sensory skin disorder
DESCRIPTION
skin, ear, and vision disorderTRANSCRIPT
Management of Sensory DisordersDean Jane L. Olid
SKIN Largest organ of the body Functions: Protection Sensation Fluid balance Temperature regulation Vitamin D production Immune response
Primary Skin LesionsMacule Flat, circumscribed area that is a change in color of the skin; less than 1 cm in diameter PapuleAn elevated, firm. Circumscribed area less than 1 cm in diameter e.g.Wart (verruca), elevated moles, lichen planus, cherry angioma, skin tag
e.g.
Primary Skin LesionsPLAQUE Elevated, firm, and rough lesion with flat top surface greater than 1 cm in diametere.g.Psoriasis, seborrheic and actinic keratoses, eczema
Primary Skin LesionsWHEAL Elevated irregular-shaped area of cutaneous edema; solid, transient, variable diameter Ex. Insect bite, urticaria, allergic reaction
Primary Skin LesionsNODULE Elevated, firm, circumscribed lesion; deeper in dermis than a papule; 1 to 2 cm in diameter Ex. Dermatolfibroma, erythema nodosum, lipomas, melanoma, hemangioma, neurofibroma
Primary Skin LesionsTUMOR Elevated and solid lesion; may or may not be clearly demarcated; deeper in dermis; greater than 2 cm in diameter Ex. Neoplasma, lipoma, hemangioma
Primary Skin LesionsVESICLE Elevated, circumscribed, superficial, not into dermis; filled with serous fluid; less than 1 cm in diameter Ex. Varicella (chickenpox, herpes zoster, impetigo, acute eczema
BULLA Vesicle greater than 1 cm in diameter Ex. Blister, lupus, impetigo, drug reaction
PUSTULE Elevated, superficial lesion; similar to a vesicle but filled with purulent fluid Ex. Impetigo, acne, folliculitis, herpes simplex
PUSTULE Elevated, superficial lesion; similar to a vesicle but filled with purulent fluid Ex. Impetigo, acne, folliculitis, herpes simplex
SKIN CONFIGURATIONS
Secondary Skin LesionsSCALE Heaped-up keratinized cells; flaky skin; irregular; thick or thin; dry or oily; variation in size Ex. Seborrheic dermatitis following scarlet fever
Secondary Skin LesionsLICHENIFICATION Rough, thickened epidermis secondary to persistent rubbing, itching or skin irritation; often involves flexor surface of extremity
Secondary Skin LesionsSCAR Thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis
Secondary Skin LesionsKELOID Irregular-shaped elevated, progressively enlarging scar, grows beyond the boundaries of the wound; caused by excessive collagen formation during healing
EXCORIATION Loss of the epidermis linear hollowed-out crusted area Ex. Abrasion or scratch scabies
FISSURE Linear crack or break from the epidermis to the dermis, may be moist or dry Ex. Athletes foot, cracks at the corner of the mouth, eczema
EROSION Loss of part of the epidermis; depressed, moist, glistening; follows rupture of a vesicle or bulla Ex. Varicella, variola after rupture, candidiasis, herpes
ULCER Loss of epidermis and dermis, concave; varies in size Ex. Decubiti, stasis ulcers, syphillis chancre
ATROPHY Thinning of the skin surface and loss of skin markings; skin appears translucent and paperlike Ex. Aged skin, striae, discoid lupus erythematosus
Vascular Skin Lesions TELANGIECTASIA Fine, irregular red lines produced by capillary dilation Ex. Vascular spider, lupus erythematosus
Vascular Skin LesionsCHERRY ANGIOMA Small, slightly raised, bright red areas that appear on the face, neck and trunk of the body. These increase in size and number with advanced age.
Vascular Skin Lesions Petechiae Spider Angioma
Ecchymoses
Anatomic Distribution of Common Skin DisordersContact Dermatitis
Anatomic Distribution of Common Skin DisordersSeborrheic Dermatitis and Acne
Anatomic Distribution of Common Skin DisordersScabies and Herpes Zoster
Skin AppearanceCYANOSIS JAUNDICE
Normal Aging Changes Thinning of skin Uneven pigmentation Wrinkling, skin folds, and decreased elasticity Dry skin Diminished hair Increased fragility and increased potential for injury Reduced healing ability
Assessment of the Skin Prepare the patient: explainthe purpose and provide privacy and coverings MALE PATTERN BALDNESS
Ask assessment questions Inspect the patients entire body including mucosa, scalp, hair, and nails Wear gloves Assess any lesions; palpate and measure them Note hair distribution Photographs may be used to document nature and extent of skin conditions and to document progress resulting from treatment; they may also be used to track moles
Diagnostic Procedures Skin biopsy Immunofluorescence Patch testing Skin scrapings Tzanck smear Woods light examination
Management of Patients with Burn InjuryCauses: dry heat - fire, moist heat - steam or hot liquids, Radiation friction heated objects, the sun, Electricity or chemicals. Thermal burns are the most common type. Most burns occur in the home. Young children and the elderly are at high risk for Goals Related to Burns Prevention Institution of life-saving measures for the severely burned person Prevention of disability and disfigurement through early specialized and individualized care Rehabilitation through reconstructive surgery and rehabilitation programs
Classification of Burns Superficial partialthickness (1ST DEGREEBURN)
First-degree burns affect only the outer layer of the skin epidermis. Manifestation: minor pain, redness (erythema) Mild swelling. cause: e.g.sunburn
First-degree burnsManagement: Remove jewelry or tight clothing from the burned area before it begins to swell. Flush the burn with cool running water or apply cold-water compresses (a wet towel or handkerchief) until the pain lessens. Do not use ice or ice water, which can cause more damage to the tissues. Cover the burn with a clean (sterile, if possible), dry, nonfluffy bandage such as a gauze pad. Do not put tape on the burn.
Classification of Burns 2nd degree burn
affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering. Causes: deep sunburn exposure to flames contact with hot liquids burning gasoline or kerosene contact with chemicals.
2 degree burnnd
Manifestations: skin is bright red and blotchy blisters. It usually looks wet because of the loss of fluid through the damaged skin. very painful.
3rd Degree BurnCAUSES: contact with: corrosive chemicals, flames, electricity, or extremely hot objects; immersion of the body in extremely hot water, clothing that catches fire. Third-degree burns can also damage fat, muscle, and bone
Skin with a third-degree burn may appear white
or black and leathery on the surface. Because the nerve endings in the skin are destroyed, the burned area may not be painful, but the area around the burn may be extremely painful. Pain causes the breathing rate and pulse to increase. Some areas of the burn may appear bright red, or may blister.
3rd Degree Burn Electrical burns damage the deep tissues. Often only the area of the skin where the electricity entered the body looks black and charred. Electrical shocks can make a person stop breathing and interrupt the rhythm of the heart. Shock occurs when loss of fluids causes the blood pressure to become so low that not enough blood reaches the brain and other major organs.
3 Degree Burnrd
The symptoms of shock : fainting, general weakness, nausea and vomiting, rapid pulse and breathing, a blue tinge to the lips and finger nails, and pale, cold, moist skin. If the victim has been burned in a fire and has been exposed to large amounts of smoke, he or she may also have chest pain, red and burning eyes, and a cough. All third-degree burns require emergency medical treatment.
Rule of Nines
Estimation of Total Body Surface Area (TBSA) Burned
Pathophysiology of Burns Burns are caused by a transfer of energy from a heat source to the body. Thermal (includes electrical) Radiation Chemical
Physiologic Changes Burns less than 25% TBSA produce a primarily local response. Burns more than 25% may produce a local and systemic response and are considered major burns. Systemic response includes release of cytokines and other mediators into the systemic circulation. Fluid shifts and shock result in tissue hypoperfusion and organ hypofunction.
Effects of Major Burn Injury Fluid and electrolyte shifts Cardiovascular effects Pulmonary injury Upper airway Inhalation below the glottis Carbon monoxide poisoning Restrictive defects
Renal and GI alterations Immunologic alterations Effect upon thermoregulation
Nomenclat Tradition ure al nomencl ature Superficial thickness Firstdegree
Depth
Clinical findings
Epidermis involvement
Erythema, minor pain, lack of blisters
Partial thickness superficial Partial thickness deep Full thickness
Seconddegree
Superficial (papillary) dermis
Blisters, clear fluid, and pain
Seconddegree
Deep (reticular) dermis
Whiter appearance, with decreased pain. Difficult to distinguish from full thickness Hard, leather-like eschar, purple fluid, no sensation (insensate
Third- or fourthdegree
Dermis and underlying tissue and possibly fascia, bone, or muscle
FOR MAJOR BURNS: Initial Care Make sure that the person is no longer in contact with smoldering materials. However, DO NOT remove burnt clothing that is stuck to the skin. If breathing has stopped, or if the person's airway is blocked, open the airway. If necessary, begin CPR. Cover the burn area with a cool, moist sterile bandage (if available) or clean cloth. A sheet will do if the burned area is large. DO NOT apply any ointments. Avoid breaking burn blisters. If fingers or toes have been burned, separate them with dry, sterile, non-adhesive dressings. Elevate the body part that is burned above the level of the heart. Protect the burnt area from pressure and friction. Take steps to prevent shock. Lay the person flat, elevate the feet about 12 inches, and cover him or her with a coat or blanket. However, DO NOT place the person in this shock position if a head, neck, back, or leg injury is suspected or if it makes the person uncomfortable.
Phases of Burn Injury Emergent or resuscitative phase Onset of injury to completion of fluid resuscitation
Acute or intermediate phase From beginning of diuresis to wound closure
Rehabilitation phase From wound closure to return to optimal physical and psychosocial adjustment
Emergent or Resuscitative Phase: On-the-Scene Care Prevent injury to rescuer. Stop injury: extinguish flames, cool the burn, irrigate chemical burns. ABCs: Establish airway, breathing, and circulation. Start oxygen and large-bore IVs. Remove restrictive objects and cover the wound. Do assessment, surveying all body systems, and obtain a history of the incident and pertinent patient history. Note: Treat patients with falls and electrical injuries as for potential cervical spine injury.
Emergent or Resuscitative Phase Patient is transported to emergency department. Fluid resuscitation is begun. Foley catheter is inserted. Patients with burns exceeding 20-25% should have an NG tube inserted and placed to suction. Patient is stabilized and condition is continually monitored. Patients with electrical burns should have an ECG. Address pain; only IV medication should be administered. Psychosocial consideration and emotional support should be given to patient and family.
Acute or Intermediate Phase 48-72 hours after injury Continue assessment and maintain respiratory and circulatory support. Prevention of infection, wound care, pain management, and nutritional support are priorities in this stage.
Rehabilitation Phase Rehabilitation is begun as early as possible in the emergent phase and extends for a long period after the injury. Focus is upon wound healing, psychosocial support, self-image, lifestyle, and restoring maximal functional abilities so the patient can have the best-quality life, both personally and socially. The patient may need reconstructive surgery to improve function and appearance. Vocational counseling and support groups may assist the patient.
Management of Shock: Fluid Resuscitation Maintain BP above 100 mm Hg systolic and urine output of 30-50 mL/hr. Maintain serum sodium at near-normal levels. Consensus formula Evans formula Brooke Army formula Parkland Baxter formula Hypertonic saline formula Note: Adjust formulas to reflect initiation of fluids at the time of injury.
Fluid and Electrotype Shifts: Emergent Phase Generalized dehydration Reduced blood volume and hemoconcentration Decreased urine output Trauma causes release of potassium into extracellaur fluid: hyperkalemia. Sodium traps in edema fluid and shifts into cells as potassium is released: hyponatremia. Metabolic acidosis
Fluid and Electrolyte Shifts: Acute Phase Fluid re-enters the vascular space from the interstitial space. Hemodilution Increased urinary output Sodium is lost with diuresis and due to dilution as fluid enters vascular space: hyponatremia. Potassium shifts from extracellular fluid into cells: potential hypokalemia. Metabolic acidosis
Burn Wound Care Wound cleaning Hydrotherapy
Use of topical agents Wound dbridement Natural dbridement Mechanical dbridement Surgical dbridement
Wound dressing, dressing changes, and skin grafting
Use of Biobrane Dressing
Comparison of Integra Template and Split-Thickness Autograft
Pain Management Analgesics IV use during emergent and acute phases Morphine Fentanyl Other
Decrease/avoid sleep deprivation Nonpharmacologic measures
Decrease level of anxiety
Nutritional Support Goal of nutritional support is to promote a state of nitrogen balance and match nutrient utilization. Nutritional support is based on patients preburn status and % of TBSA burned. Enteral route is preferred. Jejunal feedings are frequently used to maintain nutritional status with lower risk of aspiration in a patient with poor appetite, weakness, or other problems.
Other Major Care Issues Pulmonary care Psychological support of patient and family Patient and family education Restoration of function
Nursing Process: Care of the Patient in the Emergent Phase of Burn Care:Diagnosis Impaired gas exchange Ineffective airway clearance Fluid volume deficit Hypothermia Acute pain Anxiety Potential Complications/Collaborat ive Problems Acute respiratory failure Distributive shock Acute renal failure Compartment syndrome Paralytic ileus Curlings ulcer
Nursing Process: Care of the Patient in the Acute Phase of Burn Care: Diagnosis Excessive fluid volume Risk for infection Imbalanced nutrition Acute pain Impaired physical mobility Ineffective coping Interrupted family processes Deficient knowledge Potential Complications/Collaborati ve Problems Heart failure and pulmonary edema Sepsis Acute respiratory failure Visceral damage (electrical burns)
Home Care Instructions Mental health Skin and wound care Exercise and activity Nutrition Pain management Thermoregulation and clothing Sexual issues
Assessment and Management of Patients with Eye and Vision Disorders
Extraocular Muscles
Visual Pathways
Cross-Section of the Eye
Internal Structures of the Eye
Assessment and Evaluation of Vision Ocular history Visual acuity Snellen chart Record each eye 20/20 means the patient can read the 20 line at a distance of 20 feet
Finger count or hand motion
Examination of the External Structures Note any evidence of irritation, inflammatory process, discharge, etc. Assess eyelids and sclera Assess pupils and pupillary response in a darkened room Note gaze and position of eyes Assess extraocular movements Ptosis: drooping eyelid Nystagmus: oscillating movement of eyeball
Diagnostic Evaluation Ophthalmoscopy Direct and indirect Examines the cornea, lens, and retina
Slit-lamp examination Color vision testing Amsler grid Ultrasonography Fluorescein and indocyanine green angiography
Tonometry Measures intraocular pressure
Gonioscopy Visualizes the angle of the anterior chamber
Perimetry testing Evaluates field of vision Scotomas: blind areas in the visual field
Impaired Vision Refractive errors Can be corrected by lenses that focus light rays on the retina
Emmetropia: normal vision Myopia: nearsighted Hyperopia: farsighted Astigmatism: distortion due to irregularity of the cornea
Eyeball Shape Determines Visual Acuity in Refractive Errors
Glaucoma A group of ocular conditions in which damage to the optic nerve is related to increased intraocular pressure (IOP) caused by congestion of the aqueous humor Open-angle glaucoma Chronic open-angle glaucoma Normal-tension glaucoma Ocular hypertension
Angle-closure (pupillary block) glaucoma Acute angle-closure Subacute angle-closure Chronic angle-closure
Congenital glaucomas and glaucoma secondary to other conditions
Pathophysiology of Glaucoma Normal outflow of aqueous humor In glaucoma, aqueous production and drainage are not in balance When aqueous outflow is blocked, pressure builds up in the eye Increased IOP causes irreversible mechanical and/or ischemic damage
Clinical Manifestations Called the silent thief, glaucoma renders the patient unaware of the condition until there is significant vision loss, including peripheral vision loss, blurring, halos, difficulty focusing, and difficulty adjusting eyes to low lighting Patient may also experience aching or discomfort around the eyes or a headache
Diagnostic Findings Tonometry to assess IOP Gonioscopy to assess the angle of the anterior chamber Perimetry to assess vision loss
Goal is to prevent further optic nerve damage
Maintain IOP within a range unlikely to cause damage Pharmacologic therapy: Surgery Laser trabeculoplasty Laser iridotomy Filtering procedures Trabeculectomy Drainage implants or shunts
Nursing Management Focus on maintaining the therapeutic regimen for lifelong control of a chronic condition Emphasize the need for adherence to therapy and continued care to prevent further vision loss Provide education regarding use and effects of medications Medications used for glaucoma may cause vision alterations and other side effects; the action and effects of medications need to be explained to promote compliance Provide support and interventions to aid the patient in adjusting to vision loss/potential vision loss
Cataracts An opacity or cloudiness of the lens Increased incidence with aging
Clinical Manifestations Painless, blurry vision Sensitivity to glare Reduced visual acuity Other effects include myopic shift, astigmatism, diplopia (double vision), and color shifts including brunescent c. (color value shift to yellow-brown) Diagnostic findings include decreased visual acuity and opacity of the lens by ophthalmoscope, slit-lamp, or inspection
Surgical Management If reduced vision does not interfere with normal activities, surgery is not needed Surgery is performed on an outpatient basis with local anesthesia Surgery usually takes less than 1 hour and patients are discharged soon afterward Complications are rare
Types of Cataract Surgery Intracapsular cataract extraction (ICCE): removes entire lens; rarely done today Extracapsular cataract extraction (ECCE): maintains the posterior capsule of the lens, reducing potential postoperative complications Phacoemulsification: an ECCE that uses an ultrasonic device to suction the lens out through a tube; incision is smaller than with standard ECCE Lens replacement: after removal of the lens by ICCE or ECCE, the surgeon inserts an intraocular lens implant (IOL), which eliminates the need for aphakic lenses; however, the patient may still require glasses
Nursing Management Preoperative care Usual preoperative care for ambulatory surgery Dilating eye drops or other medications as ordered Postoperative careProvide written and verbal instructions Instruct patient to call physician immediately if: vision changes; continuous flashing lights appear; redness, swelling, or pain increase; type and amount of drainage increases; or significant pain is not relieved by acetaminophen
Corneal Disorders Treatment of diseased corneal tissue Phototherapeutic keratectomy Keratoplasty Use of donor tissue for transplant: see Chart 58-9 Need for follow-up and support Potential graft failure; teach signs and symptoms
Refractive surgery Elective procedures to recontour corneal tissue and correct refractive errors Patients need counseling regarding potential benefits, risks, and complications
LASIK
Retinal Disorders Retinal detachment Retinal vascular disorders Central retina vein occlusion Branch retinal vein occlusion Central retinal vein occlusion Macular degeneration
Retinal Detachment Separation of the sensory retina and the retinal pigment epithelium (RPE) Manifestations: sensation of a shade or curtain coming across the vision of one eye, bright flashing lights, and sudden onset of floaters Diagnostic findings: assess visual acuity; assess retina by indirect ophthalmoscope, slit-lamp, stereo fundus photography, and fluroescein angiography; tomography and ultrasound may also be used
Surgical Treatment Scleral buckle Pars plana vitrectomy Removal of the vitreous, locating the incisions at the pars plana Frequently used in combination with other procedures
Pneumatic retinopexy Injected gas bubble, liquid, or oil is used to flatten the sensory retina against the RPE Postoperative positioning is critical
Nursing Management Patient teaching Eye surgery is most often done as an outpatient procedure, so patient education is vital Teach the signs and symptoms of complications, especially increased IOP and infection
Promote comfort Patient may need to lie in a special position with pneumatic retinopexy
Retinal Vein or Artery Occlusion Loss of vision can occur from retinal vein or artery occlusion Occlusions may result from atherosclerosis, cardiac valvular disease, venous stasis, hypertension, and increased blood viscosity; associated risk factors are diabetes mellitus, glaucoma, and aging Patients may report decreased visual acuity or sudden loss of vision
Macular Degeneration Age-related macular degeneration (AMD) The most common cause of vision loss in persons older than age 60 Types Dry or nonexudative type is most common, 85%-90% Slow breakdown of the layers of the retina with the appearance of drusen
Wet type May have abrupt onset Proliferation of abnormal blood vessels growing under the retinachoroidal revascularization (CNV
Vision Loss Associated With Macular Degeneration
Retina Showing Drusen and AMD
Nursing Management Patient teaching Supportive care Safety promotion Recommendations include improving lighting, getting magnification devices, and referring patient to vision center to improve/promote function
Trauma Emergency treatment Flush chemical injuries Do not remove foreign objects Protect using metal shield or paper cup
Potential exists for sympathetic ophthalmia, causing blindness in the uninjured eye with some injuries
Infectious and Inflammatory Disorders Dry eye syndrome Conjunctivitis (pink eye) Classified by cause: bacterial, viral, fungal, parasitic, allergic, and toxic Viral conjunctivitis is contagious: see Chart 58-11
Uveitis Orbital cellulitis
Hyperemia in Viral Conjunctivitis
Ocular Consequences of Systemic Disease Diabetic retinopathy Diabetes is a leading cause of blindness in people age 20 to 74
Ophthalmic complications associated with AIDS Eye changes associated with hypertension
Ophthalmic Medications Ability of the eye to absorbmedication is limited
Topical anesthetics Mydriatics (dilate) and cycloplegics (paralyze): Contraindicated with narrow angles or shallow anterior chambers and for inpatients on monoamine oxidase inhibitors or tricyclic antidepressants May cause CNS symptoms and increased BP especially in children and the elderly
Barriers to absorption include the size of the conjunctival sac; corneal membrane barriers; bloodocular barriers; and tearing, blinking, and drainage Intraocular injection or systemic medication may be needed to treat some eye structures or to provide high concentrations of medication Topical medications (drops
Anti-infective medications Antibiotic, antifungal, and antiviral products
Anti-inflammatory drugs; corticosteroid suspensions Side effects of long-term topical steroids include glaucoma, cataracts, and increased risk of infection; to avoid these effects, oral NSAID therapy may be used as an alternate to steroid use
Medications used for glaucoma Increase aqueous outflow or decrease aqueous production May constrict the pupil and affect ability to focus the lens of the eye; affects vision May also may produce systemic effects
Low Vision and Blindness Low vision Visional impairment that requires devices and strategies in addition to corrective lenses Best corrected visual acuity (BCVA) of 20/70 to 20/200
Blindness BCVA of 20/400 to no light perception Legal blindness is BCVA that does not exceed 20/200 in better eye, or widest field of vision is 20 degrees or less
Impaired vision often is accompanied by functional impairment
Assessment of Low Vision History Examination of distance and near visual acuity, visual field, contrast sensitivity, glare, color perception, and refraction Special charts may be used for low vision Nursing assessment must include assessment of functional ability and coping and adaptation in emotional, physical, and social areas
Management Support coping strategies, grief processes, and acceptance of visual loss Strategies for adaptation to the environment Placement of items in room Clock method for trays
Communication strategies: see Chart 58-3 Collaboration with low vision specialist, occupational therapy, or other resources Braille or other methods for reading/communication Use of service animals
Guidelines for Instilling Eye Medications Shake suspensions or milky solutions to obtain the desired medication level. Wash hands thoroughly before and after the procedure. Ensure adequate lighting. Read the label of the eye medication to make sure it is the correct medication. Assume a comfortable position. Do not touch the tip of the medication container to any part of eye or face. Hold the lower lid down; do not press on the eye-ball. Apply gentle pressure to the cheek bone to anchor the finger holding the lid Instill eye drops before applying ointments. Apply a -inch ribbon of ointment
Guidelines for Instilling Eye Medications Instill eye drops before applying ointments. Apply a -inch ribbon of ointment to the lower conjunctival sac. Keep the eyelids closed, and apply gentle pressure on the inner canthus (punctal occlusion) near the bridge of the nose for 1 or 2 minutes immediately after instilling eyedrops. Using a clean tissue, gently pat skin to absorb excess eyedrops that run onto the cheeks. Wait 5 to 10 minutes before instilling another eye medication.
Assessment and Management of Patients with Hearing and Balance Disorders
Anatomy of the Ear
Anatomy of the Inner Ear
Bone Conduction Compared to Air Conduction
Assessment Inspection of the external ear Otoscopic examination Gross auditory acuity Whisper test Weber test Rinne test
Otoscope
Assessment
Weber test
Rinne Test
Speech Discrimination
Diagnostic Evaluation Audiometry Tympanogram Auditory brain stem response Electronystagmography Platform posturography Sinusoidal harmonic acceleration Middle ear endoscopy
Hearing Loss Increased incidence with age: presbycusis Risk factors include exposure to excessive noise levels: Types Conductive: due to external middle ear problem Sensorineural: due to damage to the cochlea or vestibulocochlear nerve Mixed: both conductive and sensorineural Functional (psychogenic): due to emotional problem
Manifestations: Early symptoms include: Tinnitus: perception of sound; often ringing in the ears Increased inability to hear in a group Turning up the volume on the TV
Impairment may be gradual and not recognized by the person experiencing the loss As hearing loss increases, patients may experience deterioration of speech, fatigue, indifference, social isolation, or withdrawal; for other symptoms see
Hearing impairment: Mild, moderate, severe, or profound Consequences Depends on age and severity