

o   What are the different types of hearing loss and how do you differentiate between them?

§ Conductive: problem with external or middle ear

§ Sensorineural: problem with inner ear or neural structures

§ Mixed

§ Noise Induced Hearing Loss

o   What interventions could you implement today while Ms. Jones is in the office to help with her hearing loss?

Answer 1

Age related hearing loss are common. Because as we age there are greater chances for internal ear change.Loss of hair cells or when it cannot regrow or die, hearing loss will be permanent.Presbycusis is usually a sensorineural hearing disorder which can be caused by noise, work place environment, disease conditions

Age and environmental noise are the main factors which caused hearing impairments.

HHIE-S stands for hearing handicap inventory for the elderly. The score 28 reveals she has severe hearing handicap.

Her behaviour of asking for repeatimg things and continuously turning her head towards the direction of nurse indicates she has hearing loss.

Additional questions like how she communicated to a stranger,does she speaks in louder tone to people,does she leans towards the stranger during conversation to hear closely are some points which can asked to assess her hearing loss.

Conductive hearing loss means there will be problems in conduction.Difficulty of transmission waves.

Sensorineural indicates problems with inner ear due to nervous system impairments as ageing occurs.

Or else it can be a mixed hearing loss.

Repeating noise pollution can also lead to hearing loss

An ENT visit has to be scheduled to regain her hearing capacity who can help her for get her hearing sensation to an extent to lead good quality of life.Some are hearing aid, cochlear implant,bone anchored hearing system,assistive listening devices.