If you experience any hearing loss, you should visit an audiologist. It is not always possible for a person to be sure that there is a dysfunction in various parts of the ear. In this article, we will look at how to test your hearing correctly.
A hearing passport is a table that contains information from tuning fork and speech studies of violations of the sound analyzer of patients and he althy people.
Basic concepts
So, the auditory passport is a table with data from speech studies on the impairment of auditory analyzers in patients. Proposed back in 1935 by scientists Woyachek and Bohon, this technique is still used today. It is used as one of the primary diagnostic methods for identifying hearing loss in people.
Doctors usually use classical research methods in the form of a tuning fork, rattles, whisper, colloquial speech, and at the same time additional auditory testing in the format of the experiments of Zhellet, Kutursky and Bint,which allow to detect unilateral complete deafness.
The results of the tuning fork test are entered into the auditory passport of the medical history, without them it is often impossible to determine an accurate diagnosis, especially with the development of hearing loss due to some diseases.
What are the norms?
Annually, specialists update this table. When the hearing passport is normal, it usually does not change, only new data is entered there. In order to perform their calculation, they take the average duration of the audible sound of a tuning fork for ten he althy subjects aged twenty to twenty-five who have no deviations in sound perception and speech.
Drawing up such a passport
As part of the formation of the diagnostic table, a step-by-step examination of the patient's hearing is carried out:
- Find out the presence of subjective noise in the patient during the physical examination.
- The degree of hearing loss is examined in a whisper or colloquially.
- In the event that there is a suspicion of complete unilateral deafness, then tests with Barany's ratchet are used.
- Determine the air and bone conduction of both auditory analyzers at once using a set of tuning forks.
- In conclusion, as part of the preparation of the auditory passport, the experiments of Rinne, Weber and Schwabach are carried out.
Next, we will find out what is the significance of the examination in the diagnosis of various pathologies, and we will talk about decoding the hearing passport.
Table explanation and diagnostic value
The data obtained after the study is compared with the auditory passport of he althy people. Based on the identified deviations, a preliminary diagnosis is made and a rational plan for therapy or correction of an existing deviation is developed.
The method of diagnostic examination allows to identify the causes of the development of hearing pathology against the background of diseases in which the membranes do not suffer and remain intact, for example, as is the case with serous otitis media, otosclerosis, neuroma of the nerve, Meniere's disease, and so on.
How to test your hearing, it is important to find out in advance.
Hearing loss
Depending on the nature of the damage to which the auditory analyzer has undergone, neurosensory and conductive hearing loss are distinguished. In the first case, as a rule, the sound-conducting sections of the analyzers are affected, we are talking about the outer ear, auditory ossicles and membrane. In the process of performing testing with a tuning fork and live speech, patients hear the sound with their diseased ear. Rinne tests give negative results, as sound transmission through bone is usually much more effective than air.
In the second case, the sound-perceiving lobes of the analyzer in the form of nerves, central sections and the inner ear may be affected. In the auditory passport with sensorineural hearing loss, patients perceive sounds better with their he althy ear. It is worth noting that in this case the Rinne test will be positive, and air conduction, in turn, is more effective than bone conduction.
Hearing Passportotitis media
It is mandatory to draw up such a passport in the presence of otitis media. It makes it possible to make a final diagnosis to the patient, prescribing the correct treatment and achieving a complete recovery without any complications on auditory analyzers.
This test is for differential diagnosis in people with hearing loss. It is based on a comparison of the perception of pure sound during bone and air conduction. There are special sets of tuning forks that allow you to conduct research in a fairly wide frequency range. True, for everyday practice, you can have only the following two tuning forks:
- Low (128 cycles per second).
- Tall, which has two thousand and forty-eight oscillations per second.
Each tuning fork must have a passport, that is, information about the time in seconds during which its sound will be perceived by otologically he althy people.
Let's look at what it is and how audiometry is performed.
Learn more about audiometry
Within the framework of clinical otorhinolaryngology, subjective and objective methods of audiometric diagnosis for hearing loss are used. The subjective ones include threshold tone audiometry and determination of the degree of auditory sensitivity to ultrasound. In addition, there is an above-threshold test, speech, noise characteristics, a study of the noise immunity of the spatial hearing system along with the determination of the spectrumsubjective tinnitus.
What it is - audiometry, how this study is carried out, is not known to everyone. It can be carried out in an extended frequency range, with the definition of the lower limits of the perceived sound frequencies, including. As part of the suprathreshold analysis, they examine:
- Differential force perception thresholds.
- Sound frequency study.
- Reverse adaptation period along with uncomfortable volume levels.
- Analysis of the dynamic range of the auditory field.
It is worth noting that one of the tasks of pure-tone audiometry of the above-threshold form is to determine the phenomenon of accelerated increases in volume, characteristic of damage to the receptor cell of the organ of Corti. The objective methods of audiological diagnostics in the presence of hearing loss include the impedance system and the study of auditory evoked potentials with otoacoustic emission.
Tonal threshold audiometry is the most common method of sound diagnostics. Any audiological research begins with it, so every otolaryngologist must know its methodology and be able to evaluate the result.
Such a study is carried out by means of audiometers, which differ from one another in their functionality, and at the same time in control. They provide a set of different frequencies. Sound stimuli of the auditory system are pure tones with noise (narrowband and broadband), which are formed by means of a generator. Audiometers equipa headband with a pair of air phones, bone vibrators, a patient button, a microphone. They have a low-frequency input for connecting a tape recorder or a CD player for research.
The ideal condition for audiometry is a sound-dampened room (we are talking about a sound chamber), with a noise background of up to 30 dB. To date, many portable sound chambers are being produced. In practice, it is possible to perform an examination in a normal room that is not affected by external noise (walking, talking in the corridors, traffic on the street, etc.).
The tone perception threshold is the minimum sound pressure against which an auditory sensation arises. The study begins with the ear that hears better. And in the absence of hearing asymmetry, everything is done from the right ear.
Among he althy people, the response time to an acoustic signal is 0.1 second, while in elderly and hearing-impaired patients, this time increases. The examined patient is given a short briefing. During the audiometry, the researcher maintains a microphone connection with the patient at all times to ensure that the analysis is being performed correctly.
The sequence of the procedure in which you can test your hearing is as follows:
- First measure the sensitivity of the tone, and then higher frequencies.
- Finish the study by measuring the thresholds of a low-frequency tone. Signals are given, as a rule, from 0 dB to above-threshold loudness. This is done so that the patientwas able to assess the nature of the presented signal.
- Further, the volume of the sound immediately decreases to an inaudible level, after which a threshold is determined at the level of faintly audible tones, which are confirmed three times in 5 dB steps using the interrupt button.
The value of each sound threshold is applied to the audiogram.
Possible pathologies
Hearing loss can have various causes:
- The appearance of disturbances in sound conduction is a condition that can occur with perforation or scarring of the eardrum. Also, this happens against the background of an inflammatory process and scars within the tympanic cavity, with a tumor of the middle ear and auditory canal, in case of impaired mobility of the auditory ossicles. All such processes are united by one circumstance: they are eliminated surgically, so such patients have a chance to restore their hearing.
- The presence of cerumen is the simplest and most common cause of hearing loss. Following the removal of the plugs that closed them from the ear canals, hearing is immediately restored.
- Occurrence of a disturbance of sound perception in the form of damage to the sound-perceiving structure in the inner ear, brain or auditory nerve. This is a very serious pathology. If such damage for some reason appears suddenly and it can be detected immediately, in the first few hours or, in extreme cases, days, then restoration of hearing, subject to proper treatment, is quite possible. At the same time, a course of special conservative therapy is carried out,which includes medication. Reflexology and barotherapy are also undertaken. When time was lost, and the diagnosis, in turn, was not made on time, the patient has very little chance of a full recovery.
Thus, in the presence of any, at first glance, a simple hearing loss, an urgent and accurate diagnosis will be required. First of all, it is necessary to examine the ear with a microscope or endoscope, which will make it possible to identify any smallest changes in the ears and correctly diagnose. The examination is supplemented with audiometry and tympanometry, which provide a complete picture of the state of hearing. To clarify the diagnosis, in addition, a computed tomography of the temporal bones will be required, which makes it possible to detect a destructive change in the bone structure of the middle and inner ear.
In addition, in case of suspected pathology in the brain and auditory nerve, magnetic resonance imaging will be required. All such studies are performed in modern clinics, mainly in audiology and X-ray departments. Based on the information received, further tactics are determined.
Below we will consider tests for auditory perception. What is it?
Tests
As part of the Jelle experiment, the patient is put a sounding tuning fork to the region of the crown of the head. At the same time, air within the external auditory canal is condensed by means of a pneumatic funnel. At the moment of air compression, a person with normal hearing feels a decreaseperception, this may be directly related to the deterioration of the mobility of the system that conducts impulses due to the indentation of the window of the vestibule of the stapes into the niche.
Jelle test in this situation is considered positive. Against the background of the immobility of the stirrup (with otosclerosis), no changes in perception occur at the moments of air thickening in the external auditory canals. In the case of a disease of the sound-perceiving apparatus, the same sound attenuation occurs as in the norm. The experiment can be carried out in another way, when the ossicular chain is immobilized with light pressure on the short processes of the malleus with a probe wrapped with cotton wool.
In Federici's experiment, the stem of a sounding tuning fork is placed alternately against the tragus. At the same time, it is gently pressed into the auditory external passage, and, in addition, to the mastoid process. Normally, and in the presence of sensorineural hearing loss, the patient perceives the sound from the tragus much louder. Against the background of conductive hearing loss, the opposite happens, and then the experience turns out to be negative. All tests, as a rule, end with the completion of a hearing passport. The result of speech and tuning fork research is recorded in the appropriate table.
What other research is being done on hearing loss?
A popular way to check at home is special testing. To carry it out, the patient will need an assistant. He should have good diction, as well as a clear voice. The assistant is located at a distance of 6 meters from the subject. A he althy person will hear how they read the text aloud - anyear perceives loud sounds at a distance of 18–20 meters.
Air Conductivity Study
As part of the study of air conduction, the tuning fork is brought into sound by sieving the maximum dosed beats of the percussion hammer (it is worth noting that the bass tuning fork can be brought into sound by hitting the lower third of the thigh). The instrument is brought with branches to the ear of the patient, who must report whether he hears any sound. Then it is brought to the external passage as close as possible, while not touching the ear itself, so that its axis (passing across both jaws) could coincide with the line of the ear canal.
To avoid adaptation or sound fatigue, the tuning fork should be brought to the ears every four to five seconds. The study of bone conduction is carried out using a bass-sounding tuning fork, the leg of which is tightly attached to the middle of the human crown. The duration of perception of a sounding tuning fork against the background of air and bone conduction is determined in seconds (this is a quantitative study). Qualitative testing of tuning fork hearing involves a range of different experiments.
It is worth noting that during the Rinne experiment, the superiority of air sound conductivity over bone at least two times is normally observed. And with a negative, on the contrary, the bone predominates over the air, which often occurs when the sound-conducting apparatus is damaged. In diseases of the latter, as in the normal state, an overweightdegree of air conduction over bone.
In the Schwabach experiment, a sounding tuning fork is placed on the crown of the subject and held until the person stops hearing. Further, the researcher (that is, a person with normal hearing) puts a tuning fork on his crown. In the event that he continues to pick up the sound of the instrument, then for the researched person such an experience is considered to be shortened. If he does not hear, then the test of the subject is normal.
We reviewed the diagnostic value of the hearing passport.
