Care & Usage of Hearing Instruments in

a Skilled Nursing Facility

Statistical Information

• As many as 70-80% of nursing home residents may have some degree of hearing loss.

• In residents with hearing aids, approximately 50% will have hearing aids that are malfunctioning or are in need of repair.

Role of the CNA• As the caregiver who has the most

frequent contact with the resident, it is important that the CNA:– recognize the symptoms of hearing loss– understand how a hearing aid works– know how to keep hearing aids working – learn how to troubleshoot hearing aid

problems– know how to effectively and

appropriately communicate with the hearing impaired resident

Lesson Instructions

• Use the Table of Contents on the next two slides to hyperlink to the various components of this lesson. Click on the icon next to each topic.

• When you have completed the lesson, see your instructor in order to complete the practical demonstration and the written test.

Table of Contents

Table of Contents(continued)

Anatomy of the Ear

Three parts of the human ear:

• Outer ear• Middle ear • Inner ear

Anatomy of the EarOuter Ear Middle Ear Inner Ear

Outer Ear

• Auricle or pinna • External auditory canal

Auricle (pinna)

External auditory canal

Outer Ear

Middle Ear

• Tympanic membrane (ear drum)• Three bones:

– Malleus– Incus– Stapes

Middle Ear3 Ossicles (malleus, stapes, incus)

Tympanic membrane

Inner Ear

• Semicircular canals• Cochlea• Auditory nerve• Round window• Eustachian tube

Inner Ear

Semicircular canals

Auditory nerve

Cochlea

Round window

Eustachian tube

Anatomy of the Ear

Auricle (pinna)

External auditory canalCochlea

Tympanic membrane

3 Ossicles (malleus, stapes, incus)

Semicircular canals

Auditory nerve

Eustachian tube

Round window

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Types & Causes of Hearing Loss

Hearing loss can occur in any or all parts

of the ear.

Types of Hearing Loss

• Conductive– problem with conduction, or the transfer of

sound, through outer or middle ear

• Sensori-neural– dysfunction of inner ear; involves problem

with nerve and/or sound interpretation

• Mixed– combination of conductive and sensori-

neural hearing loss

Some Causes of Conductive Hearing Loss

• Debris blocking ear canal (example: wax or other foreign objects)

• Fluid build-up behind ear drum (example: otitis media)

• Perforated ear drum

Some causes of Sensori-neural Hearing

Loss• Dysfunction of inner ear related to:

– aging process (presbycsis)– chronic noise exposure– toxic medications– viral infections (mumps; meningitis)

Example of Mixed Hearing Loss

• Hearing loss related to aging, plus hearing loss related to infection and fluid behind the ear drum.

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Symptoms of Hearing Loss

• High volume on TV, radio• Talking loudly• Frequently asking to have things

repeated• Complaints of not understanding

what has been said• Intently watching face of speaker

More Signs of Hearing Loss

• Cupping the ear • Lack of response to questions• Frequent inappropriate or incorrect

answers to questions• Frustration; anger• Confusion• Withdrawal

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Types of Hearing Aids

• Completely-in-the-canal (CIC)• In-the-canal (ITC) (half shell)• In-the-ear (ITE) (full shell)• Behind-the-ear (BTE)

Behind the ear

In the ear

(full shell)

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(half shell)

How a Hearing Aid Works• Power source = battery• Microphone - receives sound wave and

converts it into an electrical signal• Amplifier - increases intensity of

incoming sound• Receiver - converts electrical signal

back into audible sound wave that can be heard

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Identifying Parts of the Hearing Aid

Volume control

Battery door

Ear mold (body)

Tubing

OTM switch

Canal portionBehind-the-ear

ear-piece

Identifying Hearing Aid Parts

• O-T-M switch -- turns hearing aid on and off, and adjusts for use on telephone.

O=Off T=Telephone M= (microphone) On

• Volume Control - permits the user to increase or decrease loudness of sound

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Care of Hearing Aids

• Cleaning– Clean regularly– Wipe off

accumulated debris from ear mold with kleenex

– Use wax pick , toothpick or small brush to remove ear wax

• Store in a labeled container, away from moisture/heat

• Remove battery when not in use for extended period of time

• DO NOT DROP

Care of Hearing Aids

• Test hearing aid battery at least every 2 weeks.

• Battery should register 1.4 on the tester.

• Replace battery as needed.

• A “listening check” of hearing aid should be done regularly.

To reduce risk of choking, swallowing, KEEP BATTERIES OUT OF RESIDENT’S REACH

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Troubleshooting Hearing Aid Problems

Potential Problems• No amplification or

sound• Weak/reduced sound• Whistling• Buzzing• Static

• Turn OTM switch to “M”

• Adjust volume• Check battery

position• Test battery• Replace battery, if

needed

• Clean / Remove wax

• Check hearing aid for damaged/broken parts

• Notify your supervisor

Troubleshooting Hearing Aid Problems

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Communicating with theHearing Impaired

• Speak at slightly greater intensity. DO NOT YELL.

• Speak at normal pace -- not too rapidly.

• Speak from a distance not greater than 6 feet; but, preferably, not less than 3 feet.

• Make sure you are visible to resident when speaking so that your facial expressions and gestures can be seen.

• Try to reduce environmental noise.

• NEVER speak directly into person ‘s ear. (Clarity may be lost as loudness is increased; and resident can’t make use of visual cues.)

• Do not over-articulate. This distorts sound as well as facial expressions.

• Rephrase, rather than just repeat, your statement or question when it appears that a resident doesn’t understand.

• Treat all residents with courtesy and respect.

Communicating with theHearing Impaired

End of Presentation

• You have now completed the Lesson on Care & Usage of Hearing Instruments in a Skilled Nursing Facility.

• See your instructor for a practical demonstration on hearing aids, and to complete the written test.