Health Promotion and Disease Prevention: Considerations and Interventions

Health promotion and disease prevention strategies for a healthy vestibulocochlear system need to be appropriate for each specific individual, so you should carefully consider all collected data, both subjective and objective. Subjective data collection involves asking the client about risk factors and social determinants, while also attending to developmental considerations. This kind of inquiry should be integrated throughout the entire assessment. You will ask many probing questions during the subjective assessment, but also formulate additional questions based on critical reflection of the data you have collected during the subjective and objective assessment. Together, the findings will inform your clinical judgement for each specific client and the health promotion needed.

Ear Hygiene

Ear hygiene is a common topic of discussion, as clients often wonder how they should clean their ears. However, typically ears do not require cleaning as cerumen keeps them clean. 

Most importantly, discuss with clients that they should NOT insert any sort of small instrument to clean their ears such as cotton swabs, one’s fingers, pens/pencils, or car keys. 

Clients with loose earwax can be advised to use a warm damp washcloth to wipe the external facing part of the ear. If the client has extensive earwax or cerumen impaction, refer them to their primary care provider. In these cases, it is sometimes advised to insert 2 to 3 drops of a warm mineral oil solution (or 1 part hydrogen peroxide, 1 part warm water) in the ear and leave it for at least 15 minutes to both soften and loosen the earwax (American Academy of Otolaryngology-Head and Neck Surgery Foundation, 2024). This is then followed by flushing of the ear with gentle spray of warm water in the shower or with a syringe. This kind of interventions is fairly safe, but should not be attempted without consulting a physician or nurse practitioner if the client has had ear surgery, ear infections, or perforation of the tympanic membrane (Berg, 2023).

Probing questions related to ear hygiene include:

• Do you clean your ears? If so, how do you clean them? How often do you clean them?
• Do you use cotton swabs? (i.e., Q-tips).
• Have you noticed excessive earwax?

Environment

Advise clients to use ear protection – against physical trauma as well as loud sounds and environments – to prevent various conditions. Physical trauma to the ear can lead to external ear deformities, damage to the middle and inner ear, and hearing impairment, among other conditions. Excessive loud sounds and environments are a common cause of hearing impairment that is often not recognized until later in life.

Therefore, advise clients to wear ear protection in environments where the ear is at risk of physical injury. Many jurisdictions have implemented recommendations or requirements to wear helmets or specific headgear protection during activities such as wrestling, boxing, baseball, cycling, and hockey. 

Loud noises – often defined as 85 decibels or louder – are of concern because they can cause impaired hearing (National Institute on Deafness and Other Communication Disorders, 2022; WHO, 2015).

To give you a sense of how loud 85 decibels is, here are the decibels of some common sounds:

• Whispering: 30 decibels.
• Talking with another person (normal level): 60 to 70 decibels.
• Hairdryer or subway train: 100 decibels.
• Motor sounds (lawnmower, vacuum, power tools): 75 to 100 decibels.
• Ambulance siren, bulldozer, chainsaw, nightclub/bar: 95 to 129 decibels.
• Listening to music at maximum volume through headphones: 94 to 110 decibels.

(National Institute for Occupational Safety and Health, 2024; National Institute on Deafness and Other Communication Disorders, 2022; World Health Organization, 2015)

Loud noises can cause problems if they involve one-time exposure to a very loud noise (a firecracker) or prolonged exposure to loud noise (a music concert or occupational hazards). Therefore, it is important to consider both the intensity and the duration of the sound, as well as the distance one is from the sound source (WHO, 2015). If the sound cannot be turned down, or it is impossible to move away from it, hearing protectors (wearable equipment such as earplugs or earmuffs) should be worn (National Institute on Deafness and Other Communication Disorders, 2022). Explore with clients whether they are exposed to activities or hobbies that involve loud noises such as music and concerts, sports like auto racing, or use of loud equipment such as power tools. 

Many jurisdictions have developed recommendations specific to workplace-related noise. For example, the Canada Labour Code and the Canada Occupational Health and Safety Regulations include regulations about health hazards such as exposure to loud sounds in workplaces and the need for hearing protectors (Government of Canada, 2022). It may be useful to discuss the CDC NIOSH Sound Level Meter App with clients and workplace communities: https://www.cdc.gov/niosh/noise/about/app.html. 

Use the following guidelines to help clients prevent or manage noise-induced hearing impairment:

• Ensure clients are aware of noisy environments, particularly those 85 decibels or louder. 
• Educate clients about occupational guidelines related to noise.
• Recommend hearing protectors for noisy environments, especially those involving very loud noises or prolonged exposure. Variety types of hearing protectors are available, including ear plugs (small devices inserted into the external ear canal) and earmuffs (soft ear cushions that fit over the entire ear, typically with hard outer cups held together by a headband). Depending on the type used, ear protectors should be replaced regularly or cleaned. In particular, foam earplugs should be replaced regularly because they can provide a warm, moist place for bacteria to grow and lead to risk of infection. 
• Discuss personal use of audio devices: 
  • Inform clients about the 60-60 rule (reduce use to 60 minutes per day and reduce volume to less than 60% of the maximum volume of the device). However, be aware that the volume on devices isn’t always standardized so this isn’t always a truly objective recommendation. The main point: keep the volume below 85 decibels.
  • Suggest use of well-fitting in-ear earbuds (fit right into the external ear canal) or noise canceling over-the-ear headphones (sit over the entire external ear). Well-fitting earbuds and noise-canceling headphones can help reduce extraneous noise, enabling clients to keep the volume low while still hearing music well. Still, the main point remains: keep the volume below 85 decibels.

Probing questions include: 

• Are you involved in any physical activity or work-related activity where your ears could be physically injured? For example, do you play any sports such as wrestling?
• Are you exposed to noise in your home or with any hobbies or sports (e.g., music, gaming)?
  • If affirmative, do you use any strategies to protect your ears?
• Are you exposed to noisy environments in your workplace?
  • If affirmative, does your workplace provide hearing protectors or guidance or training related to protecting your hearing?

Diet

An overall healthy diet is important to all body systems including the vestibulocochlear system. A healthy diet promotes vascular health to the ear and reduces inflammation (Curhan et al., 2018). 

Hearing health is supported by diets high in vitamins (particularly vitamin D) and antioxidants, low in fat, and rich in fruits and vegetables overall (Dawes et al., 2020). One study involving women found that healthy dietary patterns were associated with lower risks for hearing impairments, particularly the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH diet) (Curhan et al., 2018).

Probing questions related to diet include:

• Tell me about your usual diet?
• What have you eaten in the last 24 hours? Is that your usual diet?
• Have you had any recent changes in your life that have affected your diet?

References

Curhan, S., Wang, M., Eavey, R., Stampfer, M., & Curhan, G. (2018). Adherence to healthful dietary patterns is associated with lower risk of hearing loss in women. The Journal of Nutrition, 148(6), 944-951. https://doi.org/10.1093/jn/nxy058

Dawes, P., Cruickshanks, K., Marsden, A., Moore, D., & Munro, K. (2020). Relationship between diet, tinnitus, and hearing difficulties. Ear and Hearing, 41(2), 289-299. https://doi.org//10.1097/AUD.0000000000000765

Government of Canada (2022). Protect your ears! Occupational health and safety. https://www.canada.ca/en/employment-social-development/services/health-safety/reports/ears.html

Health Canada. (2023). Ear candling. https://www.canada.ca/en/health-canada/services/medical-procedures/ear-candling.html

National Institute for Occupational Safety and Health (NIOSH) (2024). Noise and hearing loss. https://www.cdc.gov/niosh/noise/about/noise.html

National Institute on Deafness and Other Communication Disorders. (2022). Hearing protectors. https://www.nidcd.nih.gov/health/hearing-protectors

World Health Organization (2015). Hearing loss due to recreational exposure to loud sounds: A review. https://iris.who.int/bitstream/handle/10665/154589/9789241508513_eng.pdf?sequence=1&isAllowed=y