1. Care & Usage of Hearing Instruments in a Skilled Nursing Facility

2. 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.

3. 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

4. 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.

5. Table of Contents

6. Table of Contents (continued)

7. Anatomy of the Ear Three parts of the human ear: Outer ear Middle ear Inner ear

8. Anatomy of the Ear Outer EarMiddle EarInner Ear

9. Outer Ear Auricle or pinna External auditory canal

10. Auricle (pinna) External auditory canal Outer Ear

11. Middle Ear Tympanic membrane (ear drum) Three bones: –Malleus –Incus –Stapes

12. Middle Ear 3 Ossicles (malleus, stapes, incus) Tympanic membrane

13. Inner Ear Semicircular canals Cochlea Auditory nerve Round window Eustachian tube

14. Inner Ear Semicircular canals Auditory nerve Cochlea Round window Eustachian tube

15. Anatomy of the Ear Auricle (pinna) External auditory canal Cochlea Tympanic membrane 3 Ossicles (malleus, stapes, incus) Semicircular canals Auditory nerve Eustachian tube Round window Return to Table of Contents

16. Types & Causes of Hearing Loss Hearing loss can occur in any or all parts of the ear.

17. 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

18. 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

19. 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)

20. Example of Mixed Hearing Loss Hearing loss related to aging, plus hearing loss related to infection and fluid behind the ear drum. Return to Table of Contents

21. 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

22. More Signs of Hearing Loss Cupping the ear Lack of response to questions Frequent inappropriate or incorrect answers to questions Frustration; anger Confusion Withdrawal Return to Table of Contents

23. 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)

24. Behind the ear In the ear (full shell) Return to Table of Contents (half shell)

25. 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 Return to Table of Contents

26. Identifying Parts of the Hearing Aid Volume control Battery door Ear mold (body) Tubing OTM switch Canal portion Behind-the-ear ear-piece

27. 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 Return to Table of Contents

28. 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

29. 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. 9To reduce risk of choking, swallowing, KEEP BATTERIES OUT OF RESIDENT’S REACH Return to Table of Contents

30. Troubleshooting Hearing Aid Problems Potential Problems No amplification or sound Weak/reduced sound Whistling Buzzing Static

31. 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 Return to Table of Contents

32. Communicating with the Hearing 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.

33. 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 the Hearing Impaired

34. 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.