If audiologists are to be considered independent healthcare providers, they must develop a broader view of the patient that goes beyond the cochlear hair cells.
Fifty years ago, Rosen and Olin discussed the impact of high-fat diets on the development of hearing loss (Arch Otolaryngol 1965;82:236-243), but the importance of the blood supply to the body, specifically to the inner ear, is still an area that eludes most hearing healthcare practitioners. A steady supply of nutrients and the elimination of waste are needed for normal hearing and balance.
This article discusses what the hearing healthcare practitioner should know about blood pressure (BP) and provides important information about heart attack and stroke that may assist practitioners in better helping their patients.
BLOOD PRESSURE VALUES
The blood supply to the inner ear starts with the contraction of the heart muscles, which forces blood through the arterial system. When the heart muscles relax, the heart fills with the blood returning from the body via the venous system.
Blood pressure is the force of blood against the arterial walls. In addition to the strength of the heart contraction, BP is also affected by resistance to blood flow within the blood vessels, which can vary due to stress and disruption of the smooth lining of the vessels from excessive cholesterol.
The blood pressure ranges between a maximum—the systolic pressure, which occurs when the heart contracts and forces blood through the arteries—and a minimum, or diastolic, pressure when the heart muscles relax. It is usually measured on the inside of the elbow at the brachial artery, the upper arm's major blood vessel, and it is expressed as systolic pressure (higher value, top number) over diastolic pressure (lower value, bottom number) in millimeters of mercury (mm Hg).
BP can vary from moment to moment, influenced by a wide variety of factors, including intense noise, gravity, emotional state, and so-called white-coat hypertension—the presence of higher readings when a patient's blood pressure is measured at the doctor's office compared with other settings.
The table shows the BP values for normal and abnormal ranges. Good health dictates that resting blood pressure should be within the normal range, as high blood pressure, or hypertension, is a major risk factor for stroke, the fourth-leading cause of death in the United States.
HEART ATTACK AND STROKE
Every 40 seconds, on average, someone has a stroke in the United States. A stroke—which is also called a cerebrovascular accident, or CVA—is a disruption of the blood supply to the brain.
When the disruption is caused by a blockage within a blood vessel supplying blood to the brain, the stroke is called an ischemic stroke. An ischemic stroke is further classified as thrombotic or embolic. In a thrombotic stroke, the blockage is caused by a blood clot that has formed in the blood vessel itself, usually the consequence of buildup from fatty deposits or plaques on the artery walls. In an embolic stroke, a portion of a blood clot that formed elsewhere in the body breaks loose, traveling through the bloodstream to the brain before becoming stuck in narrower blood vessels.
Hemorrhagic strokes are caused by bleeding from a ruptured blood vessel. If bleeding occurs within the brain, it is termed “intracerebral.” Subarachnoid hemorrhage is bleeding in the space surrounding the brain.
The disruption of blood flow to other parts of the body can also cause serious consequences. Disruption in the blood supply to the inner ear, for example, is a cause of sudden hearing loss (Essentials of Otolaryngology. Philadelphia: Lippincott Williams & Wilkins, 1999). When blood flow to the heart is disrupted, a heart attack may result. A pulmonary embolism disrupts the blood flow to the lungs and may result in sudden death.
The colored boxes on this page list common symptoms of a heart attack and stroke. Every hearing healthcare provider should be aware of these signs and know what to do if they occur, as most of our patients are elderly and may be at increased risk for such cardiovascular events. To help inform patients, a colorful chart may be obtained from the American Heart Association or the National Stroke Association and posted in a suitable office location.
If someone is having a stroke, it is very important that treatment be administered as quickly as possible. To accomplish this, the hearing healthcare provider or family member must recognize the signs of stroke and act FAST by calling 911 immediately. The acronym FAST provides an easy-to-remember assessment tool.
* Face: Ask the person to smile. Does one side of the face droop?
* Arms: Ask the person to raise both arms. Does one arm drift downward?
* Speech: Ask the person to repeat a simple phrase. Is speech slurred or strange?
* Time: If you observe any of these signs, call 911 immediately.
It would be reasonable for all hearing healthcare providers to include this information in their consumer newsletter and other patient communications. An important part of marketing is building trust, and the more services one provides to the community, the greater the enhancement of professional status.
Hypertension is asymptomatic, and about 20 percent of those who have it don't know they do, according to a 2008 brief from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics. In the United States, the prevalence of adult hypertension has been stable at about 29% since 1999, noted the CDC publication, which used data from the National Health and Nutrition Examination Surveys. While hypertension was about as common in women as it was in men, prevalence of the condition increased with age; 67% of those 60 and older had hypertension. Prevalence of hypertension also varied with ethnicity. Non-Hispanic blacks had a prevalence of 41%, versus 28% for non-Hispanic whites and 22% for Mexican Americans.
Hypertension is often preventable and treatable, the data brief showed: 64% of patients taking antihypertensive medication successfully controlled their blood pressure. However, Mexican Americans with hypertension were less likely to be aware of their condition compared with non-Hispanic blacks, and they were less likely to be treated for it than non-Hispanic blacks and non-Hispanic whites were. In addition, 28% of adults older than 18 had prehypertension and were not taking antihypertensive medication.
While it is uncommon for hearing healthcare practitioners to measure a patient's blood pressure, there is no reason why this step should not be a routine part of the intake exam, particularly for patients being seen for dizziness or tinnitus, or for those who report lightheadedness. There are training and certification courses available for blood pressure measurement that hearing healthcare professionals can take.
A wide range of BP devices called sphygmomanometers are commercially available at low cost, may be completely automatic, and take just a few minutes to measure blood pressure. Patients who exhibit abnormal readings should be referred to their primary care provider, and those exhibiting stage 2 hypertension or a hypertensive crisis should be seen immediately by a physician. Patients having a hypertensive crisis or heart attack should not drive themselves to the emergency room, as they would pose a danger to themselves and others.
While treatment of hypertension is beyond the scope of practice for audiologists and hearing instrument specialists, referral for hypertension might save a patient's life and could be an auxiliary tool to build referrals from physicians.
Another important way to help our patients is for every hearing healthcare provider to maintain cardiopulmonary resuscitation (CPR) certification from an American Heart Association-certified instructor. One never knows when this training may come in handy—I have used my CPR training at a baseball game, at the scene of a car accident, and during a visit to Walmart!
A list of local training sessions and class schedules is available online. It is necessary to recertify every two years, as the procedure does change slightly to reflect current knowledge. The courses only take a few hours to complete, but they can save a life. The longer the brain is deprived of oxygen, the greater the risk of death or brain damage. A trained hearing healthcare provider can begin CPR while waiting for the emergency medical team to arrive.
If a heart attack is suspected, avoid delay in calling 911. Many heart attack victims deny the symptoms until it is nearly too late. Early treatment enhances the possibility of living through the event without significant handicap.
Some of our patients live alone, and the absence of support can be devastating when an emergency happens in the middle of the night. Any individual who is alone during a medical crisis should call a friend or relative who lives nearby immediately after calling 911.
The stress of a heart attack can reduce the capability of a patient or loved one to take appropriate action. Finding and using a hearing aid or Bluetooth device may be overwhelming in such a situation. If you have a hearing loss and can't communicate with the 911 operator because you do not use a TTY or a similar device and you're unable to find or operate your hearing aid, say to the operator, “I'm hard of hearing, and I can't hear you. My name is (your name). My address is (your address). I'm having a heart attack (or state other emergency).” Keep repeating this as long as you can or until help arrives. Do not hang up!
Chewing a full-sized aspirin for 30 seconds is one of the most important steps anyone can take for a suspected heart attack. This simple action can reduce the impact of a heart attack almost immediately but does not deny the need for emergency medical care. It takes just five minutes for a chewed aspirin to show benefits, versus 12 minutes for an aspirin swallowed with water (Am J Cardiol 1999;84:404-409). It is important to advise emergency medical personnel if a patient has ingested an aspirin so they can take that information into account when determining the type and amount of emergency medications to give. The medical community recommends not to delay calling 911 to take aspirin for a suspected heart attack.
Patients should have an up-to-date list of all the medications and vitamins they routinely take. A useful marketing tool for hearing healthcare providers is to provide an emergency medical information card that patients can carry in their purse or wallet. Physicians might be willing to distribute such cards to their patients.
An understanding of blood flow and pressure, as well as the warning signs for heart attack and stroke, are important for the hearing healthcare professional. This article provides basic information that everyone should know. Such information can improve patient care, enhance professional image, and provide another marketing tool for patient and physician relationships.
Warning Signs of a Heart Attack
* Chest pain or discomfort.
* Discomfort in one or both arms, back, neck, jaw, or stomach.
* Shortness of breath.
* Cold sweat.
Women may have the above and/or:
* Unexplained fatigue.
* Abdominal pressure that feels like indigestion.
Warning Signs of a Stroke
Sudden onset of:
* Numbness or weakness of the face, arm, or leg, especially on one side of the body.
* Confusion, trouble speaking, or difficulty understanding.
* Trouble seeing in one or both eyes, including double vision.
* Trouble walking, dizziness, or loss of balance or coordination.
* Severe headaches with no known cause.