Reference — Med-Surg
Hearing Assessment Reference
A hearing deficit changes every other assessment you do — so screen for it early. The bedside tools are simple: watch behavior, whisper, and know which way the tuning fork points.
Educational use only. Bedside tests screen — they don’t diagnose. Abnormal findings, sudden hearing loss, and unilateral symptoms warrant audiology/provider evaluation. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Behavioral Signs First
- ✦Asks for repetition, answers inappropriately, or nods without understanding
- ✦Turns one ear toward the speaker; watches lips intently
- ✦Speaks unusually loudly (sensorineural) or softly (conductive)
- ✦TV/phone volume that others find too loud; withdrawal from group conversation
- ✦Appears confused or "noncompliant" — always rule out not-hearing before labeling either
The Whisper Test
Stand at arm’s length (about 2 feet) behind the patient’s field of vision. Have them occlude the opposite ear. Exhale fully, then whisper a combination of letters and numbers (“5-B-6”) and ask them to repeat it. Passing is correctly repeating at least three of six characters over two attempts per ear. Failure → otoscopic check (cerumen is the most reversible cause) and referral.
Weber & Rinne Interpretation
Weber: vibrating fork on the midline forehead — ask where the sound is heard. Rinne: fork on the mastoid until the sound stops, then beside the canal — air conduction should outlast bone.
| Pattern | Weber (forehead) | Rinne (mastoid vs air) |
|---|---|---|
| Normal hearing | Midline — heard equally in both ears | Air conduction > bone conduction (positive Rinne), both ears |
| Conductive loss (e.g., cerumen, otosclerosis, effusion) | Lateralizes to the AFFECTED (worse) ear | Bone conduction ≥ air conduction in the affected ear (negative Rinne) |
| Sensorineural loss (e.g., presbycusis, noise, ototoxicity) | Lateralizes to the GOOD (unaffected) ear | Air > bone in both ears, but both reduced on the affected side |
Ototoxic Medications
| Drug / Class | Nursing Note |
|---|---|
| Aminoglycosides (gentamicin, tobramycin, amikacin) | Monitor levels and renal function; damage can be permanent |
| Loop diuretics (furosemide, bumetanide) | Risk rises with rapid IV push and renal impairment — give IV furosemide slowly |
| Vancomycin | Risk increases with high troughs and combined aminoglycoside use |
| High-dose aspirin / NSAIDs | Tinnitus is an early salicylate-toxicity sign; usually reversible |
| Cisplatin and platinum chemotherapy | High-frequency loss first; baseline and serial audiograms |
New tinnitus, aural fullness, or subjective hearing decline on any of these = report before the loss becomes permanent.
Communicating with the Hearing-Impaired Patient
- ✦Get attention first; face the patient in good light so your mouth is visible
- ✦Lower your pitch, don't raise your volume — shouting distorts and raises pitch into the lost range
- ✦Slow slightly, rephrase rather than repeat verbatim, one idea at a time
- ✦Reduce background noise (TV off, door closed) before important conversations
- ✦Written backup for safety-critical content: medications, consent, discharge instructions
- ✦Confirm with teach-back, not "Did you hear me?"
- ✦Hearing aids in and working before teaching; qualified interpreter (not family) for Deaf patients who sign
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →