By U. Armon. Georgia State University.

Increasing the volume include the semicircular canals and a small does not improve the quality of sound or rounded chamber at their base called the make the words more clear if this type of vestibule order viagra soft 100mg free shipping impotence 17 year old male. Hearing loss related to the nerve endings through which balance intensity or loudness involves more diffi- is controlled generic viagra soft 50mg with mastercard erectile dysfunction causes prostate. Like the organ of Corti, they culty in hearing because of reduction in contain numerous hair cells that project sound volume. The move- loss, amplification of sound may improve ment of the head sets the fluid in motion hearing. In instances where individuals and moves the hair cells, stimulating the have hearing loss related to both frequen- nerve endings, which then transmit the cy and intensity, increasing volume alone impulses to the vestibular nerve. Hearing Loss HEARING LOSS AND DEAFNESS Disruption of any part of the hearing system can result in hearing loss. Any Frequency and Intensity of Sound degree or type of hearing loss is classified as a hearing impairment. The greater the The sense of hearing is the neural per- degree of hearing impairment, the more ception of sound energy and is based on difficulty individuals have hearing in a transmission of external sound to the number of situations. Pitch or tone is de- with sensitivity loss may be unable to hear termined by the frequency of vibrations of soft speech or may have difficulty hearing sound waves. Individuals with dis- Individuals with mild to moderate con- crimination deficit may, even though vol- ductive hearing loss usually have good ume is adequate, be unable to clearly hear success with hearing aids if hearing aids certain phonetic elements of speech (for are necessary. Individuals can and/or the auditory nerve and can lead to have both sensitivity loss and discrimina- total deafness. In some cases, the hair cell function of the cochlea is unaf- • Cause and location of hearing loss fected; rather, the cause of hearing loss is • Duration of loss or age of onset related to the nerve transmission pathway • Degree of hearing loss to the brain. With sensorineural loss, hear- ing is affected in terms of not only loud- Cause and Location ness but also pitch or clarity. Individuals may perceive no sound, or sound when Cause and location of the loss are clas- perceived may be distorted. Sensorineur- sified as: al hearing loss can be caused by a num- ber of factors, including heredity, acute • conductive infection such as meningitis or mumps, • sensorineural ototoxic drugs (drugs that damage nerves of • mixed the central nervous system that are asso- Conductive hearing loss occurs when ciated with hearing), tumors, or exposure there is damage, obstruction, or malforma- to loud noise. The problem may also be tion in the external or middle ear that pre- due to a disorder of the auditory centers of vents sound waves from reaching the the brain, such as from head injury or cochlea in the inner ear. When this type of hearing loss correction of the underlying problem can occurs, the individual is said to have cen- restore diminished hearing. In this type of deafness, loss may result from buildup of earwax in there is a disruption of the ability of the the ear canal, a foreign object in the ear, sound stimulus to reach the hearing cen- infection of the middle ear (otitis media), ters of the brain, or the hearing center in or hardening of the small bones in the ear the brain incorrectly receives and process- (otosclerosis) that are important for con- es signals. Some- cause the nerve function cannot be times conductive hearing impairments restored, associated hearing loss is usual- cannot be corrected and hearing aids may ly permanent. Although the cause of sen- be used to amplify sound and restore nor- sorineural loss should be evaluated mal loudness. Conductive hearing losses are medically, individuals with sensorineural Hearing Loss and Deafness 147 hearing loss should also consult with a the most severe type of hearing loss. The conductive component may lend The degree of hearing loss is common- itself to medical treatment while the sen- ly defined on the basis of the audiogram, sorineural component remains. The audio- uals in some instances may benefit from gram is a method of recording the softest amplification. Normal hear- loss experienced with mixed hearing im- ing sensitivity ranges from –10 to +20 pairments and the success of intervention decibels. A general guide for describing the depend on the degree and type of sen- degrees of hearing loss associated with sorineural damage. Duration of Loss or Age of Onset Another classification of hearing loss is Table 5–1 Functional Implications of Degrees based on when the hearing loss occurred: of Decibel Loss • Prelingual hearing loss occurs before 26–40 Mild hearing loss. In ideal listening the individual acquires language, usu- conditions, hearing is minimally ally before the age of 3. Degree of Hearing Loss Hears loud conversational speech that is close by. Has difficulty Hearing loss can also be classified hearing in group situations. Conversational • Hard of hearing refers to individuals speech severely affected. May hear (or feel from usually have difficulty understanding than 90 vibrations) only very loud sounds. Hearing loss may be congenital or The type and degree of hearing loss ex- acquired. Congenital hearing loss is present perienced by individuals, regardless of the at birth. Hearing loss usually hearing loss are genetic transmission (inheri- involves more than a reduction in the ted hearing loss), caused by the mother’s loudness of sound.

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The intoxicating effects of alcohol correlate The effect of alcohol on the body proven viagra soft 100 mg erectile dysfunction treatment muse, like roughly with the alcohol concentrations the effect of any drug purchase 100 mg viagra soft with mastercard impotence quoad hoc meaning, depends on the in the blood, which, in turn, reflect the interaction between properties of the spe- alcohol concentration in the brain. At low cific pharmacologic agent and the charac- levels of intoxication (0. There is hol may produce a sense of relaxation and evidence to suggest that women tend to well-being. As the concentration of alco- be more sensitive to the effects of alcohol hol increases (0. Judgment may Physical Effects of Alcohol Abuse and Dependence 209 also be impaired. Continued elevation of Alcoholics Anonymous for alcohol-depend- blood alcohol concentrations (0. One such drug, rological disturbances associated with disulfiram (Antabuse), interferes with the intensive alcohol intoxication is the normal metabolism of alcohol. Con- occurrence of blackouts, periods of am- sequently, individuals who ingest alcohol nesia characterized by an inability to after taking Antabuse have severe gastroin- remember events during the time of the testinal distress. The most severe Alcohol-Related Medical Illness form of alcohol withdrawal is delirium tremens. Individuals with delirium tremens Medical conditions that can result from experience significant restlessness, gross chronic alcohol abuse, other than those disorientation, cognitive disruption, and caused by trauma due to intoxication, are elevation of temperature and pulse rate. These conditions period of delirium tremens usually lasts can involve all organ systems. The prog- from 2 to 10 days, but it can be more pro- nosis of alcohol-related medical illness longed if withdrawal is severe. The with- depends on the nature of the illness and drawal syndrome may be treated medi- its severity. Although some alcohol- cally by the administration of a cross-tol- related medical illnesses are reversible, erant drug, such as a sedative. Initially, almost no alcohol-related illness can be sedatives are given in large doses to sup- cured if the individual continues to abuse press the withdrawal symptoms. Because of wide variations in drug toler- Korsakoff’s Syndrome ance, treatment is individualized. Associated with an excessive intake of Treatment of Alcohol Dependence alcohol, chronic malnutrition, and a defici- ency of the B vitamins (thiamine in par- Alcohol dependence is a chronic, life- ticular), Korsakoff’s syndrome is charac- long disorder. It requires long-term treat- terized by gross disturbances in forming ment that extends beyond the initial new memories and recalling past memo- period of detoxification and generally ries. The use of confabulation, in which involves a wide variety of services, includ- individuals make up experiences to fill ing individual, group, and family therapy. In 210 CHAPTER 7 CONDITIONS RELATED TO SUBSTANCE USE addition to abstinence, treatment consists Cardiovascular System of the administration of thiamine. Some cognitive improvement is possible, but full Cardiomyopathy recovery is unlikely. Several months may Alcoholic cardiomyopathy occurs after be required before improvement is notice- long-term chronic use of alcohol. The heart may be- Wernicke’s Encephalopathy come enlarged (cardiomegaly), and the (Wernicke’s Disease) heart muscle may become more fibrous. The heart’s ability to pump effectively may Although Wernicke’s encephalopathy can be compromised so that symptoms of con- occur in other conditions, it is most com- gestive heart failure, such as difficulty in monly associated with chronic alcohol breathing and swelling (see Chapter 11), may abuse. It is characterized by the sudden occur as the cardiac damage increases. It often occurs in combination with Korsakoff’s syndrome Beriberi Heart Disease and, like Korsakoff’s syndrome, is related A deficiency in thiamine is thought to to thiamine deficiency. Treatment consists contribute to the development of beriberi of the replacement of thiamine. Individuals with the condi- treatment is mandatory to prevent perma- tion have a high cardiac output, even at nent deficits. Prompt treatment resolves rest, because of the dilation of the periph- many of the symptoms. Beriberi heart dis- syndrome accompanies Wernicke’s en- ease responds well to the administration cephalopathy, however, memory deficits of supplemental thiamine. Alterations in Heart Rate and Rhythm Peripheral Neuropathy Alcohol can affect both the speed at Although there are many causes of which the heart beats and the rhythm that peripheral neuropathy, a number of indi- it maintains. The direct long-term effect viduals who chronically abuse alcohol on blood pressure is variable. Alcohol develop disorders of the peripheral nerves withdrawal can put a heavy load on the (see Chapter 3). Peripheral neuropathy heart, sometimes compromising cardiac associated with chronic alcohol abuse is function so severely during detoxification thought to be the result of inadequate that death can result. Consequently, nutrition, specifically inadequate amounts detoxification should be conducted under of thiamine and the other B vitamins.

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