If there are any violations on the part of the hearing organ, it is necessary to visit an audiologist. Not always a person can be sure that there is dysfunction in various parts of the ear. In this article, we will look at how to test your hearing correctly.
An auditory passport is a table in which information from tuning fork and speech studies of a violation of the sound analyzer of patients and healthy people is entered.
Basic concepts
So, the auditory passport is a table with data from speech studies on violations of auditory analyzers in patients. Proposed back in 1935 by scientists Voyachek and Bohon, this technique is still used. It is used as one of the primary diagnostic methods for detecting hearing loss in people.
Doctors usually use classical research methods in the form of a tuning fork, rattles, whispers, colloquial speech, and at the same time additional auditory testing in the format of the Jelle, Kutursky and Bint experiments, which allow one-sided complete deafness to be detected.
The results of a tuning fork test are entered into the auditory passport of the medical history, without them it is often impossible to determine the exact diagnosis, especially with the development of hearing loss due to some diseases.
What are the norms?
Annually, specialists update this table. When the auditory passport is normal, it usually does not change; only new data is entered there. In order to carry out their calculation, they take the average duration of the audible tuning fork sound for ten healthy subjects aged twenty to twenty-five years, 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 his physical examination.
- The degree of hearing loss is investigated in a whisper or colloquial speech.
- In the event that there is suspicion of complete unilateral deafness, then samples with rattles of Barani are used.
- Determine the air and bone conductivity of both auditory analyzers at once by means of a set of tuning forks.
- In conclusion, as part of compiling an auditory passport, experiments are carried out by Rinne, Weber and Schwabach.
Next, we will find out what the significance of the examination is in the diagnosis of various pathologies, and we will talk about deciphering the auditory passport.
Explanation of the table and diagnostic value
The data obtained after the study are compared with the auditory passport of healthy people. Based on the identified deviations, they make a preliminary diagnosis and develop a rational plan of therapy or correction of the existing deviation.
The diagnostic examination technique 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, nerve neuroma, Meniere's disease, and so on.
How to check the hearing, it is important to find out in advance.
Hearing loss
Depending on the nature of the lesion to which the auditory analyzer has undergone, sensorineural 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. While testing with a tuning fork and live speech, patients hear sound with their sore ear. Rinne tests give negative results, since conducting sound through the bone is usually much more effective than the air method.
In the second case, the sound-absorbing lobes of the analyzer in the form of nerves, central departments and the inner ear can be affected. In the auditory passport with sensorineural hearing loss, patients perceive sounds better with their healthy ear. It is worth noting that in this case, the Rinne test will be positive, and aerial conduction, in turn, is more effective than bone.
Auditory passport with otitis media
They must compile such a passport in the presence of otitis media. It makes it possible to give the patient a final diagnosis by prescribing the correct treatment and achieving complete recovery without any complications on auditory analyzers.
This study is carried out for the purpose of differential diagnosis in people with hearing loss. It is based on a comparison of the perception of pure sound in bone and air conduction. There are special sets of tuning forks that allow you to conduct research in a fairly wide frequency range. However, for everyday practice, you can have only the following two tuning forks:
- Low (one hundred twenty eight oscillations per second).
- High, which has two thousand forty eight oscillations per second.
Each tuning fork should have a passport, that is, information about the time in seconds during which its sound will be perceived by otologically healthy people.
Below we consider what it is and how audiometry is performed.
More on audiometry
In the framework of clinical otorhinolaryngology, subjective and objective methods of audiometric diagnosis for hearing loss are used. Subjective include threshold tonal audiometry and determination of the degree of auditory sensitivity to ultrasound. In addition, a suprathreshold test, a speech, noise characteristic, research of noise immunity of the spatial hearing system along with the determination of the spectrum of subjective ear noise are distinguished.
What is it - audiometry, how this study is conducted, not everyone knows. It can be carried out in an extended frequency range, with the definition of the lower boundaries of the perceived sound frequencies, including. In the framework of the above-threshold analysis, the following is examined:
- Differential thresholds of perception of force.
- The study of sound frequency.
- The period of reverse adaptation along with the level of uncomfortable volume.
- Analysis of the dynamic range of the auditory field.
It is worth noting that one of the tasks of tonal audiometry of a suprathreshold form is the determination of the phenomenon of accelerated volume increases characteristic of damage to the receptor cell of a Corti organ. The objective methods of audiological diagnosis in the presence of hearing loss include the impedance system and research on evoked auditory potentials with otoacoustic emission.
Threshold audiometry is the most common method of sound diagnostics. Any audiological studies begin precisely with her, therefore, each specialist otolaryngologist must necessarily know her methodology and be able to evaluate the result.
Such a study is carried out by means of audiometers that differ from each other in their functional capabilities, and at the same time in control. They provide a set of different frequencies. The sound stimuli of the auditory system are pure tones with noises (narrow-band and broad-band), which are formed by means of a generator. Audiometers are equipped with a headband with a pair of air telephones, bone vibrators, a patient button, a microphone. They have a low-frequency input for connecting a tape recorder or a CD player for research.
An ideal condition for conducting audiometry is a soundproofed room (we are talking about a sound chamber), with a noise background of up to 30 dB. To date, many portable sound cameras are produced. In practice, you can perform research in a normal room, not subject to external noise (walking, talking in the corridors, transport on the street, etc.).
The threshold for the perception of tone is the minimum sound pressure, against which there is an auditory sensation. Research begins with the ear that hears better. And in the absence of asymmetric hearing, everything is done from the right ear.
Among healthy people, the response period to an acoustic signal is 0.1 second, and in elderly and deaf patients this time increases. The patient under examination is briefed. During audiometry, the researcher constantly communicates through the microphone with the patient to ensure that the analysis is 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 the low-frequency tone. As a rule, signals are generated from 0 dB to a threshold above the threshold. This is done so that the patient can evaluate the nature of the presented signal.
- Further, the sound volume decreases immediately to an inaudible level, after which a threshold is determined at the level of weakly audible tones, which are confirmed three times in 5 dB steps using the breaker button.
The value of each sound threshold is applied to the audiogram.
Possible pathologies
Hearing impairment can have various causes:
- The appearance of disturbances in sound conduction is a condition that can occur with perforation or cicatricial change in the eardrum. Also, this happens against the background of the inflammatory process and scars within the tympanic cavity, with a tumor in the middle ear and ear canal, in case of impaired mobility of the auditory ossicles. All such processes are united by one circumstance: they are removed surgically, so such patients have a chance to restore their hearing.
- Sulfur plugs are the simplest and most common cause of hearing loss. Following the removal of the congestion from the ear canals, the ear is immediately restored.
- The occurrence of impaired sound perception in the form of damage to the sound-absorbing structure in the inner ear, brain or auditory nerve. This is a very serious pathology. If, for some reason, such damage appears suddenly and it is immediately possible to detect it immediately, in the first few hours or, in the worst case, days, then hearing restoration, provided that it is properly treated, is quite possible. At the same time, they conduct a course of special conservative therapy, which includes drug treatment. Reflexology and barotherapy are also undertaken. When time was lost, and the diagnosis, in turn, was not delivered on time, the patient has very few chances for a full recovery.
Thus, in the presence of any, at first glance, simple hearing loss, immediate and accurate diagnosis will be required. First of all, it is necessary to conduct an examination of the ear through a microscope or endoscope, which will make it possible to identify any minor changes in the ears and correctly diagnose it. The examination is supplemented by audiometry and tympanometry, which provide a complete display 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 is required. All such studies are performed in modern clinics, mainly in surdology rooms and x-ray departments. Based on the information received, further tactics are determined.
Below we consider tests for auditory perception. What it is?
Tests
As part of the Jelle experiment, the patient is assigned a sounding tuning fork to the crown of the head. At the same time, air is condensed by means of a pneumatic funnel within the external auditory canal. At the time of air compression, a person with normal hearing feels a decrease in perception, this may be directly related to the deterioration of the mobility of the system, which conducts impulses due to the pressing of the window of the vestibule in the niche.
The Jelle test in a similar situation is considered positive. Against the background of immobility of the stapes (with otosclerosis), no changes in perception at the time of thickening of air in the external auditory canals occur. In the case of a disease of the sound-receiving apparatus, the same sound attenuation occurs as normal. The experiment can be carried out in another way, when the chain of auditory ossicles is immobilized by light pressure on the short processes of the malleus with a probe, on which cotton wool is wound.
In the Federici experiment, the leg of the sounding tuning fork is alternately attached to the tragus. At the same time, it is carefully pressed into the auditory external passage, and, in addition, to the mastoid process. Normally, and in the presence of sensorineural hearing loss, the sound from the tragus is perceived much louder by the patient. Against the background of conductive hearing loss, it happens the other way around, and then the experience is negative. All tests usually end with an auditory passport. The result of speech and tuning fork research is recorded in the corresponding table.
What other hearing impairment studies are being conducted?
A popular way of checking at home is through special testing. To conduct it, the patient will need an assistant. He should have a good diction, as well as a clear voice. The assistant is located at a distance of 6 meters from the subject. A healthy person will hear how they read the text aloud - the ear perceives any loud sounds at a distance of 18–20 meters.
Air conduction study
As part of the study of air conduction, the tuning fork is sounded by the sifting of the maximum dosed strokes of the percussion hammer (it is worth noting that the bass tuning fork can be brought to sound by hitting the lower third of the thigh). The tool is brought in jaws to the patient’s ear, which should indicate if he hears any sound. Then it is brought to the outer passage as close as possible, without touching the ear itself, so that its axis (running across both branches) can coincide with the line of the ear canal.
In order to avoid adaptation or sound fatigue, the tuning fork should be brought to your 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 head. 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). As part of a qualitative study of hearing tuning forks, a number of different experiments are used.
It is worth noting that during the Rinne experiment, the superiority of air sound conductivity over bone is at least twice normal. And with a negative, on the contrary, the bone over the air prevails, which often occurs when the sound-conducting apparatus is damaged. In diseases of the latter, as in a normal state, an excess of the degree of air conduction over bone is observed.
In the Schwabach experiment, the sounding tuning fork is placed on the crown of the subject and held until the person stops hearing. Next, 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 the subject under study is considered to be shortened. If he does not hear, then the test of the subject is normal.
We examined the diagnostic value of an auditory passport.