Peds, part 32: Nervous Disorders - Visual and Hearing Impairments
by Cathy Parkes January 04, 2022 Updated: August 10, 2023 6 min read
I am Cathy, with Level Up RN. In this video, I will be talking about visual and hearing impairments in children. At the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video. So definitely stay tuned for that. And if you have our Level Up RN Pediatric Nursing Flashcards, definitely pull those out, so you can follow along with me.
First up, let's talk about some visual impairments. Impairments that I would be familiar with include myopia, which means nearsightedness. So this is where you can see things clearly up close, but you have a hard time seeing things that are farther away. Our cool chicken hint here on the card to help you remember this is, I'm so nearsighted I can only see myself. So myself and myopia both start with the M-Y. Hyperopia means far sightedness. This means you can see things clearly that are far away, but you have a difficult time seeing things that are closer in.
Another condition I'd be familiar with is astigmatism. This is where we have the unequal curvature of the lens or cornea that often causes blurred vision. Another condition is amblyopia, which is often referred to as lazy eye. This is where we have decreased visual acuity in one eye. And then finally, we have strabismus, which is the misalignment of the eyes that causes either inward or outward deviation, and this is caused due to an issue with the nerves or the muscle that controls the eye. So signs and symptoms that a child may have a visual impairment include complaints of headache or dizziness. Also, if you see the child squinting, or having excess tearing, or rubbing at their eyes, that may mean they have a visual impairment. In addition, if they have a difficult time reading or poor school performance, they may need to be assessed for a visual impairment.
Let's talk about diagnostic testing that can be used to identify a visual impairment. Of course, we can do an eye examination using an ophthalmoscope. We can also do vision screening using a Snellen chart, a Tumbling E chart, or picture chart. Best practices indicate having the child stand 10 feet away from the chart, and then, depending on how many letters or pictures they can see from that distance, they will be given a score, such as 20 over 40. A score of 20 over 40 means the child can see something from 20 feet away that most people can see from 40 feet away. So that's what that means.
We can also check for misalignment of the eyes, so strabismus, using a cover test, as well as a corneal light reflex test. So with a cover test, if I suspect that the child has deviation of this eye, right - it's either outwardly deviated or inwardly deviated - if I covered their good eye, we will suddenly see this eye move and start tracking straight ahead. And if we see that movement while we have this eye covered, then that is really indicative that we may have misalignment of the eyes and that strabismus may be present. With the corneal light reflex test, we would have the patient look straight ahead and we would shine a light into their eyes, and we would look for the reflection of the light, and see if it's in the same spot for both eyes. So if I see that light reflection in the middle of the pupil for this eye, I should see it in the middle of the pupil on the other eye. If that's not the case, if I see it in one place on this eye and kind of a different place on the other eye, then that is also strongly indicative that we have some misalignment and that strabismus may be present.
So in terms of treatment, of course, we have contact lenses, glasses, and laser surgery that can help correct some visual impairments. If the patient has strobismus, so misalignment of the eyes, we would patch the strong eye. So if this eye was affected, we would patch this eye, and that would force the muscles of this eye to work harder to keep the eye aligned. So that is a key treatment for strabismus. In terms of nursing care, we want to make sure we are providing adequate lighting for the child, that we are orienting the child to their surroundings, and that we promote independence whenever possible.
Now let's talk about hearing impairment. So we have two types of hearing loss. We have conductive hearing loss and sensory neural hearing loss. With conductive hearing loss, we have an issue with the transmission of sound getting into the cochlea, so we have an issue in the middle ear. This is the more common of the two types of hearing loss, and it is typically caused by recurrent otitis media, so recurrent middle ear infections. With sensory neural hearing loss, we have damage to the inner ear or the auditory nerve, and this can be caused due to congenital defects, autotoxic medications, infections, or exposure to excessive noise.
In terms of symptoms for infants, if an infant lacks their startle reflex, meaning normally, if you would clap or make a loud sound, it would really startle the infant. If they are not startled, if they are lacking in that reflex, then that is a red flag that they may have hearing loss. Also, if they are not babbling and kind of indifferent to sound, or if they fail their newborn hearing assessment, then those are also signs and symptoms of hearing loss. In children, if the child has a speech delay, if they speak using a monotone voice, or if they yell all the time, then that may be indicative of hearing loss. Also, if the child is inattentive, shy, or withdrawn, that may also indicate hearing loss.
So when I was young, I had recurrent ear infections, such that I ended up with conductive hearing loss. And at the time, my mom thought I was not paying attention to her, and she would talk to me and I would ignore her, and she just thought I was being not a good kid. But as it turns out, I just couldn't hear her. So eventually, I did get tubes placed in my ear, and that let the fluid drain out of my middle ear, and it restored my hearing. So that is one of the treatments for conductive hearing loss. So if it's due to that recurrent otitis media, we can do a myringotomy, which is where we do an incision into the tympanic membrane or the eardrum, place these little tubes, then excess fluid can drain out of the middle ear. Also, a hearing aid may be indicated for some patients with conductive hearing loss. For sensory neural hearing loss, the preferred treatment is usually a cochlear implant. In terms of nursing care and patient teaching, we want to provide a referral to a speech therapist and to an audiologist. We want to encourage the family to get yearly hearing screenings for their child. And then we want to advise our parents to prevent exposure to hazardous noises and to provide ear protection as needed.
All right. It's quiz time. Are you guys ready? I have three questions for you. First question, what disorder is characterized by the inward or outward deviation of an eye? The answer is strabismus. Question number two, what treatment is used for strobismus? The answer is occlusion therapy. So that's where we place an eye patch over the strong eye. Question number three, what type of hearing loss is caused by damage to the inner ear or auditory nerve? The answer is sensory neural hearing loss.
Okay. That is it for this video. In my next video, we are going to talk about seizures, so definitely stay tuned for that. And if you found value out of this video, be sure to like the video. Leave me a comment. Take care and good luck with studying.
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