Audiology. Anita Gáborján MD, PhD.

Transcription

1 Audiology Anita Gáborján MD, PhD.

2 Scope of audiology Is there a hearing loss? (Tinnitus? Vertigo? Neurological symptom? Speech development? ) How severe is the hearing loss? What is the reason of the hearing loss? Where is the origin? Prevention, rehabilitation Know the regulation (law, insurance, beneficiary, guidelines ) Diagnosis and therapy

3 Diagnostic Hearing loss Conductive Sensorineural Neural Cochlear tone Outer ear Middle ear Inner ear

4 Diagnostic methods Subjective Communication, active cooperation with the patient Can you hear? Where can you hear? Is it louder? Please, sign when you can hear! press a button Please, repeat! numbers, words Objective Without interoperability Newborn, infant, children Unconscious patient Real hearing true or not? (insufficient cooperation, adventage, disadventage ) differentiation

5 Diagnostic methods Subjective Objective Conversation, repeat words Tuning fork tests Audiometry with measuring instrument Pure tone audiometry Speech test Impedance audiometry Evoked responses: Reflex (stapedius reflex) Acoustic response (otoacoustic emission) Electrical responses (electrocochleaography, brainstem response cortical response)

6 First examination Call the patient Ask about problems Give instructions Speech? Hearing aid? Repeat words whispering, normally, shouting

7 Tuning fork tests C C 128 Hz C1 256 Hz C2 512 Hz C Hz C Hz C Hz

8 Weber-test compares the bone conduction of the 2 ears unilateral hearing loss Where can you hear? In the middle? Which side? Normal: Middle, equally Conductive hearing loss: In the wrong defective ear Sensorineural hearing loss: In the good normal ear

9 Rinne-test Compares the air and bone conduction in one ear Normal: Air conduction is better Rinne positiv (R +) Conductive hearing loss: Bone conduction is better Rinne negativ (R -) Sensorineural hearing loss: Rinne positive (R +)

10 Conductive hearing loss

11 Sensorineural hearing loss

12 Pure tone audiometry Pure tone 1 frequency Hearing threshold lowest intensity what we can hear Air- and bone conduction Similar or different? Mild, moderate, severe hearing loss The shape of the audiogram

13 Audiogram

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15 0 db HL Relative value Hearing threshold of normal hearing people (18 years of age) 30 db whispering db normal speech 80 db shouting, loud street 100 db metro Ear plug? Headphone? Music? MP3 smartphone? hearing damage???

16 Cross hearing Air conduction Bone conduction MASKING!!!!! Cross and bicross hearing aid BAHA

17 Speech audiometry

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19 Objective hearing investigation Newborn, infant, little child Questionable subjective result No cooperation simulation Differentiation conductive, cochlear, neural origin

20 Newborn hearing screening Early recognition of hearing loss Early rehabilitation Normal speech Guidelines in Hungary 2015 objective brainstem response

21 35 db tone in the hospital AABR

22 Diagnostics Until 1 month of age screening Until 3 month of age diagnosis Until 6 month of age rehabilitation

23 Impedance audiometry - Tympanometry

24 Impedance resistance Compliance opposite of impedance how the tones can be transmitted

25 Impedance audiometry - Stapedius reflex

26 Stapedius reflex brainstem nucl. cochlearis n. cochlearis nucl. motorius n. facialis n. facialis n. stapedius Outer middle inner ear Loud tone

27 Otoacoustic emission ear canal Ossicular chain Inner ear Outer hair cell plug

28 OAE Spontaneous 50% measurable Evoked Transient OAE - Distorsion Product OAE

29 Transient OAE (TOAE)

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31 Distorsion product OAE (DPOAE)

32 Acoustically evoked brainstem responses (ABR)

33 ABR

34 BERA latency Acoustic neurinoma l.s.

35 Steady state responses

36 ASSR Objective hearing threshold

37 Genetic investigation Blood sample connexin 26

38 Rehabilitation Pharmaceutical, medicaments operation Hearing aid Implanted hearing aid

39 Behind the ear (BTE)

40 Open fitting dome

41 Ear canal hearing aid

42 BAHA Bone anchored hearing aid

43 Bonebridge Egyoldali súlyos fokú halláscsökkenés vagy surditas

44 Vibrant soundbridge Vibrant soundbridge

45 Cochlear implant

46 Summary Conductive hearing loss Sensorineural hearing loss Subjective, objective audiological investigations Tuning fork tests, pure tone audiometry, speech audiometry (air conduction, bone conduction, AB gap, hearing threshold, intensity, mild-moderatesevere hearing loss) Impedance audiometry (tympanometry, stapedius reflex), otoacoustic emission, ABR Hearing aids