1. Causes
    1. Conductive: interference in transmission from outer to middle ear from chronic otitis media, foreign bodies
    2. Sensorineural: dysfunction of the inner ear; damage to cranial nerve VIII (from rubella, meningitis, drugs)
  2. Medical management
    1. Treatment of causative disorders
    2. Speech/auditory therapy
    3. Hearing aids
    4. Surgery, depending on the cause
  3. Assessment findings
    1. Infant
      1. Fails to react to loud noises (does have a Moro reflex, but not to noise)
      2. Makes no attempt to locate sound
      3. Remains in babbling stage or ceases to babble
      4. Fails to develop speech
      5. Startled by sudden appearances
    2. All children
      1. Respond only when speaker's lips are visible
      2. Cannot concentrate for long on visual images; constantly scan the surroundings for change
      3. May have slow motor development
      4. Appear puzzled or withdrawn, or strain to hear
      5. Use high volume on TV/radio
    3. Audiologic testing
      1. Slight hearing deficit: difficulty hearing faint sounds, very little interference in school, no speech defect, benefits from favorable seating
      2. Mild hearing deficit: can understand conversational speech at 3-5 feet when facing the other person, decreased vocabulary, may miss half of class discussions
      3. Marked hearing deficit: misses most of conversation, hears loud noises, needs special education for language skills
  4. Nursing interventions
    1. Speak slowly, not more loudly.
    2. Face child.
    3. Get child's attention before talking; let child see you before performing any care.
    4. Get feedback from child to make sure child has understood.
    5. Decrease outside noises that could interfere with child's ability to discern what you are saying.
    6. Be careful not to cover your mouth with hands.
    7. Teach language through visual cues, touch, and kinesthetics.
    8. Use body demonstrations or use doll play.
    9. Provide appropriate stimulation (puppets and musical toys are inappropriate).
    10. Provide client teaching and discharge planning concerning
      1. General child care, with adaptation for safety and developmental/functional levels
      2. Availability of support groups/community agencies
      3. Special education programs
      4. Care and use of hearing aids
      5. Interaction with peers: assist child as needed