Advanced Emergency Nursing Blog from AENJ

The concepts, concerns, clinical practices, researches, and future of Advanced Emergency Nursing.

Monday, March 27, 2017

What was that? What did you say?

​Clinical Tips # 200 {'Double-Century' Edition} – Helping Those with Hearing Loss, appearing Monday, March 27th, 2017 to April 3rd, 2017, brings back the "Ten Commandments the Hearing Impaired Wish You Knew" previously listed in this blog in "Ten Commandments for Emergency Professionals; a compendium."

This has particular significance and importance for us as emergency professional for several reasons:

  1. Our business is helping patients who are unselected and undifferentiated. We take all comers. Some have hearing problems also. We must be able to communicate effectively.

  2. Hearing problems may develop insidiously; the patient, perhaps with some denial, may not yet have realized how hard of hearing he has become. We may notice behaviors that indicate difficulty in hearing. In fact, we may not have admitted as much to ourselves that our hearing 'isn't what it was.'

  3. Office practices may be open forty hours weekly. We're open 168/168. Patients may come to us with a sudden decrement in hearing, or in caring for a work-related condition, we can counsel them as to the potential worsening of their present hearing.

  4. We are bombarded with noise in our own work environment. Alarms; tools; falling objects; screams and shouts; PA systems; radios; doors; computers; on it goes. Rarely is there a calm and noiseless time. (There, I wrote it without saying the dreaded "Q word.") This contributes to the totality of risk factors in our lives from genetic or familial causes to percussive sounds with high intensity.

  5. We may be able to suggest less ototoxic drug choices to lower the risk of impaired hearing or tinnitus.

  6. If we are able to counsel and intervene effectively with the patient who hasn't yet admitted to hearing loss, we can restore a sense of joy to their world and their social interactions that can ease the progression to stress, depression, learning and memory difficulties, social isolation/withdrawal, and dementia.

In my family, my brother and I had so many elders who had severe hearing loss that we took for granted that this lot would befall us also. We learned early to speak slowly, clearly, with sharpened articulation, in a normal or slightly louder voice, in good light while facing the person with whom we were talking. The dictum "Children should be seen and not heard" and other maxims of old-fashioned "polite conversation" helped ensure that only one person spoke at a time.

My brother had many ear infections, including an emergency meryngotomy while papoosed in a sheet on his own bed. His hearing deficiency was such that, as a contributory factor, he deliberately chose for his life's work, an industry known for its noise levels and the number of deaf men who worked in it so that he would not be disadvantaged. It was probably a decade in the future before sound safety muffs would be provided to the men.

Hearing loss is not always inevitable. The earlier diagnosis and assessment by otologists and audiologists can lead to better protective measures, treatments, or hearing instruments that minimize disability. (Yes, I know that 'disability' is a word that is charged with much baggage of political correctness.)

In my case, increasing tinnitus was not something that might go away {it didn't}, but a sign of increased hearing loss. As my hearing worsened, I worried that I might miss an essential clue at Triage, or that I would not be able to hear a patient's last words; such worry is a burden. It became a factor as I chose how best to carry on. If you, or someone else, is having hearing difficulty, take an audiometry test to determine how things stand. It's quick, easy, and can start one on  the road to improved hearing and participation in life.

Hearing loss is common and usually noticed by others first, be the advocate who encourages testing and treatment.


Tom Trimble, RN
All opinions are solely those of the author.
Readers must verify validity to their own practice.