Hearing Impairment Diagnostic Purposes and

Treatment in PracticePrim. MUDr.Ivan Šejna, CSc

Introduction

Measure methods of hearing: » Subjective » Objective

Before testing:- Otoscopy - Mikrootoscopy Goal and Result: Determine the Degree of

Hearing Loss and Nature of Diseases (Pathology).

Contribute to better Treatment

Anatomy

Structure and Function of the Organ of HearingConductive Part = Conductive Hearing Loss

- External Ear - Middle Ear – Tympanic Membrane Ossicles - Liquid Filled Space

Perceptive Part = Sensorineural Hearing Loss (H.L.)- Organ of Corti = Cochlear H.L.- Auditory Nerve = Neural H.L. - Hearing Pathway = Supracochlear H.L.- Cerebral Cortex = Central H.L.

Conductive + Sensorineural = Combined H.L.

• Whispering x Conversational Speech

• Tuning Force • Weber´s• Rinne´s

• Schwabach• Gelle(Obsolete ?)

Subjective Tests of Hearing without Special Devices

Tests of Hearing Subjective

Hearing Thresholds - Air Conduction Thresholds - Bone Conduction Thresholds Audiometer – Electronic Instrument Generate Pure Tone

Frequency 125 – 8000 Hz, Volume 0 – 110 dB and Noise.

Performend in a Room Reasonably free of NoiseType of Hearing: - Conductive - Sensorineural - MixMedico-Legal Methods according Fowler – Sabin

Tests of Hearing Subjective

Speech Audiometry – Determined Understanding Highly Usefful for Diagnosis.

Special Words from CD

50 % Correctly understood Word = Speech Receptual Thershold

100 % Correctly understanding Word = 100 % Speech Discrimination

Tests of Hearing Objective

• Impedance Measuremant

TYMPANOMETRY• A Tympanogram = Normal Middle Ear and Eardrum• B Tympanogram = Fluid in the Middle Ear• C Underpressure in the Tympanic Cavity

• STAPEDIUS REFLEX Changes:Present x NotpressentDecay

Test of Hearing Objective

• ERA – Evoked Response Audiometry

• Registration Electrical Charges Generated on Presentation of Sound

• in Cochlea ( Cochleography )

• In Brainstem ( BERA, BAEP )

• In Cortex ( CERA )

Test of Hearing Objective

OAE – Otoakustic Emission

The Ear, when stimulated can emit Sound (prof.Kemp).

This Sound can be Measured when Hearing is Normal

Usefful in Screening of Infants (Newborns)

Therapy• Cerumen:Preferency of Otomikroscopic

Menagement

• Sekretoric otitis: – endoskopic adenotomy – Transmyringing Drainege (Tubes)

Chronic Otitis, otosklerosis:

Otosurgery (Excelent Results )

TherapySensorineural H.L.Deafnes: Cochlear Implants

(Condition: Functional Auditory Nerve)

Sudden Hearing Loss: Corticoids + Vasoactive Drug Imidiately (in 24 hours)

Progressive Sensorineural H.L.: Binaural Hearing Aids (Digital)

Presbyacusis

• Hearing Impaired Person (Seniors) = Bad Communication:

• Central and Periferal • Hearing Threshold • Hearing Pathway• PsychologicalDifficulty Solutions (Therapy and

Rehabilitation)

Summary Progres in Hearing Imparment: Testing + Treatment G.P: Otoscopy

Whisper and Normal SpeechTuning Fork

ENT: Audiometry: Bone and Air Conduction Thresholds Speech Audiometry Objective Audiometry

Impedance Measurment (Tympanometry + Stapedius rfl.)

Evoked Potentials, OAE

Therapy: Digital Hearing Aids Cochlear Implant