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.)

Nursing education on risk factors for hearing loss focuses on identifying conditions and exposures that damage the auditory system at different levels, including the outer, middle, and inner ear. Hearing impairment can result from ototoxic medications, chronic infections, or structural damage to the tympanic membrane. Early identification of modifiable risk factors helps prevent progressive or permanent hearing loss in young adults. Understanding otologic health is essential for promoting long-term sensory function and safety. Rationale: A. Being born with a high birth weight is not associated with an increased risk of hearing loss. In fact, congenital hearing impairment is more commonly linked to factors such as genetic abnormalities, low birth weight, prematurity, or perinatal complications. High birth weight does not contribute to structural or functional damage in the auditory system. B. Frequent exposure to low-volume noise is not a significant risk factor for hearing loss because auditory damage is typically caused by prolonged exposure to high-intensity noise levels. It is loud or sustained noise exposure that damages cochlear hair cells, not low-volume sound. Therefore, this option does not represent a clinically relevant risk for hearing impairment. C. Use of a loop diuretic is a risk factor because medications such as furosemide can be ototoxic, especially at high doses or when given rapidly intravenously. These drugs can affect the electrolyte balance in the inner ear, leading to temporary or permanent sensorineural hearing loss. Careful monitoring is required when these medications are prescribed. D. Chronic infections of the middle ear (otitis media) can lead to structural damage and scarring of middle ear structures. Repeated inflammation may impair sound conduction and contribute to conductive hearing loss over time. If left untreated, chronic infections can also spread and affect deeper ear structures. E. Perforation of the eardrum is a direct risk factor for hearing loss because it disrupts the normal transmission of sound vibrations from the outer to the middle ear. This can lead to conductive hearing impairment and increase susceptibility to recurrent infections. Depending on severity, healing may restore function or result in permanent deficits.