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.)

Hearing loss can result from damage to the external, middle, or inner ear structures and may be influenced by congenital, infectious, pharmacologic, or traumatic factors. In young adults, both environmental exposures and medical conditions can contribute to either conductive or sensorineural hearing impairment. Understanding modifiable and non-modifiable risk factors helps in prevention, early identification, and timely intervention to preserve hearing function. A. Being born with a high birth weight is not a recognized risk factor for hearing loss. In contrast, low birth weight or prematurity is more commonly associated with auditory impairment due to underdeveloped organ systems or complications such as hypoxia. Therefore, this option is not associated with increased risk. B. Frequent exposure to low-volume noise does not contribute to noise-induced hearing loss. Hearing damage is typically associated with prolonged exposure to high-intensity noise levels that damage cochlear hair cells. Low-volume sounds are not sufficient to cause structural injury to the auditory system. C. Use of a loop diuretics such as furosemide, are known ototoxic medications. When administered in high doses or to patients with renal impairment, they can cause electrolyte imbalances in the endolymph of the inner ear, leading to tinnitus and sensorineural hearing loss. Other common ototoxic drugs include aminoglycoside antibiotics and certain chemotherapy agents. D. Chronic infections of the middle ear (otitis media) can lead to conductive hearing loss due to persistent inflammation, fluid accumulation, or structural damage to the middle ear components. Repeated infections may also result in long-term complications affecting sound transmission. E. Perforation of the eardrum (tympanic membrane rupture) can cause conductive hearing loss by disrupting normal sound transmission to the middle and inner ear. It may result from trauma, infection, or pressure changes and can lead to temporary or permanent hearing impairment depending on severity and healing.