A nurse is teaching a group of young adult clients about risk factors for hearing loss. Which of the following factors should the nurse include in the teaching? (Select all that apply.)

A. Born with a high birth weight: High birth weight is generally not considered a risk factor for hearing loss. In fact, low birth weight, prematurity, or complications during birth are more often associated with an increased risk of hearing issues. B. Frequent exposure to low-volume noise: Frequent exposure to low-volume noise is not typically a risk factor for hearing loss. However, exposure to loud noises (high volume) over time is a significant risk factor for hearing damage and loss. C. Use of a loop diuretic: The use of loop diuretics, such as furosemide, is associated with an increased risk of ototoxicity, which can lead to hearing loss. This is a known risk for people taking these medications, especially in high doses or with prolonged use. D. Chronic infections of the middle ear: Chronic ear infections can lead to hearing loss by damaging the structures of the middle ear or causing scarring. Recurrent middle ear infections, or otitis media, increase the risk of long-term hearing impairment. E. Perforation of the eardrum: A perforated eardrum can lead to hearing loss, particularly if it affects the middle ear's ability to transmit sound properly. It can also make the ear more susceptible to infections, which could further contribute to hearing loss.