An older patient says, "I seem to be talking so much louder these days and I don't know why!" The nurse realizes that this patient might be experiencing:
1. loss of hair cells in the middle ear.
2. cochlear atrophy.
3. impacted cerumen.
4. stiffening of the middle ear structures.
Correct Answer: 4
One age-related change of the middle ear is the weakening and stiffening of muscles and ligaments, which decreases the acoustic reflex. Sounds made from one's own body and speech are louder and may further interfere with hearing, speech, and communication. Loss of hair cells in the middle ear, cochlear atrophy, and impacted cerumen would not produce the perception that the patient is speaking more loudly.
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