1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 34 Hearing, Speech, and Vision Problems

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Hearing, speech, and vision: Allow communication, learning, and moving about Allow communication, learning, and moving about Are important for self-care, work, and most activities Are important for self-care, work, and most activities Are important for safety and security needs Are important for safety and security needs

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  EAR DISORDERS  Otitis media is infection or inflammation of the middle ear. Otitis media is acute or chronic. Otitis media is acute or chronic. Fluid builds up in the ear. Fluid builds up in the ear. Signs and symptoms include: Signs and symptoms include:  Pain and hearing loss  Fever and tinnitus An untreated infection can travel to the brain and other structures in the head. An untreated infection can travel to the brain and other structures in the head.

4. Slide 4 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Meniere’s disease Involves the inner ear Involves the inner ear Is a common cause of hearing loss Is a common cause of hearing loss Usually affects one ear Usually affects one ear Symptoms include vertigo (dizziness), tinnitus, hearing loss, and pain or pressure in the affected ear. Symptoms include vertigo (dizziness), tinnitus, hearing loss, and pain or pressure in the affected ear. Treatment involves drugs, fluid restriction, a low-salt diet, no alcohol or caffeine, and safety measures during vertigo. Treatment involves drugs, fluid restriction, a low-salt diet, no alcohol or caffeine, and safety measures during vertigo.

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Hearing loss Hearing loss is not being able to hear the normal range of sounds associated with normal hearing. Hearing loss is not being able to hear the normal range of sounds associated with normal hearing. Deafness is hearing loss in which it is impossible for the person to understand speech through hearing alone. Deafness is hearing loss in which it is impossible for the person to understand speech through hearing alone. Common causes of hearing loss are damage to the outer, middle, or inner ear and damage to the auditory nerve. Common causes of hearing loss are damage to the outer, middle, or inner ear and damage to the auditory nerve.

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Risk factors that can damage the ear structures include: Risk factors that can damage the ear structures include:  Aging  Exposure to very loud sounds and noises  Drugs (antibiotics, too much aspirin)  Infections  Reduced blood flow to the ear  Stroke  Head injuries  Tumors  Heredity  Birth defects

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Temporary hearing loss can occur from earwax (cerumen). Temporary hearing loss can occur from earwax (cerumen). Clear speech, responding to others, safety, and awareness of surroundings require hearing. Clear speech, responding to others, safety, and awareness of surroundings require hearing. A person may not notice gradual hearing loss. A person may not notice gradual hearing loss. There are some obvious signs and symptoms of hearing loss. There are some obvious signs and symptoms of hearing loss. Psychological and social changes are less obvious. Psychological and social changes are less obvious. Hearing is needed for speech. Hearing is needed for speech.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Persons with hearing loss may wear hearing aids or lip-read (speech-read). Persons with hearing loss may wear hearing aids or lip-read (speech-read). Some people learn sign language. Some people learn sign language. Some people have hearing assistance dogs (hearing dogs). Some people have hearing assistance dogs (hearing dogs). Hearing aids make sounds louder. Hearing aids make sounds louder. If a hearing aid does not seem to work properly: If a hearing aid does not seem to work properly:  Check if the hearing aid is on.  Check the battery position.  Insert a new battery if needed.  Clean the hearing aid.

10. Slide 10 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  SPEECH DISORDERS  A speech disorder results in impaired or ineffective oral communication.  Aphasia means the inability to have normal speech. Expressive aphasia (motor aphasia, Broca’s aphasia) Expressive aphasia (motor aphasia, Broca’s aphasia) Receptive aphasia (Wernicke’s aphasia) Receptive aphasia (Wernicke’s aphasia) Expressive-receptive aphasia (global aphasia, mixed aphasia) Expressive-receptive aphasia (global aphasia, mixed aphasia)  The person with apraxia of speech cannot use the speech muscles to produce understandable speech.  Dysarthria means difficult or poor speech. It is caused by nervous system damage. It is caused by nervous system damage.

11. Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  EYE DISORDERS  Vision loss occurs at all ages.  Vision loss is sudden or gradual in onset.  One or both eyes are affected.

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Glaucoma results from damage to the optic nerve. Fluid builds up in the eye and causes pressure on the optic nerve. Fluid builds up in the eye and causes pressure on the optic nerve. Peripheral vision (side vision) is lost. Peripheral vision (side vision) is lost. Other signs and symptoms vary. Other signs and symptoms vary. Risk factors Risk factors  African-Americans over 40 years of age  Everyone over 60 years of age  Those with a family history of the disease  Those with diabetes, high blood pressure, or heart disease  Those who have eye diseases or eye injuries  Those who have had eye surgery Drugs and surgery can control glaucoma and prevent further damage to the optic nerve. Drugs and surgery can control glaucoma and prevent further damage to the optic nerve.

14. Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Cataract is a clouding of the lens in the eye. Signs and symptoms include: Signs and symptoms include:  Cloudy, blurry, or dimmed vision  Colors seem faded  Sensitivity to light and glares  Poor vision at night  Halos around lights  Double vision in one eye Risk factors Risk factors  Age  Diabetes  Smoking and alcohol use  Prolonged exposure to sunlight  A family history of cataracts Surgery is the only treatment. Surgery is the only treatment.

16. Slide 16 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Age-related macular degeneration (AMD) AMD is a disease that blurs central vision. AMD is a disease that blurs central vision. Painless, it is the leading cause of blindness in persons 60 years of age and older. Painless, it is the leading cause of blindness in persons 60 years of age and older. The two types of AMD are wet AMD and dry AMD. The two types of AMD are wet AMD and dry AMD. Risk factors Risk factors  Aging  Smoking  Obesity  Whites are at greater risk than any other group.  Family history of AMD  Women are at greater risk than men.  Light-colored eyes  Exposure to sunlight  Cardiovascular disease

17. Slide 17 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. When dry AMD is advanced, no treatment can prevent vision loss. When dry AMD is advanced, no treatment can prevent vision loss. For wet AMD, some treatments may stop or slow the progress of the disease. For wet AMD, some treatments may stop or slow the progress of the disease.

18. Slide 18 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Diabetic retinopathy The tiny blood vessels in the retina are damaged. The tiny blood vessels in the retina are damaged. It is a leading cause of blindness. It is a leading cause of blindness. Everyone with diabetes is at risk for diabetic retinopathy. Everyone with diabetes is at risk for diabetic retinopathy. The person needs to control his or her diabetes, blood pressure, and blood cholesterol. The person needs to control his or her diabetes, blood pressure, and blood cholesterol. Advanced retinopathy is treated with laser surgery. Advanced retinopathy is treated with laser surgery.  Low vision is eyesight that cannot be corrected with eyeglasses, contact lenses, drugs, or surgery. The person learns how to use one or more visual and adaptive devices. The person learns how to use one or more visual and adaptive devices.

19. Slide 19 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Impaired vision and blindness Amount of vision loss varies. Amount of vision loss varies. Braille is a touch reading and writing system that uses raised dots for each letter of the alphabet. Braille is a touch reading and writing system that uses raised dots for each letter of the alphabet. Blind and visually impaired persons learn to move about using a long cane with a red tip or using a dog guide. Blind and visually impaired persons learn to move about using a long cane with a red tip or using a dog guide.  Eyeglasses and contact lenses can correct many vision problems.  Removal of an eyeball is sometimes done because of injury or disease. The person is fitted with an ocular prosthesis (artificial eye). The person is fitted with an ocular prosthesis (artificial eye).

23. Slide 23 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  QUALITY OF LIFE  Hearing, speech, and vision problems can interfere with quality of life.  The focus is on the person’s abilities. Do not pity the person. Do not pity the person. Treat the person like an adult. Treat the person like an adult. Be patient, understanding, and sensitive. Be patient, understanding, and sensitive.