{"id":2971,"date":"2024-08-13T09:42:53","date_gmt":"2024-08-13T13:42:53","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/?post_type=chapter&#038;p=2971"},"modified":"2025-01-03T15:05:20","modified_gmt":"2025-01-03T20:05:20","slug":"hearing-assessment","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/hearing-assessment\/","title":{"raw":"Hearing Assessment","rendered":"Hearing Assessment"},"content":{"raw":"<span style=\"color: #000000\">Part of the vestibulocochlear system assessment involves evaluating the <strong>client\u2019s hearing<\/strong>. This <\/span><span style=\"color: #000000\">assessment provides information on the <strong>sensorineural <\/strong>and<strong> conductive processes <\/strong>and <\/span><span style=\"color: #000000\"><strong>potential problems<\/strong>.<\/span>\r\n\r\n<span style=\"color: #000000\">Sound waves are conducted through the ear canal and the tympanic membrane. The vibrations <\/span><span style=\"color: #000000\">set the ossicles of the middle ear in motion and then move fluid within the cochlea of the inner <\/span><span style=\"color: #000000\">ear, in turn stimulating thousands of nerve endings. The vibrations are then transformed into <\/span><span style=\"color: #000000\">electrical impulses that travel to the brain along the cochlear portion of CN VIII <\/span><span style=\"color: #000000\">(vestibulocochlear nerves) (Stangor &amp; Walinga, 2014).<\/span>\r\n\r\n<span style=\"color: #000000\">Testing can begin with the client sitting on the exam table. Before testing the vestibulocochlear <\/span><span style=\"color: #000000\">nerves, ask the client about any history of impaired hearing and use of hearing devices. If the <\/span><span style=\"color: #000000\">client wears a hearing aid, they should keep it on.<\/span>\r\n\r\n<span style=\"color: #000000\">The following rudimentary hearing tests can be done by nurses and require no specialized <\/span><span style=\"color: #000000\">equipment.<\/span>\r\n<ol>\r\n \t<li><span style=\"color: #000000\"><strong>General ability<\/strong>: Begin by noting the client\u2019s general ability to hear you throughout your <\/span><span style=\"color: #000000\">ongoing assessment process. For example, have you noticed any difficulties in hearing <\/span><span style=\"color: #000000\">as manifested by leaning forward, appearing to lipread, or frequently asking you to <\/span><span style=\"color: #000000\">repeat yourself?<\/span><\/li>\r\n \t<li><span style=\"color: #000000\"><strong>Finger\/thumb rub test<\/strong>: This test helps evaluate the cochlear nerve. Ask the client to <\/span><span style=\"color: #000000\">look straight forward and place their index finger on the tragus of the right ear and push <\/span><span style=\"color: #000000\">the tragus in and move in a circular motion until you ask the client to stop. It may be <\/span><span style=\"color: #000000\">simplest to demonstrate this for them. Ask them to close their eyes so you are <\/span><span style=\"color: #000000\">specifically testing hearing and not their ability to see your hand moving. Then, place <\/span><span style=\"color: #000000\">your hand in front of the opposite ear (left ear) and rub your fingers and thumbs together <\/span><span style=\"color: #000000\">and ask them if they can hear it. Repeat on the other side. See <strong>Video 3<\/strong>.<\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\"><strong>Normally<\/strong>, the client should be able to hear the sounds in both ears with a similar <\/span><span style=\"color: #000000\">intensity.<\/span>\r\n<span style=\"color: #000000\"><\/span><\/li>\r\n \t<li><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> are when the client cannot hear the sounds or if the sounds <\/span><span style=\"color: #000000\">differ in intensity<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n[embed]https:\/\/youtu.be\/C76JgHRnNNw[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 3<\/strong>: Finger\/thumb rub test. [0.40 seconds].<\/span>\r\n<ol start=\"3\">\r\n \t<li><span style=\"color: #000000\"><strong>Whisper voice test<\/strong>: This test also helps evaluate the cochlear nerve. Tell the client that <\/span><span style=\"color: #000000\">you are going to whisper a combination of three numbers and\/or letters and you want <\/span><span style=\"color: #000000\">them to repeat what you say. Ask them to look straight forward and place their index <\/span><span style=\"color: #000000\">finger on the tragus of the right ear and push the tragus in and move their finger over the <\/span><span style=\"color: #000000\">tragus in a circular motion until you ask them to stop. Stand on their left side (slightly <\/span><span style=\"color: #000000\">behind them and about an arm\u2019s length away) to test the left ear. Take a breath in, and <\/span><span style=\"color: #000000\">as you breathe out, whisper a mixture of three numbers\/letters (e.g., 8, E, 4). The client <\/span><span style=\"color: #000000\">should be able to repeat what you say. If they don\u2019t, whisper another set of three <\/span><span style=\"color: #000000\">numbers\/letters (e.g., 2, K, 10). Repeat on the opposite ear with a different set of <\/span><span style=\"color: #000000\">numbers\/letters. <strong>See Video 4<\/strong>.<\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\"><strong>Normally<\/strong>, the client can repeat what you say into both ears. If you need to <\/span><span style=\"color: #000000\">repeat the set of numbers\/letters on one ear (for a total of six), a normal finding is <\/span><span style=\"color: #000000\">if the client is able to repeat at least half of the numbers\/letters.<\/span>\r\n<span style=\"color: #000000\"><\/span><\/li>\r\n \t<li><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> are when the client is unable to repeat the set of <\/span><span style=\"color: #000000\">numbers\/letters for one or both ears, or unable to repeat at least half of them if <\/span><span style=\"color: #000000\">the test is repeated twice.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n[embed]https:\/\/youtu.be\/j3jXT3vG1Tw[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 4<\/strong>: Whisper voice test. [0.50 seconds].<\/span>\r\n<ol start=\"4\">\r\n \t<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\r\n<span style=\"color: #000000\"><\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\"><strong>Normal findings<\/strong> might be documented as: \u201cCochlear nerve test: With whispered <\/span><span style=\"color: #000000\">voice test, client able to hear and repeat numbers and letters in both ears, able to <\/span><span style=\"color: #000000\">hear examiner rubbing fingers together beside both ears.\u201d<\/span>\r\n<span style=\"color: #000000\"><\/span><\/li>\r\n \t<li><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> might be documented as: \u201cClient unable to hear and repeat <\/span><span style=\"color: #000000\">numbers and letters whispered in left ear.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<span style=\"color: #000000\">Always consider abnormal hearing test findings in combination with your findings from other assessments. If you observe a hearing impairment with no obvious cause (such as cerumen impaction), refer the client to a hearing specialist (audiologist). The audiologist will complete a comprehensive hearing assessment that involves several tests in which each ear is tested separately. One common test involves the use of an audiometer, with the client in a sound-treated room and wearing headphones. The audiometer is a machine that can transmit speech as well as different sounds: frequencies (pitch) and intensities (loudness), and during testing the client is asked to acknowledge when they hear the sounds.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\r\n<span style=\"color: #000000\">[h5p id=\"261\"]<\/span>\r\n<h3><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/h3>\r\n<span style=\"color: #000000\">Stangor, C., &amp; Walinga, J. (2014). Introduction to psychology - 1st Canadian edition.<\/span>\r\n<a href=\"https:\/\/opentextbc.ca\/introductiontopsychology\/\" target=\"_blank\" rel=\"noopener\">https:\/\/opentextbc.ca\/introductiontopsychology\/ \u00a0<\/a>\r\n\r\n&nbsp;","rendered":"<p><span style=\"color: #000000\">Part of the vestibulocochlear system assessment involves evaluating the <strong>client\u2019s hearing<\/strong>. This <\/span><span style=\"color: #000000\">assessment provides information on the <strong>sensorineural <\/strong>and<strong> conductive processes <\/strong>and <\/span><span style=\"color: #000000\"><strong>potential problems<\/strong>.<\/span><\/p>\n<p><span style=\"color: #000000\">Sound waves are conducted through the ear canal and the tympanic membrane. The vibrations <\/span><span style=\"color: #000000\">set the ossicles of the middle ear in motion and then move fluid within the cochlea of the inner <\/span><span style=\"color: #000000\">ear, in turn stimulating thousands of nerve endings. The vibrations are then transformed into <\/span><span style=\"color: #000000\">electrical impulses that travel to the brain along the cochlear portion of CN VIII <\/span><span style=\"color: #000000\">(vestibulocochlear nerves) (Stangor &amp; Walinga, 2014).<\/span><\/p>\n<p><span style=\"color: #000000\">Testing can begin with the client sitting on the exam table. Before testing the vestibulocochlear <\/span><span style=\"color: #000000\">nerves, ask the client about any history of impaired hearing and use of hearing devices. If the <\/span><span style=\"color: #000000\">client wears a hearing aid, they should keep it on.<\/span><\/p>\n<p><span style=\"color: #000000\">The following rudimentary hearing tests can be done by nurses and require no specialized <\/span><span style=\"color: #000000\">equipment.<\/span><\/p>\n<ol>\n<li><span style=\"color: #000000\"><strong>General ability<\/strong>: Begin by noting the client\u2019s general ability to hear you throughout your <\/span><span style=\"color: #000000\">ongoing assessment process. For example, have you noticed any difficulties in hearing <\/span><span style=\"color: #000000\">as manifested by leaning forward, appearing to lipread, or frequently asking you to <\/span><span style=\"color: #000000\">repeat yourself?<\/span><\/li>\n<li><span style=\"color: #000000\"><strong>Finger\/thumb rub test<\/strong>: This test helps evaluate the cochlear nerve. Ask the client to <\/span><span style=\"color: #000000\">look straight forward and place their index finger on the tragus of the right ear and push <\/span><span style=\"color: #000000\">the tragus in and move in a circular motion until you ask the client to stop. It may be <\/span><span style=\"color: #000000\">simplest to demonstrate this for them. Ask them to close their eyes so you are <\/span><span style=\"color: #000000\">specifically testing hearing and not their ability to see your hand moving. Then, place <\/span><span style=\"color: #000000\">your hand in front of the opposite ear (left ear) and rub your fingers and thumbs together <\/span><span style=\"color: #000000\">and ask them if they can hear it. Repeat on the other side. See <strong>Video 3<\/strong>.<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\"><strong>Normally<\/strong>, the client should be able to hear the sounds in both ears with a similar <\/span><span style=\"color: #000000\">intensity.<\/span><br \/>\n<span style=\"color: #000000\"><\/span><\/li>\n<li><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> are when the client cannot hear the sounds or if the sounds <\/span><span style=\"color: #000000\">differ in intensity<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Finger thumb rub test - Testing of Vestibulocochlear Nerves CN VIII\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/C76JgHRnNNw?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 3<\/strong>: Finger\/thumb rub test. [0.40 seconds].<\/span><\/p>\n<ol start=\"3\">\n<li><span style=\"color: #000000\"><strong>Whisper voice test<\/strong>: This test also helps evaluate the cochlear nerve. Tell the client that <\/span><span style=\"color: #000000\">you are going to whisper a combination of three numbers and\/or letters and you want <\/span><span style=\"color: #000000\">them to repeat what you say. Ask them to look straight forward and place their index <\/span><span style=\"color: #000000\">finger on the tragus of the right ear and push the tragus in and move their finger over the <\/span><span style=\"color: #000000\">tragus in a circular motion until you ask them to stop. Stand on their left side (slightly <\/span><span style=\"color: #000000\">behind them and about an arm\u2019s length away) to test the left ear. Take a breath in, and <\/span><span style=\"color: #000000\">as you breathe out, whisper a mixture of three numbers\/letters (e.g., 8, E, 4). The client <\/span><span style=\"color: #000000\">should be able to repeat what you say. If they don\u2019t, whisper another set of three <\/span><span style=\"color: #000000\">numbers\/letters (e.g., 2, K, 10). Repeat on the opposite ear with a different set of <\/span><span style=\"color: #000000\">numbers\/letters. <strong>See Video 4<\/strong>.<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\"><strong>Normally<\/strong>, the client can repeat what you say into both ears. If you need to <\/span><span style=\"color: #000000\">repeat the set of numbers\/letters on one ear (for a total of six), a normal finding is <\/span><span style=\"color: #000000\">if the client is able to repeat at least half of the numbers\/letters.<\/span><br \/>\n<span style=\"color: #000000\"><\/span><\/li>\n<li><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> are when the client is unable to repeat the set of <\/span><span style=\"color: #000000\">numbers\/letters for one or both ears, or unable to repeat at least half of them if <\/span><span style=\"color: #000000\">the test is repeated twice.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Whisper Voice Test  Testing of Vestibulocochlear Nerves CN VIII\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/j3jXT3vG1Tw?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 4<\/strong>: Whisper voice test. [0.50 seconds].<\/span><\/p>\n<ol start=\"4\">\n<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span><br \/>\n<span style=\"color: #000000\"><\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\"><strong>Normal findings<\/strong> might be documented as: \u201cCochlear nerve test: With whispered <\/span><span style=\"color: #000000\">voice test, client able to hear and repeat numbers and letters in both ears, able to <\/span><span style=\"color: #000000\">hear examiner rubbing fingers together beside both ears.\u201d<\/span><br \/>\n<span style=\"color: #000000\"><\/span><\/li>\n<li><span style=\"color: #000000\"><strong>Abnormal findings<\/strong> might be documented as: \u201cClient unable to hear and repeat <\/span><span style=\"color: #000000\">numbers and letters whispered in left ear.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p><span style=\"color: #000000\">Always consider abnormal hearing test findings in combination with your findings from other assessments. If you observe a hearing impairment with no obvious cause (such as cerumen impaction), refer the client to a hearing specialist (audiologist). The audiologist will complete a comprehensive hearing assessment that involves several tests in which each ear is tested separately. One common test involves the use of an audiometer, with the client in a sound-treated room and wearing headphones. The audiometer is a machine that can transmit speech as well as different sounds: frequencies (pitch) and intensities (loudness), and during testing the client is asked to acknowledge when they hear the sounds.<\/span><\/p>\n<\/div>\n<\/div>\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\n<p><span style=\"color: #000000\"><\/p>\n<div id=\"h5p-261\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-261\" class=\"h5p-iframe\" data-content-id=\"261\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"How can the nurse determine if an adult client is having trouble hearing the conversation? Select 2.\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<h3><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/h3>\n<p><span style=\"color: #000000\">Stangor, C., &amp; Walinga, J. (2014). Introduction to psychology &#8211; 1st Canadian edition.<\/span><br \/>\n<a href=\"https:\/\/opentextbc.ca\/introductiontopsychology\/\" target=\"_blank\" rel=\"noopener\">https:\/\/opentextbc.ca\/introductiontopsychology\/ \u00a0<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"author":34,"menu_order":7,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-2971","chapter","type-chapter","status-publish","hentry"],"part":2956,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2971","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":20,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2971\/revisions"}],"predecessor-version":[{"id":3675,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2971\/revisions\/3675"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/2956"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/2971\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=2971"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=2971"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=2971"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=2971"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}