Audiology Anita Gáborján MD, PhD.
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
Diagnostic Hearing loss Conductive Sensorineural Neural Cochlear tone Outer ear Middle ear Inner ear
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
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)
First examination Call the patient Ask about problems Give instructions Speech? Hearing aid? Repeat words whispering, normally, shouting
Tuning fork tests C C 128 Hz C1 256 Hz C2 512 Hz C3 1024 Hz C4 2048 Hz C5 4096 Hz
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
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 +)
Conductive hearing loss
Sensorineural hearing loss
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
Audiogram
0 db HL Relative value Hearing threshold of normal hearing people (18 years of age) 30 db whispering 50-60 db normal speech 80 db shouting, loud street 100 db metro Ear plug? Headphone? Music? MP3 smartphone? hearing damage???
Cross hearing Air conduction Bone conduction MASKING!!!!! Cross and bicross hearing aid BAHA
Speech audiometry
Objective hearing investigation Newborn, infant, little child Questionable subjective result No cooperation simulation Differentiation conductive, cochlear, neural origin
Newborn hearing screening Early recognition of hearing loss Early rehabilitation Normal speech Guidelines in Hungary 2015 objective brainstem response
35 db tone in the hospital AABR
Diagnostics Until 1 month of age screening Until 3 month of age diagnosis Until 6 month of age rehabilitation
Impedance audiometry - Tympanometry
Impedance resistance Compliance opposite of impedance how the tones can be transmitted
Impedance audiometry - Stapedius reflex
Stapedius reflex brainstem nucl. cochlearis n. cochlearis nucl. motorius n. facialis n. facialis n. stapedius Outer middle inner ear Loud tone
Otoacoustic emission ear canal Ossicular chain Inner ear Outer hair cell plug
OAE Spontaneous 50% measurable Evoked Transient OAE - Distorsion Product OAE
Transient OAE (TOAE)
Distorsion product OAE (DPOAE)
Acoustically evoked brainstem responses (ABR)
ABR
BERA latency Acoustic neurinoma l.s.
Steady state responses
ASSR Objective hearing threshold
Genetic investigation Blood sample connexin 26
Rehabilitation Pharmaceutical, medicaments operation Hearing aid Implanted hearing aid
Behind the ear (BTE)
Open fitting dome
Ear canal hearing aid
BAHA Bone anchored hearing aid
Bonebridge Egyoldali súlyos fokú halláscsökkenés vagy surditas
Vibrant soundbridge Vibrant soundbridge
Cochlear implant
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