Hearing loss disclosure...

[vetiver]

I am soon beginning the upper division nursing courses for my BSN. I have congenital unilateral hearing loss that is getting worse over time. My last screening results were called "moderate to severe mid range loss" by my audiologist. I have recently developed early signs of Meniere's Disease as well, which has been causing slight dizzyness without warning. I am very concerned about how this will affect my performance in school and at work. I have never disclosed my hearing loss to any teacher or employer. I have been able to adapt well so far.

My question is this....What, if any, is the protocol for this type of disclosure? Do I simply say, I have hearing loss, or is there a more official way of doing this with a form or letter from my Audio/ENT? Also, at what level of loss is this considered a disability? That may seem like a simple question, but I want to be clear about the boundary.

Thanks in advance for any info.

[llg, PhD, RN]

There are no hard and fast rules about that sort of thing. The ADA is not that specific. In the future, each employer will have to evaluate your abilities and decide whether or not they will prevent you from employment with them.

I lost complete function in my one ear (hearing and balance) at the age of 38, after my nursing career was well-established and I was no longer doing direct patient care. Also, my loss is not progressive and the other ear has remained normal. However, that is not your situation. I strongly advise you to learn as much as possible aoubt your condition and your likely prognosis so that you can take that into consideration as you plan your career.

While most people here on allnurses will problaby say "Go for it!" "You can do it!" etc. to anyone with any reservations about nursing or any disabilities that may pose problems, I urge caution. If your condition is progressive, you will encounter many challenges -- some of which you may not be able to overcome. Yes, there are many nursing jobs in which your hearing and balance problems will not be much of an issue. However, most of those jobs require previous clinical experience and some require an advanced education. Will you have time to get that education and experience before your hearing and balance deteriorates to the point at which it interferes with your ability to work?

There are lots of us with hearing/balance impairments in nursing -- and I hope your particular situation is one which will allow that. But I have also met several nurses who were unable to continue their careers as their hearing/balance deteriorated. That's why you have to find out as much about YOUR particular prognosis as you can before you invest your time, effort, and money into nursing education.

As for disclosing ... I think you have an obligation to disclose before entering the clinical arena -- though perhaps not a legal one. (I don't know about the legal aspect as I am a nurse, not a lawyer.) There could be a safety issue if people think you hear them and you don't -- or if your balance effects your ability to safely lift or carry things or people.

[misplaced1]

As far as the single sided deafness. Look into a BAHA. I am also single sided deaf and got a BAHA about 6 months ago. It doesnt sound as "nice" as regular hearing but now I can hear on that side. One of the nurses in the PACU during my recovery from the implant stage of receiving the device had one and told me I was going to love it and she was right!

I have been single sided deaf for ten yrs and with time adjusted very well to this kind of hearing loss. No one ever knew unless I told them. For me the main issue was I was always getting a cramped neck. And occassionally someone would whisper right into my deaf ear and of course I could not hear that. But in general people dont go around whispering into your ear at work! In fact I dont remember that ever happening anywhere but in my personal life. I think this kind of hearing loss would be more of a problem if you worked in a big loud factory.

That said although with time you will become so accustomed to it, the BAHA does make things simpler. No more turning your head slightly to hear the person next to you talk when you are walking. I still do it automatically even though I can hear on that side now. People always tell me I am so attentive and I am! I really that there are very few careers that SSD(single sided deafness) would stop you from doing. If that did not happen too long ago I can guarentee you your brain with accomidate and that will get MUCH better. Although it may be years before you dont really think about it.

As far as the balance goes I feel your pain there. But dont borrow trouble. Right now you are just having little episodes of imbalance, right? Find out your triggers and avoid them like the plague! I had sudden sensory hearing loss and then residual balance stuff. A neurootologist, not just an ENT, is the one you want to see. They can do things for you that most ENTs dont even know about. As far as a little imbalance goes stop sweating if its not bad. This could be the worse it ever gets. Are you aware of how many people have little imbalance problems? Many many many. Heck, most people with colds and sinus infections get a little lightheaded periodically. If this is what you have join the club. Those of us approaching menopause would also like to welcome you. You may have it a little more often then most. Find your triggers and you may have it less then most that never had it as often as you.

If you have something like Sorgen's syndrome, think that is what its called, then you are going to have to plan carefully and try to get your clinical time in before the worse stuff happens. Although I know some of these syndromes can progress to be so bad you could not possibly work and in some vision is also affected, I would work as much as I could because at least you would then be able to collect more SSD and perhaps have disability insurance.

If you are having true vertigo spells you really need to get to a good doc. Even then that good doc will tell you that is rare to have someone who cant be helped at all with this problem. And generally this is a problem that goes into spontaneous remission quite often. Unfortunately, it can come back out again but by then maybe you wil have your experience. I have a friend that has it and he is one of those guys you see up in the buckets working on the lines. He has had to take a leave of absence a couple times but is still a bucket man. Easier for him though, he works for the power company. and they are cool about it From what I have seen/heard not only do the older nurses in our profession eat their young but the employers do too. Yikes! We must be tasty.

I can also tell you that if you actually have big problems with this the key is to find your triggers, just like migranes. Then avoid them like the plague. My neck was a big problem so I go to the chirpractor once a month. I know that menieres is progressive but if someone is telling you that you will eventually be a cripple from it , get somebody else. Menieres is extremely variable. It is true you may be down for a while but with this disorder you always come back, if you want to. Maybe with less of a functioning balance system. But remember even people without any balance nerves can walk, if they want to . Some people resign themselves to walkers and wheelchairs but rehab is available and works. You just have to reeducate your brain.

There are so many causes of dizziness. Menieres, benign paraoxomyal positional vertigo, basilar artery migranes, neck injuries (these nerves feedback to your balance system).

I too am not sure nursing is for me but for different reasons than you. Balance problems are a big problem but they also tend to be temporary. Most people have more problems when they dont work right then when they are gone. That said this can be very disabling, but again IF that happens perhaps it will happen LATER as opposed to sooner. Even with progressive problems the nerve will eventually die out and then you are just not as steady as most. That can take a long time though and prior to the nerve dying you can have periods where you are quite disabled. Obviously I have some experience in this area known others that have gone through it. I dont know anyone who is not functional but all of the people I have known were very motivated. Even if you loose a whole balance nerve on both sides you can still be retrained to walk so well that the only way a regular person could tell is if you stand on one leg for them!

So do not take any jobs working as a flamingo lawn ornament. Other then that do what you are capable of and its nobodys business what your health status is as long as you CAN do the job!

[misplaced1]

I know that was long but I wanted to add. If your condition becomes severe ask about intratympanic gentamycin injections. That can be followed by vestibular rehab. The gent injections will knock out some of the balance nerve to reduce the symptoms. They can also take the nerve out that way. With one balance nerve and vestibular rehab that you are faithful to you will most likely be quite steady. Be prepared to vomit during rehab and just keep on going. Ask your neurootolygist about this.

For lesser problems there are some different meds like acetazolamide you can take. The big problems really come if you get it in both ears from what I understand as they can always kill off one balance nerve and you still have balance. Your brain just has to adjust. I only know of one person with it in both ears and and yes it is a big problem for her and she can no longer work. But she still gets around, lives her life and you really would not know there was anything wrong by looking at her. But yes she is dizzy a lot. Not vertigo, dizzy and nauseous. They can damped both nerves in people like her somehow but she opted not to get that. Maybe it doesnt work good I dont know. She also has two hearing aids and really needs a cochlear implant which she also opted against. She is older and I think she just wants to take it easy and I dont blame her. Other than what she told me I know very little about having problems in both ears except that it is bad. But that is not your problem from what I have read.

I am typing all this out because I feel for you but urge you to get top notch care and do all the rehab that is available as it will likely make all the difference. No matter what you do for a living dont feel like your life is over or that you will end up an invalid for your whole life. You could get messed up for a while if it gets bad but there is a great chance you will come back.

As an aside, if you type in vestibular implant, you will find they are working on a vestibular implant just like the cochlear one.

Best to you

[Silverdragon102, BSN]

Please be aware we can't offer medical advice but can post experiences on what worked for us.