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CH 59: Patient with a
Sensory Impairment
DH201 Clinician Sciences
Lisa Mayo, RDH, BSDH
Objectives
1. Visual Impairment
2. Hearing Impairment
Americans with Disabilities Act
 Protects person with a disability who has a physical
or mental impairment that substantially limits
major life activities
 Hearing & Visually impaired fall under this act
 Business’s must provide services & devises
Review Sheet #1-2
Visually Impaired
Review Sheet #2-5
Visual Impairment
Legally blind (legal term, not medical)
 Central vision (or acuity) of not more than 20/200 in the
better eye with correction (glasses)
 Peripheral fields (side vision) of no more than 20 degrees
diameter or 10 degrees radius
Visual Impairment
Causes of blindness:
 Leading causes: diabetic retinopathy, age-related
macular degeneration, senile cataracts, glaucoma,
vascular disease, trauma, infections
 Children: ½ is of prenatal origin, particularly
resulting from maternal infections (rubella,
syphilis, toxoplasmosis)
Visual Impairment
Glaucoma
 Grp of diseases of the eye
 Increase intraocular pressure
NBQ
Failure of the liquid in the eye to drain resulting in increased
pressure and optic nerve destruction defines:
a. Cataract
b. Retrolental fibroplasia
c. Retinitis pigmentosa
d. Glaucoma
NBQ
Failure of the liquid in the eye to drain resulting in increased
pressure and optic nerve destruction defines:
a. Cataract
b. Retrolental fibroplasia
c. Retinitis pigmentosa
d. Glaucoma
Review
Which of the following is a visual impairment?
A) Diplopia
B) Otitis media
C) Vertigo
D) Tinnitus
E) Sensorineural loss
Answer
A) Diplopia
Diplopia is double vision. The other choices are all
conditions that affect hearing.
NBQ
Legally blind is defined as central visual acuity of 20/100. This
means that the person who has received the best optical
correction can see at 100 feet what a normal-visioned person can
see at 200 feet.
a. The first statement is true, and the second statement is
false.
b. The first statement is false, and the second statement is
true.
c. Both statements are false.
d. Both statements are true.
NBQ
Legally blind is defined as central visual acuity of 20/100. This
means that the person who has received the best optical
correction can see at 100 feet what a normal-visioned person can
see at 200 feet.
a. The first statement is true, and the second statement is
false.
b. The first statement is false, and the second statement is
true.
c. Both statements are false.
d. Both statements are true.
20/20
20/100 = you must be at 20 feet to see what I can see at
100 feet away
Review Sheet #6
NBQ
All but one of the following may be a problem for an 85-yr old
woman with a vision problem. Which one is the EXCEPTION?
a. Glare from the dental light
b. Heavy shag rug in the waiting room
c. Changes in color between the tile floor and the carpet
d. Raised door thresholds
e. Signs on the receptionist’s desk
NBQ
All but one of the following may be a problem for an 85-yr old
woman with a vision problem. Which one is the EXCEPTION?
a. Glare from the dental light
b. Heavy shag rug in the waiting room
c. Changes in color between the tile floor and the carpet
d. Raised door thresholds
e. Signs on the receptionist’s desk
DH Care for the
Totally Blind Patient
Review Sheet #17-18
 Assistance in completing the personal questionnaire
 Relay on your tone of voice more heavily than others
(cannot see your facial expressions or body language)
 Lower chair before bringing pt to the op & move all
barriers out of the way
 Explain why you are leaving the room and when you will
be back
 Guide dogs: do not distract the dog, do not touch the
dog, ask pt where best place is for the dog (usually lie in
the corner of the tx room)
DH Care for the
Totally Blind Patient
Review Sheet #17-18
Clinical procedures
 Describe each step in detail of your appt
 Explain instruments, materials, flavors, etc…
 Let children touch and hold non-sharp instruments
so they can feel it and become familiar with it
 Prepare pt for power instruments, water, prophy
cup, ect…
 Speak before touching patient
Escorting a Blind Patient
You
Pt
NBQ
When being escorted, a blind client holds the arm of the person
acting as the escort just below the escort’s wrist. Then the client
walks beside and slightly behind the escort.
a. The first statement is true, and the second statement is
false.
b. The first statement is false, and the second statement is
true.
c. Both statements are false.
d. Both statements are true.
NBQ
When being escorted, a blind client holds the arm of the person
acting as the escort just below the escort’s wrist. Then the client
walks beside and slightly behind the escort.
a. The first statement is true, and the second statement is
false.
b. The first statement is false, and the second statement is
true.
c. Both statements are false.
d. Both statements are true.
DH Care for
Partially Sighted
Review Sheet #15
 Chair position: supine may bother a pt with
glaucoma (increase pain & pressure)
 Light: avoid light in pt eye’s = increased sensitivity
to light
 OHI: position pt for best vision
 Ex: glaucoma = no peripheral vision, so sit directly
in front of pt
 Cannot see fine detail (small radiograph)
Hearing Impaired
Hearing Impairment
 Deaf: When hearing is impaired to the extent that it
has no practical value for the purpose of spoken
communication
 Hard of hearing: defective but functional w/ or w/out
hearing aid
 Causes of hearing impairment
 Outer, middle, inner ear mechanisms
 Heredity, prenatal infection in the mother (rubella),
birth trauma are significant in the earliest years
http://www.youtube.com/watch?
v=xSXaWa-brlc
Marlee Matlin
Golden Globes
Academy Award
Oscar
Hearing Impairment
Wilkins p.912
Review Sheet #29
Types
1. Conductive hearing loss: Outer or middle ear
involvement of the conduction pathways to the inner
ear
2. Sensorineural hearing loss: damage to sensory
3. Mixed hearing loss: combo
4. Central hearing loss: Damage of the nerves or nuclei of
the central nervous system in the brain or the
pathways to the brain
Review
Conductive hearing loss is defined as damage to the:
A) outer or middle ear conduction pathways to the inner ear
B) sensory hair cells of the inner ear or the nerves of the inner ear
C) nerves or nuclei of the central nervous system in the brain or the
pathways to the brain
D) inner, middle, and outer ear pathways
Answer
A) Outer or middle ear conduction pathways to the inner ear
Conductive hearing loss is defined as damage to the outer or
middle ear conduction pathways to the inner ear. Sensorineural
hearing loss is damage to the sensory hair cells of the inner ear
or the nerves that supply the inner ear. Central hearing loss is
damage of the nerves or nuclei of the central nervous system in
the brain or the pathways to the brain.
Hearing Impairment
Hearing Impairment
 Hearing aids
 Electronic device that amplifies & shapes sound waves that
enter the external auditory canal
 In-the-ear model or Canal aid model
 Cochlear implants
 Small electronic device that helps provide a sense of sound
to a child or adult who is profoundly deaf or severely hard
of hearing
 Does not restore normal hearing
Review Sheet #30, 32
Modes of Communication




American Sign Language (ASL)
Fingerspelling in the air – combined w/ALS
Speech-reading (lip reading)
Write down instructions
 Clipboard with a marker-type pen attached and
large paper, at least 8-1/2 x 11 inches
Review Sheet #33
Dental Hygiene Care
 Patient with hearing aid
 Do NOT touch a hearing aid when it is turned on
 Turn off when using a power-driven dental
instrument
 Patient with partial hearing ability
 Speak clearly and distinctly
 Face the patient
 Eliminate interfering noises: suction
Review Sheet #31
Dental Hygiene Care
Review Sheet #34-35
Speech-reader
 Face them straight on, do not turn to side
 Speak in normal tone, do not exaggerate words
 Slow the pace of speech, pause more frequently than
usual
 Do not raise voice, raising voice can distort lip
movements and make lip reading more difficult
Dental Hygiene Care
Review Sheet #35
 General suggestions
 Written appointment card
 Telecommunication Relay Service (TRS) to call a
deaf patient directly with appointment
reminders
Review
A patient with a hearing aid may need which modification in
delivery of dental hygiene therapy?
A) Remove eyeglasses
B) Cover ear canal with gauze
C) Speak very loudly and slowly so the patient can hear you over
other noise
D) Remove or turn off hearing aid when using a power-driven scaler
Answer
D) Remove or turn off hearing aid when using a
power-driven scaler
It is important to ask patients with hearing aids to
turn them off or to take them out when using a
power-driven scaler. The noise can be amplified
many times, making it uncomfortable for
patients. All other modifications listed are
unnecessary.
NBQ
Mr. Smith is 90 years old and wears a hearing aid. Which of the
following will be important when communicating with
Mr.Smith?
a.
b.
c.
d.
Speak as loud as you can
Speak slowly and enunciate
Don’t communicate with him
Communicate only with his spouse
NBQ
Mr. Smith is 90 years old and wears a hearing aid. Which of the
following will be important when communicating with
Mr.Smith?
a.
b.
c.
d.
Speak as loud as you can
Speak slowly and enunciate
Don’t communicate with him
Communicate only with his spouse