The organ of hearing is one of the main analyzers that provide a person with the external environment. There are many different problems and violations. However, the appropriate therapy can be selected only after a full comprehensive examination, which is necessarily carried out under the supervision of a specialist.
There are a variety of methods for examining hearing, thanks to which it is quite possible to determine the presence of a problem, as well as to conduct the correct treatment that will get rid of existing problems.
Formation of hearing organs
The hearing aid is formed around the 7th week of a baby's development and by the end of the 20th week it is fully formed. The development of its functionality is gradual. The baby immediately after birth hears only very loud sounds, and then gradually, starting from the age of 3 months, he can perceive weaker sounds, especially in response to the voices of his parents.
At about 6 months of age, if the childhears well, he tries to find the source of the sound. Also at this age there is an interest in music. When a baby turns 9 months old, he can distinguish the voices of his relatives, recognize household noises and sounds, and also begins to react when contacted.
Then there is a gradual formation of speech. The kid begins to carry out instructions given to him, answer questions and repeat the name of things.
Main types of diagnostics
There are a variety of methods for examining hearing, allowing you to identify possible violations in a timely manner, which will help to avoid many problems. Initially, the diagnosis is carried out with the acquaintance of the patient's complaints, as well as the study of the history of the development of the disease. Methods for studying hearing in various conditions differ significantly from each other. This largely depends on the characteristics of the course of the disease, as well as the age of the patient.
In diagnostics, subjective and objective methods of hearing research are distinguished. They are equally applicable to people of different ages, however, examination in children has its own specific characteristics. For children at a very early age, doctors prescribe various reflex techniques to assess general auditory perception.
Unconditioned reflex way
A fairly common method of hearing research is unconditioned reflex, which is based on response to a sound stimulus. A similar reaction is formed without additional preparations. It includes such reflexes as:
- increased blinking, eyelid activity in responseto sound;
- pupil dilation;
- oculomotor and sucking reflex;
- increased heart rate and breathing.
All these manifestations on the part of the baby can be considered positive if they are repeated 3 times on a sound stimulus. In addition, in response to a sufficiently loud sound stimulus, the baby may experience fear, awakening, freezing, and facial expressions appear.
Despite all the availability and ease of use, this technique has certain disadvantages, in particular, such as:
- each child has their own reaction to the applied stimulus;
- when re-testing, a decrease in the reflex is noted;
- Not good enough detection of hearing loss.
Such a method of studying hearing in children may not be informative enough in the presence of concomitant pathologies of the nervous system.
Conditioned reflex method
The conditioned reflex method of studying the organ of hearing is used only in children from one year to 3 years, since in the older age group the child no longer has the same interest. And in babies up to a year there is a high degree of fatigue. A similar technique is based on the occurrence of a conditioned reflex against the background of existing unconditioned reflexes, in particular, such as food and defensive ones.
Most often in children appear nictitating, pupillary and vascular reactions. This method has certainshortcomings, in particular, with frequent repetition, the reflex begins to gradually fade away, so it is impossible to accurately determine the threshold of hearing. In children with mental disorders, this type of diagnosis is rather difficult.
Quite good subjective methods of hearing research include tone audiometry, however, since it is used for children over 7 years old, play audiometry has become widespread among the younger group. It is carried out at the age of a child older than 3 years. The baby is shown a toy or a picture, additionally reinforcing this action with a sound signal. As a result, children develop a certain reaction to the conditioned signal.
To prevent the extinction of the reflex, it is imperative to replace pictures or toys. The volume of the sound signal must also be reduced. The data obtained allow us to assess the acuity of hearing and the intensity of the sound, which allows us to evaluate the auditory conduction.
Subjective evaluation
From the age of 2, it is permissible to use subjective hearing tests, exactly the same as for adults. However, this is only possible if the baby has begun to master speech, and he can already repeat words and point to their images in pictures. In addition, you can conduct research in the form of whispered speech.
This diagnostic method is based on the ability of a person to easily recognize speech signals, being at a certain distance from the sound source. Usually for researchuse two-digit numbers or specially selected short words. If a person has a somewhat distorted perception of spoken phrases, but at the same time a fairly good understanding of sounds is preserved, then we can talk about the presence of violations in the auditory center.
Research of hearing organs in newborns
During the neonatal period, the study of the hearing organs is mainly carried out with the help of screening, as well as a comprehensive, professional examination of the child in the presence of disorders. When choosing a survey method, you need to consider criteria such as:
- high sensitivity;
- non-invasive;
- specificity;
- quick and easy to do.
There are several different modern methods for examining hearing in newborns and during early development, which should include such as:
- reaction study;
- behavioral audiometry;
- otoacoustic emission.
Examination is carried out by studying a certain reaction of the newborn to external acoustic stimulation. In this case, the doctor fixes all reflexes. Methods of studying the organ of hearing include behavioral audiometry. It is based on the occurrence of an orientation reaction after the complete elimination of unconditioned reflexes. This occurs at about 5 months of age. During the examination, the characteristic reaction of the child to sounds is studied. Only a qualified specialist should process the received data.
The technique used as a screeningregistration of otoacoustic emissions. This is due to the fact that in a newborn child it has a large amplitude height, since the baby has an immaturity of the inner ear and a small auditory canal. All this determines the reliability and ease of the study. It is carried out during the sleep of the baby and makes it possible to assess the condition of the cells located outside. The disadvantage of this study is the inability to identify some hearing problems.
When doing all this research at an older age, one thing to keep in mind is that older kids have more light sleep than newborns. As the age of the child increases, the urgency of the problem increases even more. Therefore, the age period up to 2 years is considered the most difficult to diagnose.
Additional difficulties are caused by the impossibility of establishing psychological contact with the child and the need to use medications for the study.
Examination of children under 2 years old
Early comprehensive diagnosis and subsequent correction of hearing impairment is very important for the development of the required communication skills of the baby. If predisposing risk factors have been identified in the anamnesis, then at the age of about 3 months, audiometry should be performed, which refers to modern methods for studying the child's hearing. Anxiety in parents may arise about possible deafness and may appear if the baby does not react at all to the sound of voices or familiar to homeenvironment noises.
Parental observations during early development are very important and any suspicions they may have about hearing should be carefully checked. Special audiometry techniques are mainly used by an audiologist, they help to assess the capabilities of the baby from the moment of his birth. In such tests, psychological reactions to sound stimuli with a certain intensity are necessarily taken into account.
In children up to 6 months of age, audiometric tests include electrophysical methods of hearing examination, which will provide a reliable assessment of general auditory perception. Such testing can be carried out in the first days of a child's life. If sensorineural deafness is suspected, then behavioral tests should be performed to ensure that the hearing aid can be fitted correctly.
At the age of 12 months and older, methods of studying hearing by speech are used. To do this, the child is offered, in response to an appeal to him, to point to parts of the body or certain objects. However, with the help of such an examination, it is possible to obtain a quantitative assessment of the speech perception threshold.
Features of the study of hearing in children older than 2 years
In some cases, objective hearing testing methods may be used that do not require the direct participation of the child. They can be carried out while the baby is sleeping or when he is under anesthesia. However, speech techniques are often used to conduct the examination, since at this age it is already possible to establish emotional contact with the baby,arouse interest in research using special psychological techniques.
The success of the procedure in this case largely depends on the imagination of the doctor. With a sufficiently high level of the child's basic psychomotor development and sufficiently good contact with him, it is possible to conduct a speech method for studying hearing. In children with hearing loss, pure tone audiometry may be used to make an accurate diagnosis.
Thus, at this age, the baby is involved in the game process, during which attention is fixed on the sound components.
Hearing research in preschool and school children
At preschool age, all the methods that are used at a younger age can be quite relevant. Having briefly studied the methods of studying phonemic hearing, you can understand exactly what they are and what violations can be identified.
Recently, impedancemetry has become very popular, as it allows you to detect an anomaly in the development or disease in the Eustachian tubes, which is often provoked by the growth of adenoids. When working with children of primary school and preschool age, one must remember that they get tired quite quickly and cannot concentrate and focus on a certain type of activity for a long time. That is why all research must be carried out in the form of a game.
For the study of hearing in schoolchildrenage, it is quite possible to use all available modern psychophysical methods for studying hearing, including instrumental tests with a tuning fork. A feature of this period is the need to limit the time of the examination to the maximum in order to prevent the possibility of exhaustion of the child and the likelihood of obtaining an unreliable result.
At the same time, regardless of age, the study should begin with a preliminary history taking, clarification of possible risk factors, and the search for the possibility of establishing contact with the child and his parents. In the course of working with children, a creative approach is required, an individual attitude to each child, taking into account his age, level of development, and contact.
Otoacoustic techniques
Despite the fact that subjective methods are widely used, objective methods of hearing research have gained high popularity due to their accuracy and information content. One of these diagnostic methods is otoacoustic emission. It is carried out at the initial stage of human examination and is carried out for the purpose of mass screening.
A miniature microphone is installed in the area of the external auditory canal, which registers a weak sound that is formed as a result of the motor activity of the external cells. If the audibility is reduced, then this weak sound cannot always be registered during the study.
Doctors distinguish spontaneous otoacoustic emission, which occurs without stimulation andprovoked by an acoustic stimulus that is single, short, and pure-tonal. Characteristics change according to the age of the patient.
This method of examination also has negative sides, since the amplitude of otoacoustic emission may decrease when exposed to high noise levels. However, such a technique allows only to establish the fact of hearing loss, and not to detail the degree and level of damage.
Acoustic techniques
At average hearing potentials, hearing research methods imply an acoustic impedance. This method makes it possible to determine the peculiarity of pressure in the region of the middle ear, the presence of damage and fluid in the eardrum and the connection of certain auditory ossicles. This technique is based on the measurement of the resistance that appears on the middle and outer ear in response to an incoming sound signal.
The obtained low indicators correspond to physiological standards. Any, even the most minimal deviation from the norm indicates the presence of various kinds of disorders and anomalies in the development of the middle ear and tympanic membrane. In addition, this technique implies a dynamic measurement.
Negative values are often determined in the presence of otitis, which is accompanied by the accumulation of fluid, as well as in the case of inflammation in the Eustachian tube. To obtain the most reliable results, it is necessary to take into account the patient's well-being during the examination. In particular, it is important to considerthe presence of deviations from the nervous system, taking certain sedatives. The age of the person matters.
Features of audiometry
The most informative electrophysiological method for studying hearing is computer audiometry. They begin to conduct such an examination with the introduction of a person into a state of medical sleep, since such a procedure lasts quite a long time. Similar diagnostics can be carried out in children from the age of three.
The basis of this technique is the registration of the ongoing electrical activity of the hearing organs, which occurs in its different departments, as a certain reaction to a sound stimulus. This method is quite actively used in the diagnosis of pathological conditions in childhood. At the same time, electrical potentials significantly supplement the information obtained by other methods about the features of the existing disorders of the hearing aid.
The complexity of this type of study lies in the need for special training of the subject. Now this diagnostic method is used only in specialized centers, since it requires good equipment and the work of qualified specialists. Among the main advantages of this technique, it is necessary to highlight such as:
- received data is expressed in decibels;
- accuracy of information is very high;
- there is an opportunity to conduct mass research.
If availablehearing problems, you should definitely consult a specialist. They will diagnose, assess the state of he alth and allow you to choose the most appropriate treatment method.
Other research methods
Quite often, a hearing test using tuning forks is used. With the help of this method, it is possible to determine the acuity of hearing, both by air and bone sound conduction. The results of the survey allow you to get a complete picture of the state of the auditory function, but do not solve the issue regarding the features of the loss of auditory function, as well as the performance of people with occupational hearing loss.
Tuning fork evaluation is based on the quantitative determination of the time during which the maximum sounding tuning fork is perceived through air or bone.
It is worth remembering that if you delay treatment, serious complications can occur. In some cases, a person is completely deaf. That is why it is necessary to briefly study the methods of hearing research, as their diversity makes it possible to get rid of existing problems.
