The organ of hearing refers to one of the main analyzers that provide a connection between a person and the environment. There are many different problems and violations. However, appropriate therapy can only be selected after a full comprehensive examination, which is necessarily carried out under the supervision of a specialist.
There are a variety of methods for hearing research, thanks to which it is possible to determine the presence of a problem, as well as conduct the correct treatment, which will get rid of existing problems.
Hearing Aid
The formation of the hearing aid occurs at about the 7th week of the child’s development, and by the end of the 20th week it is already fully formed. The development of its functionality occurs gradually. The child immediately after birth hears only very loud sounds, and then gradually, starting from the age of 3 months, he can perceive weaker sounds, especially responding to the voices of the parents.
At the age of about 6 months, if the baby hears well, he tries to find the source of the sound. Also at this age there is an interest in music. When the baby is 9 months old, he can distinguish the voices of his relatives, recognize everyday noises and sounds, and also begins to react when he calls him.
Then there is a gradual formation of speech. The kid begins to fulfill the instructions given to him, answer questions and repeat the name of things.
The main types of diagnostics
There are a variety of methods for hearing research, allowing timely identification of possible impairments, which will avoid many problems. Initially, the diagnosis is carried out with familiarization of the patient's complaints, as well as a study of the history of the disease. Methods of hearing research in various conditions vary significantly. This largely depends on the characteristics of the course of the disease, as well as the age of the patient.
In the diagnosis distinguish between subjective and objective methods of hearing. They are equally used for people of different ages, however, examination in children has its own specific features. For children at a very young age, doctors prescribe various reflex techniques to assess the overall auditory perception.
Absolutely reflex method
A fairly common method of hearing research is unconditionally reflex, which is based on the response to a sound stimulus. A similar reaction is formed without additional preparations. Reflexes such as:
- increased flashing, eyelid activity in response to sound;
- pupil dilation;
- oculomotor and sucking reflex;
- increased heart rate and respiration.
All these manifestations on the part of the baby can be considered positive if they are repeated 3 times for a sound stimulus. In addition, in response to a sufficiently loud sound stimulus, the baby may experience fear, awakening, fading, and facial expressions appear.
Despite all the availability and ease of use, this technique has certain disadvantages, in particular such as:
- each child is characterized by its own reaction to the applied stimulus;
- with repeated testing, a decrease in reflex is noted;
- detectability of hearing impairment is not good enough.
A similar method of hearing research in children may not be sufficiently informative in the presence of concomitant pathologies of the nervous system.
Conditionally reflex method
The conditioned-reflex method of examining the organ of hearing is used only in children from one to 3 years old, since the child already has no previous interest in the older age group. And babies under one year old have 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, children develop a blinking, pupillary and vascular reaction. This method has certain drawbacks, in particular, with frequent repetition, the reflex begins to fade away, so it is impossible to determine the auditory threshold completely accurately. In children with mental disorders, this type of diagnosis is quite difficult.
To fairly good subjective methods of hearing research include tonal audiometry, however, since it is used for children over 7 years old, playing audiometry is very common among the younger group. Spend it at the age of a child older than 3 years. The kid 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 fading of the reflex, it is imperative to replace the 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 sound intensity, which allows us to assess auditory conduction.
Subjective assessment
Starting from 2 years of age, it is permissible to use subjective methods of hearing research, exactly the same as for adults. However, this is only possible if the baby has begun to master speech, and he can already repeat the words and point to their images in the pictures. In addition, you can conduct research in the form of whispering speech.
A similar diagnostic method is based on a person’s ability to easily recognize speech signals, being at a certain distance from the sound source. Usually, double-digit numbers or specially selected short words are used to conduct the study. If a person has a somewhat distorted perception of the pronounced phrases, but at the same time a good understanding of sounds is preserved, then we can talk about the presence of violations in the area of the auditory center.
The study of hearing in newborns
During the neonatal period, a hearing examination is mainly carried out using screening, as well as a comprehensive, professional examination of the child in the presence of violations. When choosing a survey method, you need to consider criteria such as:
- high sensitivity;
- non-invasiveness;
- specificity;
- speed and ease of execution.
There are several different modern methods for studying hearing in newborns and during early development, which include:
- reaction study;
- behavioral audiometry;
- otoacoustic emission.
The examination is carried out by studying the specific reaction of the newborn to external acoustic irritation. In this case, the doctor fixes all the reflexes. Behavioral audiometry is a method of researching the organ of hearing. It is based on the occurrence of an orientation reaction after the complete elimination of unconditioned reflexes. This occurs around the age of 5 months. During the examination, the characteristic reaction of the child to sounds is studied. Only qualified personnel should process the received data.
As a screening, a method for recording otoacoustic emission is used. 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 ear canal. All this determines the reliability and ease of research. It is carried out during the baby’s sleep and makes it possible to assess the condition of cells located outside. The disadvantage of this study is the inability to identify some hearing problems.
When carrying out all these studies at an older age, it must be remembered that adult children have a more sensitive sleep than newborns. With increasing age of the child, the urgency of the problem increases even more. Therefore, the age period of 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 for the use of 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 communicative capabilities of the baby. If a history of predisposing risk factors was determined, then at the age of about 3 months it is necessary to conduct audiometry, which refers to modern methods of examining a child’s hearing. Anxiety in parents can arise about a possible deafness and can occur if the baby does not react at all to the sound of the voice or the noises that are familiar to the home environment.
Observations of parents in the early period of development are very important, and all their suspicions regarding hearing should be carefully monitored. Special methods of audiometry are mainly used by an audiologist, helping to assess the capabilities of the baby from the moment of his birth. Such tests necessarily take into account psychological reactions to sound stimulants with a certain intensity.
In children up to 6 months of age, audiometric tests include electrophysical methods for examining hearing, which will allow a reliable assessment of overall auditory perception. Such testing can be carried out in the first days of a child’s life. If there is a suspicion of the presence of sensorineural deafness, then you need to conduct behavioral tests so that you can choose the right hearing aid.
At the age of 12 months and older, methods for examining hearing with speech are used. To do this, the child is asked to indicate body parts or certain objects in response to an appeal to him. However, using such an examination, you can get a quantitative assessment of the threshold of speech perception.
Features study of hearing in children older than 2 years
In some cases, objective hearing methods may be used that do not require the direct involvement of the child. They can be performed while the baby is sleeping or when he is under general anesthesia. However, often for the examination, speech techniques are used, since at this age it is already possible to establish emotional contact with the baby, to arouse interest in the study 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 main psychomotor development of the child and fairly good contact with him, it is possible to conduct a speech method of hearing research. In children with hearing impairment, tonal audiometry can additionally be used for an accurate diagnosis.
Thus, at this age, the baby is involved in the gameplay, during which the attention is fixed on the sound components.
Study of hearing in children of preschool and school age
In preschool age, all methods that are used at a younger age may be quite relevant. Having briefly studied the methods of studying phonemic hearing, you can understand exactly what they are and what violations can be determined.
Recently, impedancemetry has become very popular, since it allows you to detect an anomaly of development or a disease in the Eustachian tubes, which is often triggered by the growth of adenoids. When working with children of primary school and preschool age, you need to remember that they get tired quickly enough 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 school-age children, it is quite possible to use all the available modern psychophysical methods for hearing research, including instrumental tests with a tuning fork. A feature of this period is the need to maximize the time limit for the examination to prevent the possibility of depletion of the child and the likelihood of an unreliable result.
At the same time, regardless of age, the study should begin with a preliminary medical history, clarification of possible risk factors, and the search for possible 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, as well as contact.
Otoacoustic Techniques
Despite the fact that subjective methods are widely used, it was objective methods of hearing research that gained high popularity due to accuracy and information content. One of these diagnostic methods includes otoacoustic emission. It is carried out at the initial stage of the examination of a person and is carried out with the aim of mass screening.
A miniature microphone is installed in the area of the external auditory meatus, which records a weak sound, which is formed as a result of the motor activity of the external cells. If audibility is reduced, then this weak sound during the study is not always possible to register.
Doctors distinguish between spontaneous otoacoustic emission, which is noted without stimulation and provoked by an acoustic stimulus, which is single, short and clean. Characteristics vary according to the age of the patient.
A similar method of examination has negative aspects, since the amplitude of otoacoustic emission can 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
With average auditory potentials, methods for studying hearing imply conducting acoustic impedance. This method makes it possible to determine the feature of pressure in the middle region of the ear, the presence of damage and fluid in the eardrum and the connection of certain auditory ossicles. The basis of such a technique is the measurement of resistance, which is on the middle and outer part of the ear in response to an incoming sound signal.
The resulting low rates correspond to physiological standards. Any, even the most minimal deviation from the norm indicates the presence of various kinds of violations and developmental abnormalities from the middle ear and eardrum. 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, you need to take into account the well-being of the patient during the examination. In particular, it is important to consider the presence of deviations from the nervous system, the intake of certain sedatives. The age of a person is important.
Audiometry features
The most informative electrophysiological method of hearing research is computer audiometry. They begin to conduct a similar examination with the introduction of a person into a state of drug sleep, since such a procedure lasts long enough. A similar diagnosis can be carried out in children, starting from the age of three.
The basis of such a technique is the registration of the flowing electrical activity of the hearing organs, which occurs in its various departments, as a specific reaction to a sound stimulus. This method is quite actively used in the diagnosis of pathological conditions in childhood. In this case, electric potentials significantly supplement the information obtained by other methods on the peculiarities of the existing disorders on the part of the hearing aid.
The complexity of this type of research is the need for special training of the subject. Now, a similar diagnostic method is used only in specialized centers, as it requires good equipment and the work of qualified specialists. Among the main advantages of such a technique, it is necessary to highlight such as:
- data received is expressed in decibels;
- the accuracy of the information is very high;
- there is the opportunity to conduct mass research.
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