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Nursing Care of the Child
With a Disorder of the Eyes
or Ears
Chapter 17
What we are going to cover
• Differentiate between the anatomic and physiologic differences of the eyes and
ears in children as compared with adults.
• Identify various factors associated with disorders of the eyes and ears in infants and
children.
• Discuss common laboratory and other diagnostic tests useful in the diagnosis of
disorders of the eyes and ears.
• Discuss common medications and other treatments used for treatment and
palliation of conditions affecting the eyes and ears.
• Recognize risk factors associated with various disorders of the eyes and ears.
• Distinguish between different disorders of the eyes and ears based on the signs and
symptoms associated with them
• Discuss nursing interventions commonly used in regard to disorders of the eyes and
ears.
• Devise an individualized nursing care plan for the child with a sensory impairment
or other disorder of the eyes or ears.
• Develop child/family teaching plans for the child with a disorder of the eyes or ears.
• Describe the psychosocial impact of sensory impairments on children.
Variations in Pediatric Anatomy and
Physiology
• Eyes
– Eye color determined by 6-12 months
– Eyeball occupies a larger space in orbit so more prone to injury
– Newborn’s lens can only accommodate 8-10 inches and color
discrimination incomplete
– Visual acuity improves with age, 20/20 by 6-7 years
– Rectus muscle uncoordinated at birth and matures over time.
Binocular vision (simultaneous focus by both eyes) achieved by 4
months
Variations in Pediatric Anatomy and
Physiology of the Eyes and Ears
• Eyes
– Visual acuity develops from birth through early childhood.
– Eyeball occupies larger space, within the orbit than the adult’s does,
making it more susceptible to injury.
– Color discrimination is incomplete.
– Retinal vascularization is incomplete.
Variations in Pediatric Anatomy and
Physiology of the Eyes and Ears
• Ears
– Hearing is intact at birth.
– Recurrent ear disorders may affect
hearing.
– Placement of Eustachian tubes and
enlarged adenoids make ears prone
to infection.
– Infant’s relatively short, wide, and
horizontally placed Eustachian
tubes allow bacteria and viruses to
gain access to the middle ear easily,
resulting in increased numbers of
ear infections as compared to the
adult.
Ears
• Congenital deformities usually associated with other
anomalies and genetic syndromes
• Infants short, wide and horizontally placed Eustachian tube
allows bacteria and viruses to reach middle ear more easily,
so more prone to ear infections
– As child matures, tubes more slanted
• If adenoids enlarged may lead to obstruction of Eustachian
tubes > infection
Common Laboratory and Diagnostic
Tests
• Culture of the eye or ear discharge
• Tympanic fluid culture
• Tympanometry
– used to detect problems in the middle ear
– looks inside the ear to make sure nothing is blocking
the eardrum
– a device is placed into ear
– changes the air pressure in ear and makes the
eardrum move back and forth
– A machine records the results on graphs called
tympanograms.
Common Drugs for Ear and Eye
Disorders
Adapted from Taketokmo, C. K., Hodding, J. H., & Kraus, D. M. (2010). Lexi-comp’s pediatric dosage handbook (17th ed.). Hudson, OH:
Lexi-comp.
Common Medical Treatments for Eye and Ear Disorders
• Therapeutic management for both hyperopia and myopia is
prescription eyeglasses or contact lenses.
• Warm compress
• Patching
• Therapeutic management of amblyopia focuses on
strengthening the weaker eye using patching or atropine
drops in the better eye, vision therapy, or eye muscle surgery
if the cause is strabismus.
• Eye muscle surgery
• Pressure-equalizing (PE) tubes
• Hearing aids
• Cochlear implants
Types of infectious and inflammatory
Diseases of the Eye
• Conjunctivitis
• Nasolacrimal duct obstruction
• Eyelid lesions
• Periorbital cellulitis
• The risk factors for each type of infection
Conjunctivitis
• Inflamation of the bulbar or palpebral conjunctiva.
• In newborns: causes are chlamydia, gonorrhea, or herpes simplex virus
• In infants: may be sign of tear duct obstruction
• In children: causes are bacterial (most common, also called “Pink Eye”),
viral, allergic, or foreign body
• Signs and Symptoms
– Purulent eye drainage, crusting
– Inflamed conjunctiva and swollen lids
Signs and Symptoms of Conjunctivitis
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Redness of conjunctiva
Edema
Tearing
Discharge
Eye pain
Itching of the eyes
(usually with allergic
conjunctivitis)
Types of Conjunctivitis
Adapted from Braverman, R. S. (2011). Eye. In W. W. Hay, M. J. Levin, J. M. Sondheimer, & R. R. Deterding (Eds.), Current pediatric diagnosis and treatment (20th
ed.). New York: McGraw-Hill.
Bacterial Conjunctivitis
• Redness of conjunctiva
• Copious, discolored drainage with matting
• Eyelid swelling
Allergic Conjunctivitis
• Caused by perennial or
seasonal allergies
• Conjunctiva red
• Discharge clear, watery
• Child rubs eyes frequently
• The nurse would be alert
to the child's increased
risk for Atopic dermatitis
Conjunctivitis
Therapeutic and Nursing Management
– Treatment depends on cause
• Viral is self-limiting, remove secretions
• Bacterial: Culture of eye drainage. Topical antibacterial agents like polymycin and
bacitracin, Sulamyd or Polytrim
• Drops during day and ointment at night
– Nursing Care
• Keep eyes clean with cool, moist cloth.
• Wipe from inner canthus down and away from other eye. DON”T leave
compress on eye.
• Instill eye medication after cleaning eye
– Medications: topical antibacterials to eye: Polysporin, Sulamyd or Polytrim
• Teach prevention of infection to child and family: discard tissues, wash cloths
separately, don’t rub eyes.
• GOOD HAND-WASHING
• Children don’t attend school until infection treated and drainage has stopped
• CONTAGIOUS if bacterial cause
• Teach parent to administer medications
– Caution with use of steroids—may exacerbate viral infections
Child Teaching to Reduce Allergens on Child’s Skin
and Hair
• Encourage the child not to rub or touch the eyes.
• Rinse the child’s eyelids periodically with a clean
washcloth and cool water.
• When the child comes in from outdoors, wash the
child’s face and hands.
• Ensure that the child showers and shampoos before
bedtime.
Nasolacrimal Duct Obstruction
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Stenosis or simple obstruction of the nasolacrimal duct is a common disorder of
infancy, occurring in about 6% to 20% of the general population
usually resolves by 1 year old
Unilateral in 65% cases
Nursing assessment
– S&S: Tearing or discharge from one or both eyes by 2 weeks old
– Redness of lower lid of affected eye
– Culture may be done to rule out conjunctivitis
Nursing management
– Teach parents to clean eye area frequently with moist cloth
– Massage nasolacrimal duct (see page 564 in text, guideline 17.1 for technique) *
– Teach how to give antibiotic drops if needed
– Usually resolves by 1 year old
Nasolacrimal Duct Massage
• Teach procedure to parents:
– Using the forefinger or little
finger, push on the top of the
bone (the puncta must be
blocked)
– Gently push in and up
– Gently push downward along
the side of the nose
Disorder of Eyelid and Management
• Types
– Hordeolum (stye)
– Chalazion
– Blepharitis
• Management
– Topical antibiotic
ointment
Periorbital Cellulitis
• Bacterial infection of eyelids or surrounding tissue of eye
• Enters through break in skin, sinusitis, conjunctivitis
• Most common bacteria: Staph. aureus, Strep. pyogenes, Strep
pneumoniae
• Initiate inflammatory response
• Nursing assessment
– S&S: redness, swelling, pain around eye
• Nursing management
• Focuses on intravenous antibiotic administration during the acute
phase followed by completion of the course with oral antibiotics.
– Warm soaks to eye area 20 minutes every 2-4 hours
– Teach family to complete full course of antibiotics at home
– Teach parents to call PCP if eye doesn’t improve
– May require hospitalization for IV antibiotics
– Manage pain with analgesics
Complications of periorbital cellulitis
• Bacteremia
• Progression to orbital cellulitis
– more extensive infection involving the orbit of the
eye.
– Child doesn’t improve
– Inability to move eye
– Visual acuity change
– Proptosis (displacement)occurs
Visual Impairment
• General term that refers to visual loss that
cannot be corrected with regular prescription
lenses
Signs and Symptoms of Visual
Impairment
• Any age: dull, vacant stare
• Infant: does not “fix and follow,” does not make
eye contact, is unaffected by bright light, does
not imitate facial expression
• Toddler and older child: rubs, shuts, and covers
eyes; squints and blinks frequently; holds objects
close or sits close to television; bumps into
objects; displays head tilt or forward thrust
Visual Impairment Classification
• Partially sighted:
– Acuity of 20/70-20/200
– Education usually in public school system
• Legal blindness:
– Acuity of 20/200 or less
– Legal as well as medical term
Factors Increasing the Risk for
Developing Visual Impairment
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Prematurity
Developmental delay
Genetic syndrome
Family history of eye disease
African American heritage
Previous serious eye injury
Diabetes, HIV
Chronic corticosteroid use
Risk Factors for Retinopathy of
Prematurity (ROP)
• Low birthweight
• Early gestational age
• Sepsis
• High light intensity
• Hypothermia
Measures to Prevent
Visual Impairment
• Prenatal care,
prevention of
prematurity
• Rubella immunizations
for all children
• Safety counseling for
preventing eye injuries
Visual Impairments
• Astigmatism:
– unequal curvatures in refractive apparatus, usually myopic
– Treated with special lenses or laser surgery
– signs and symptoms of astigmatism including blurry
vision, difficulty seeing letters as a whole, headaches,
dizziness, eye fatigue, and tilting the head to see
better.
• Amblyopia:
– Reduced visual acuity in one eye, “Lazy eye”
– Treat primary vision defect such as strabismus
Strabismus
• Strabismus is a disorder in which the
two eyes do not line up in the same
direction, and therefore do not look at
the same object at the same time. The
condition is more commonly known as
"crossed eyes.“
• Common, occurs in 4% of children
• Most common types
– Exotropia – eyes turn outward
– Esotropia – eyes turn inward
• May affect visual development, cause
diplopia
• Infants up to 3 months may have
intermittent strabismus
– Treatment depends on cause, may
involve patching stronger eye
(occlusion therapy) or surgery
– Early diagnosis essential to prevent
vision loss from amblyopia
Nystagmus
• is a term to describe fast, uncontrollable movements of the eyes
that may be: Side to side (horizontal nystagmus);Up and down
(vertical nystagmus);Rotary (rotary or torsional nystagmus)
• Depending on the cause, these movements may be in both eyes
or in just one eye. The term "dancing eyes" has been used to
describe nystagmus.
Visual Impairments
• Cataracts
– a congenital cataract is an opacity of the lens of the eye
that is present at birth and sensory amblyopia will
result if the infant goes untreated.
– Prevents light from refracting on retina
– Symptoms include: gradual decrease in vision,
nystagmus (with blindness), gray opacities of lens,
strabismus, absence of red reflex
• Nystagmus: very rapid, irregular eye movements
which makes it hard for the brain and eyes to
communicate, affecting vision. Result of congenital
cataracts or neurological disorder.
– Treatment: Surgery to remove cloudy lens and replace
lens
Visual Impairments
• Glaucoma
– Increased intraocular pressure affects optic nerve,
leading to atrophy and blindness
– Symptoms include:
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vision loss
halos around objects
pain, redness, tearing
photophobia, winking, enlarged eyeball
Infant keeping eyes closed most of the time or rubbing
eyes
Corneal enlargement and clouding
Enlarged appearance of the eye
Tearing or conjunctivitis
Eyelid squeezing or spasm
Glucoma
• Treatment:
– medications: beta-blockers or Alphaagonists eye drops
– Oral meds acetazolamide (Diamox Sequels)
and methazolamide (Neptazane)
– Surgery to relieve pressure
– Laser surgery. In the last couple of decades, a
procedure called trabeculoplasty (truh-BEKu-lo-plas-tee) has had an increased role in
treating open-angle glaucoma.
Refractive Errors
• Refraction: bending of light rays through the
lens of the eye
• Myopia: nearsightedness
• Hyperopia: farsightedness
• Strabismus (may or may not be refractive)
Visual Disorders
• Refractive errors
– Nursing assessment
– Nursing management
• Educating about eyeglasses use
• Educating about contact lens use
• Monitoring for fit and visual correction
Healthy People 2020: Goal to increase use of
protective equipment (eye goggles) when engaged in
potentially dangerous activities.
Hospitalization of the Visually
Impaired Child
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Work closely with the family
Safe environment
Reassurance
Orient child to surroundings
Encourage independence
Consistency of team members
To promote the most appropriate effective
communication with the child use his name
before touching him.
Promoting Child’s Optimum
Development
• Play and socialization
• Development of independence
• Education:
– Braille
– Audio books and learning materials
Nursing Process Overview
• Assessment
–Health history
–Physical examination
• Inspection and observation
• Palpation
• Laboratory and diagnostic testing
Information Elicited in Health History of
Present Illness
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Onset and progression
Fever
Nasal congestion
Eye or ear pain
Eye rubbing
Ear pulling
Headache
Lethargy
Behavioral changes
Nursing diagnoses
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Disturbed sensory perception
Risk for infection
Pain
Delayed growth and development
Impaired verbal communication
Deficient knowledge
Interrupted family processes
Risk for injury
Nursing Assessment
of Vision
• Infancy:
– Response to visual stimuli
– Parental observations and concerns
– Expect binocularity by age 6 months
• Childhood:
– Visual acuity testing
Nursing Management of Child with Visual
Impairments
• Be alert to clinical
manifestations:
– Eye rubbing, headaches, dizziness,
clumsiness, frequent blinking
– Difficulty reading or doing close
work, poor school performance
• Perform vision screening or
advise parent to bring child for
eye exam with opthamologist
• Encourage child to wear
corrective lenses
• Treatment may include laser
surgery or eye surgery
External Examination of the Eyes
• Use inspection and observation to assess for eye
disorders
• Note use of eyeglasses or lenses
• Observe positioning, symmetry
• Assess if eyelids open equally (failure to open
fully is ptosis).
• Check for presence of strabismus*,
nystagmus**, and squinting.
External Examination of the Eyes
• Note variations in eye slant and the presence
of epicanthal folds.
• Assess for eyelid edema, sclera color,
discharge, tearing, and pupillary equality, as
well as size and shape of the pupils
• Observe pupils and reactions, corneal light
reflex, iris and sclera color
• Red Reflex
• Test for extraocular movement
Eversion of lid for examination
Testing of Eyes Performed During
Physical Examination
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Extraocular movements
Pupillary light response and accommodation
Symmetry of corneal light reflex
Presence of red reflex with an
ophthalmoscope
• Age-appropriate visual acuity test
Ocular Motility
Rt superior rectus
Lt inferior oblique
Lt superior rectus
Rt inferior oblique
Rt lateral rectus
Lt medial rectus
Lt lateral rectus
Rt medial rectus
Rt inferior rectus
Lt superior oblique
Lt inferior rectus
Rt superior oblique
Corneal Light Reflex to Check Symmetry
• Child on left has
symmetrical reflection
of light
• This child with
strabismus reflects
light unevenly
Red Reflex
• AKA "Bruchner's test" can detect many
different ophthalmologic problems in
children and should be performed as
part of a normal newborn screening.
• In normal eyes, the practitioner will
shine a light into the eye and will see a
red reflection with the
ophthalmoscope. This is also what
causes "red eye" in pictures.
• no red reflex (leukocoria, which means
white pupil
• Cataract,Retinoblastoma, chorioretinal
coloboma, persistent hyperplastic
primary vitreous, endophthalmitis,
Coats disease, retinal detachment,
Outcomes
The images below show the possible outcomes. You can show these
images to parents as they may have taken photographs demonstrating
usual red reflexes.
Normal red reflex
Normal red reflex = no referral
Red reflex absent
Red reflex absent
Obvious +/- asymmetry = urgent referral
Unsure/difficult assessment = Pediatric Ophthalmology Primary Care
Clinic referral
Red reflex abnormal
Red reflex abnormal = urgent referral
Periodic Recommended Screening
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Prenatal
Newborns through preschoolers
Children of all ages
Use age-appropriate visual acuity test
Periodic Recommended Screening
• Vision impairment in children refers to acuity
between 20/60 and 20/200 in the better eye
on examination
• “legal blindness” is a term used to refer to
vision of less than 20/200 or peripheral vision
less than 20 degrees.
Adolescent Dumbass
Types of Eye Injuries Requiring Referral
to Ophthalmologist
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Chemicals
Sunburns
Hematoma
Penetrating injuries
Traumatic hyphema
Blowout fracture
Ruptured globe
Thermal injury/corneal flash burn
Extensive animal bite
Lid laceration with underlying structural involvement
Corneal abrasion in which corneal penetration is
suspected
• Foreign body embedded in the globe
Eye Injuries
• Nursing management
– Managing non-emergent eye injuries
• Suture lacerations
• Child may need sedation and pain med
– Assist physician with examination
– Edema and black eye treated with ice pack on 20 minutes, off 20
minutes. Repeat cycle. May take 3 weeks to resolve
– Scleral hemorrhages will resolve without intervention
– Corneal abrasions treated with topical antibiotic and analgesics
– Remove foreign objects from eye using eyelid eversion. Irrigating
with normal saline may help. Serious foreign body will need
opthamologist to remove
– Chemical injuries require immediate irrigation with copious
amounts of water
– Visit to opthamologist advised
– Teach PREVENTION
– manage a black eye (ice pack for 20 minutes on and 20 minutes
off for first 24 hours)
Disorders of the Ears
Observation of the Ear
• Must inspect their size and shape, position, and the
presence of skin tags, dimples, or other anomalies.
• Otoscopic examination
– Note the presence of cerumen, discharge, inflammation,
or a foreign body in the ear canal.
• Visualize the tympanic membrane.
– Observe its color, landmarks, and light reflex, as well as
presence of perforation, scars, bulging, or retraction.
Otoscopic Examination of Ear
• Note presence of cerumen,
discharge, inflammation or
foreign body in ear canal
• Visualize tympanic
membrane for color,
landmarks, and light reflex.
Also for abnormalities like
perforation, bulging, scars
or retraction
Otitis Media
• Acute otitis media (AOM)
– Pathophysiology : Bacterial or viral infection of
fluid in middle ear
– Peak incidence: 0-2 years, especially 6-12 months
– Therapeutic management
– Nursing assessment
• Health history
• Physical examination and diagnostic testing
Prevention of Hearing Loss
• Treatment and management of recurrent otitis media
– A common cause of conductive/middle-ear hearing loss
– Medical tx:
• Wait and see
• Antibiotics
Acute Otitis Media – note erythema and
opacity of tympanic membrane
Otitis Media
• Acute otitis media (AOM) (cont’d)
– Nursing management
• Managing pain associated with AOM
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Analgesics like acetaminophen or ibuprofen
Narcotic analgesics like codeine for severe pain
Heat or cool compress: have child lay affected ear on compress
Numbing eardrops like benzocaine (Auralgan)
• Educating the family
– Observe for S&S and call PCP
– Teach completion of antibiotics if ordered – VERY IMPORTANT!
– Follow-up to check progress, test hearing
• Preventing AOM
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Encourage breastfeeding 6-12 months
Avoid exposing child to individuals with upper respiratory infections
DON’T EXPOSE TO SECOND HAND SMOKE
Immunize child, including flu vaccines
Xylitol, a sucrose substitute, taken in liquid or gum form, may prevent AOM
Prevention of Hearing Loss
• Surgical treatment
– Tympanostomy: placement of ear tubes
– for children less than about 5-6 years old, allow bathing, hair washing,
surface swimming, or ocean exposure...without any precautions.
– Diving deeper under water, or swimming in (dirtier) lakes and rivers is
more likely to cause infections.
– In those cases, the preventitive use of certain antibiotic ear drops (such
as Floxin Otic) may help. Your ear doctor may be adamant about
keeping your infant's ears dry...
ENT docs like to see their tube patients every 3-6 months, or until the
ears are normal.
– Adenoidectomy, with just myringotomies (making an incision, no tubes)
may be appropriate in certain children...as might a laser myringotomy.
• Prenatal preventive measures
• Avoid exposure to noise pollution
Otitis Media
Otitis Media
with Effusion
• Otitis media with effusion (OME)
– Presence of fluid in middle ear space
without S&S of infection
– Nursing assessment
• Health history
– Risk Factors: passive smoking, not breastfed, frequent upper respiratory infections,
allergy, young age, male, congenital disorders
• Physical examination
– May be asymptomatic or experience popping or fullness behind eardrum
– Otoscopic exam may reveal dull, opaque tympanic membrane that’s gray, white or bluish.
Tympanometry may diagnose OME
– Nursing management
• Educating the family
– Antihistamines, antibiotics and steroids usually don’t work
– Teach NOT to prop infant with bottle
• Monitoring for hearing loss and speech development
• Providing postoperative care for the child with pressure-equalizing tubes
– Tubes inserted and remain a few months
– May need to avoid water in ears, wear earplugs with baths and swimming
Pressure-equalizing tubes in place
Myringotomy (Ear Tubes)
• Small tubes(made of plastic, metal, or
Teflon)
• Surgically placed into child's eardrum
by an ear, nose, and throat surgeon
• Help drain fluid out of the middle ear in
order to reduce the risk of infections
• About one million children each year
have tubes placed in their ears.
• The most common ages are from 1 to 3
years old.
• By the age of 5 years, most children
have wider and longer eustachian
tubes
Myringotomy – Pre and Post-Op Nursing Care *
• Prepare child and parent for surgery: Assessment, VS
• The operation usually takes 15 to 20 minutes.
• Child will go home 2-4 hours after surgery.
• Post-Op Care and Teaching
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Normal to have fluid 3-4 days, grey/brown and slight smell Fluid may leak from your child’s ear
The tubes will stay in your child’s ears for several months
Do not put anything into your child’s ear
May have a bath. Ear plugs may or may not be recommended by surgeon. Consult surgeon
about other water activities like swimming.
• Medicines
– Antibiotic ear drops: may or may not order antibiotic ear drops. Show parent how to
put the antibiotic ear drops in child’s ear.
– Pain medicine: Acetaminophen or Ibuprofen
May return to day care or school the day after leaving the hospital, if your child
is feeling well.
First visit is normally 7-10 days after surgery, then every 2-4 months
Myringotomy – Pre and Post-Op Nursing Care *
REASONS TO CALL SURGEON
• Ears leak fluid for more than 4 days after the operation.
• Your child has a fever over 38.5°C (101°F).
• Your child’s ears start to leak fluid again after they have stopped
leaking, or the color of the drainage changes to thick greenish pus
with a strong smell.
• Your child’s ears become sore
Otitis Externa (Swimmer’s ear)
• Infection and inflammation of external ear canal
• Bacterial or fungal
• Nursing assessment
– Health history
– Physical examination
• Ear red, edematous, itchy, painful, may affect hearing
• Nursing management
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Managing pain
Treating the infection
Preventing reinfection
Recent studies recommend leaving ear wax in place as protection.
Types of Delayed-Onset Hearing Loss
• Conductive hearing loss
– Results when transmission of sound through the
middle ear is disrupted, as in the case of OME
• Sensorineural hearing loss
– Caused by damage to the hair cells in the cochlea or
along the auditory pathway
• Mixed hearing loss
– Occurs when the cause may be attributed to both
conductive and sensorineural problem
Hearing Loss and Deafness
• Nursing assessment
– Health history
– Physical examination and laboratory and
diagnostic tests
• Nursing management
– Augmenting hearing
– Promoting communication and education
– Encouraging education
– Providing support
Hearing Impairment
• Ranges from mild to profound
• Deaf: a person whose hearing disability
precludes processing linguistic information
with or without hearing aid
• Hard of hearing: generally able to hear with
hearing aid
Incidence in Children
• One of the most common disabilities
• Estimated 3 in 1000 well babies have some
degree of hearing loss
• Neonates in ICU: 2-4 per 100
• In US about 1 million children from birth to 21
years have hearing loss
– 1/3 of these children have other sensory or
cognitive problems
Causes of Hearing Impairments
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Anatomic malformation
Low birth weight
Ototoxic drugs
Chronic ear infections
Perinatal asphyxia
Perinatal infections:
– rubella, herpes, syphilis, bacterial meningitis
• Cerebral palsy
Levels of Hearing Loss
• Hearing loss may be unilateral (involving one ear) or
bilateral (involving both ears)
• Extent of hearing loss is defined based on the softest
intensity of sound that is perceived, described in decibels
(dB)
– 0 to 20 dB: normal
– 20 to 40 dB: mild loss
– 40 to 60 dB: moderate loss
– 60 to 80 dB: severe loss
– Greater than 80 dB: profound loss (ASHA,
2011b)
Symptom Severity
• Measured in decibels (dB)
– A unit of loudness
– Measured at various frequencies
– Speech range is 2000 cycles/sec
• Hearing threshold
– Measurement of a person’s hearing threshold
with audiometer
– Degree of symptom severity as it affects speech
Pathology
of Hearing Impairments
• Conductive hearing loss—middle ear
• Sensorineural hearing loss—nerve deafness
• Mixed conductive-sensorineural loss—may
follow recurrent otitis media with complications
• Central auditory interception:
– Organic: defect involves reception of auditory stimuli along central
pathways and expression of message (aphasia)
– Functional: no organic lesion exists to explain central auditory
loss(conversion hysteria, infantile autism, childhood schizophrenia)
Manifestations of Hearing Impairment
in Infancy
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Lack of startle reflex
Absence of babbling by age 7 months
General indifference to sound
Lack of response to spoken word
EARLY DETECTION, best within 3-6months,
essential to improve language and educational
outcomes
• Medical
Therapeutic Management
of Hearing Impairment
– Antibiotic therapy for otitis media
• Surgical interventions
– Tympanostomy tubes for chronic otitis media
• Hearing aid
– Learn how to use hearing aid
– Teach child to manage when old enough
– Managing acoustic feedback
• Reinsert aid
• Check for hair
• Clean ear mold or ear
• Lower volume
• Cochlear implants: May help children with
sensorineural hearing loss
• The diagnosis of a significant
disability can be extremely stressful
for the family.
• Encourage families to express their
feelings and provide emotional
support
• The child with hearing loss should
receive early intervention with
hearing aids or other augmentative
devices to minimize the
psychosocial impact of sensory
deficits.
FIG. 19-7 On-the-body hearing aids are
convenient for young children, such as this
child with severe bilateral hearing loss.
Note eye patching for strabismus.
Childhood Deafness
• Profound deafness likely to be diagnosed in
infancy
• Entry into school
• Concerns with speech development
– One reason number of words and speech assessed
at PCP’s visit
Promoting Communication
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Lipreading
Cued speech
Sign language
Speech language therapy
Socialization
Additional aids
Cochlear implant
– A cochlear implant is a small, complex electronic device that
can help to provide a sense of sound to a person who is
profoundly deaf or severely hard-of-hearing. The implant
consists of an external portion that sits behind the ear and a
second portion that is surgically placed under the skin
Care for Hearing Impaired Child During
Hospitalization
• Reassess understanding of instructions given
• Supplement with visual and tactile media
• Communication devices:
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Picture board
Common words and needs (food, water, toilet)
Sign language (need an interpreter)
Computer
Deaf-Blind Children
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Profound effects on development
Motor milestones usually achieved
Other development often delayed
Finger spelling
Developing future goals for the child