Hearing test in Khabarovsk. Diagnosis of hearing impairment

Hearing diagnostics in adults should be carried out annually, especially for those who are at risk,” say audiologists. And this is understandable, because hearing impairment can occur at any age and for various reasons. In some cases, immediate contact with a specialist is required, and in other cases, hearing decreases slowly and gradually, a person does not attach any importance to this for a long time.

Why does hearing decrease?

In fact, a person hears with the brain, but most often, hearing loss occurs because some part of the auditory system does not function properly and does not transmit sound signals to the brain.

Depending on the location of the disorder (external, middle, inner ear), three types of hearing loss are distinguished:

Conductive hearing loss occurs due to problems in the outer and middle ear. As a rule, it is easily treated with medications or surgery. This type includes:

sulfur plugs
ear canal infections, inflammation
ruptured eardrum
otosclerosis (loss of mobility of the middle ear ossicles)

Sensorineural hearing loss occurs due to damage to the hair cells of the inner ear, which negatively affects the transmission of sound signals to the auditory nerve. Causes:

presbycusis (age-related hearing loss)
excessive noise exposure
ototoxic (harmful to hearing) drugs
head injuries

Diagnosis of sensorineural hearing loss must be carried out very carefully, since in the case of acute and sudden hearing loss, prompt diagnosis and action are especially important. In case of irreversible disorders, correction occurs with the help of hearing aids.

Mixed hearing loss combines conductive and sensorineural disorders. Therefore, different methods of hearing diagnosis and treatment can be used, incl. hearing aid.

In general, the “deeper” the problem is localized, the more severe it is. Therefore, conductive violations are considered the least dangerous.

Causes of hearing loss

The perception of sound on a loudness scale of 25 dB is considered normal. Complete deafness is the inability to perceive sounds up to 90 dB. Hearing loss is divided into 4 degrees, depending on the volume of sound that a person can detect. Modern medicine identifies the following causes of disorders:

Heredity. Genes responsible for the normal development of the auditory nerve and auditory ossicles in humans have been identified;
Inflammatory diseases of the ENT organs can lead to hearing loss. This is a common complication of viral respiratory diseases, ENT diseases, influenza;
Vascular disorders lead to impairment of the ability to hear more often in older age. Atherosclerosis, hypertension, diabetes mellitus are acquired diseases, more common after 40 years;
Medicinal reasons. Certain medications (certain antibiotics, cytostatics) can lead to hearing loss;
Physical injury to the middle ear, inner ear, or the center of the brain responsible for processing the sound nerve signal can completely deprive a person of sound.
Severe noise irritation. Hearing loss can be a consequence of loud noise, either short-term or long-term. Players, shooting ranges, concerts, noisy industries, powerful home speakers can lead to a decrease or complete loss;
Acoustic neuritis. In severe cases, it can lead to decreased hearing or complete deafness;
Sulfur plugs. Sometimes it is enough to clean the ear canal to return normal sound perception;
A tumor localized in the area of the inner ear, the sound center of the brain, the auditory nerve (neoplasms of the cerebellopontine angle).

The first signs: inability to hear the interlocutor, frequent fatigue and irritation after communication, speaking in “raised tones”, increasing the volume on household appliances, a player, a telephone, inability to hear a whisper, knocking, phone ringing, the sound of an alarm clock and other sounds that are not loud enough.

In what cases is it necessary to contact an ENT specialist urgently?

You are bothered by a feeling of fullness, tinnitus (like after flying on an airplane), dizziness
Hearing loss, congestion, pain. Possibly ear discharge
Feeling of “fullness”, fluid transfusion in the ear
After acoustic or barotrauma

In all these cases, it is necessary to urgently contact an otorhinolaryngologist (ENT). During a visual examination (otoscopy), the doctor will identify a plug or inflammation in the ear, conduct a differential diagnosis of hearing impairment and, perhaps, immediately relieve you of the problem (in the case of a plug). In case of otitis media, he will prescribe general and local treatment, which will also soon give results. If necessary, the doctor will definitely prescribe an audiological examination, consultation with an audiologist and decide on further treatment tactics

Why does our hearing deteriorate with age?

Age-related hearing loss is a natural process. It usually begins between the ages of 45 and 65 and can be worsened by external factors such as noise exposure. Age-related hearing loss primarily affects higher frequencies and usually occurs in both ears. The reason is damage to the sensitive hair cells of the auricle. This leads to a decrease in signal transmission to the auditory nerve. The first sign is often a loss of the ability to hear sounds, such as rustling leaves or a ticking clock.

Drug or surgical treatment in this case is impossible. However, a hearing aid can be a significant help for this form of hearing loss. Hearing deterioration with age is a natural process.

Genetic predisposition to hearing loss

Some forms of hearing loss are hereditary. They are caused by genetic mutations that affect the development and function of the ear. Today, of the 30,000 human genes, approximately 500 can affect hearing. Genetic research is constantly bringing new discoveries to this field. For example, Professor Claes Møller from Örebro University in Sweden found that an altered or mutated gene produces too much or too little protein.

Two thirds of all congenital forms of hearing loss can be attributed to such a genetic mutation. The remaining third of cases are disease syndromes, such as Usher syndrome. It is a multisymptom disease, including ocular dysfunction. Scientists' most important goal: to find out which genes are responsible for each hearing damage. Achieving this goal will help future gene therapy patients.

When is a hearing test required?

There are a number of other reasons why hearing decreases gradually, over several months or even years. So how do you know if your hearing needs to be tested?

You have difficulty communicating and often ask again. It seems to you that the interlocutors are speaking quietly and indistinctly.
It is difficult for you to listen and understand speech in a noisy environment: on the street, at a meeting, at lectures, in a restaurant, in a park, when talking with several interlocutors.
You increase the volume of the TV, radio, phone.
You are emotionally depressed, irritated, nervous, and even avoid communication, since for you to understand the speech of your interlocutor is a colossal effort.

Prevention and treatment of hearing

To hear well, you not only need well-functioning ears, but also an efficient and trained auditory center in your brain. It is there, in the so-called “auditory cortex”, that sound impulses are interpreted and transmitted to consciousness.

Did you know? If the brain does not train long enough to perceive environmental sounds due to hearing loss, the neural connections disappear. As a result, the brain not only begins to lose hearing, but also ages faster overall: for every 10 decibels of hearing loss, the risk of dementia increases by more than 20 percent. The only way to prevent this is to correct your hearing loss early with a hearing aid. Recommendation: Get your hearing tested once a year after age 50.

Hearing exercises with music therapy

Music is not only a great way to improve your mood and relax. It can also have a therapeutic effect - not only in cases of depression and stress, but also in cases of hearing impairment.

It works like this: a complex mixture of music and speech, as well as rhythm and sounds of varying pitches and colors, trains speech understanding and communication skills. A person with hearing loss often has difficulty following a conversation if there is background noise. And it is this skill of music therapy that allows our brain to train perfectly. For people with hearing loss, music can be a way to restore hearing and thus improve their quality of life.

Can I test my hearing myself?

Such methods exist, but are not medical and will not replace the differential diagnosis of hearing impairment.

Study of spoken and whispered speech. Ask someone close to you to move away to a distance of 6 meters and whisper: “one hour, tea thicket, cabbage soup, soot, six, sixteen, sixty-six.” If you cannot distinguish these words, it is worth examining your hearing in detail.
Online hearing test. There are a number of smartphone apps that can help you do self-exploration. For example: “Mimi Hearing Test” will help you calibrate your headphones, test each ear separately and show a visual result.

Interpretation of results

In the absence of disturbances in the functioning of the sound-receiving and sound-conducting system, a person can hear whispered speech and the ticking of a clock, the intensity of which ranges from 0 to 25 dB. When perceiving sound signals in this interval, there are no ear pathologies. When decoding the results of speech audiometry, the following nuances are taken into account:

the inability to perceive whispered speech from a 2-meter distance may signal the development of stage 1 hearing loss;
the inability to distinguish words of medium intensity from a 6-meter distance indicates development;
Difficulties in perceiving high-intensity speech from a distance of 20 meters may indicate the presence of hearing loss of 2 or 3 degrees.

If you receive disappointing results, you should seek help from an otolaryngologist. Based on the patient’s testimony, he will conduct the necessary audiometric studies, during which he will be able to accurately determine the hearing threshold and the type of hearing loss.

Today, speech audiometry is no longer used to test hearing acuity, but for the selection and adjustment of hearing aids during hearing care.

It is also recommended to undergo examination by specialists if:

Your job involves noise. According to current legislation, if the noise level at your job is above 80 dB, your employer is required to provide you with personal hearing protection, as well as an annual hearing test.

You live in a big city and are constantly exposed to ambient noise: you often listen to music at an inappropriately loud level, for example, on the subway with headphones, at rock concerts, discos
Do you often suffer from otitis media?
You have grade 3 adenoids
Recently suffered a concussion or traumatic brain injury
You are 50 years or older

In all cases, if there are complaints or suspicions of hearing impairment, audiometry - a hearing test using a device - an audiometer and, possibly, other audiological examinations (impedance testing, UAE, auditory evoked potentials), the scope of the examination will be determined by the doctor.

Terminology

To understand how an audiogram is performed, it is necessary to understand the audiometry method and accompanying terminology. Hearing acuity is determined by data that takes into account two main characteristics of sound vibrations:

frequency (wavelength) – a characteristic of the number of vibrations of sound signals per second, which is expressed in hertz (Hz);
intensity is a physical quantity that determines the pressure force of vibrations created by a sound wave. For convenience, audiometric studies use not a scalar, but a relative value, which is measured in decibels (dB).

Pure-tone audiometry is a subjective method of measuring auditory perception that requires feedback from the subject. An audiologist uses an audiometer to provide sound signals of a certain frequency and intensity, and the patient reports whether he perceives the sounds or not. In otolaryngology, the tonal method is most often used to determine disturbances in the functioning of the auditory analyzer, which makes it possible to assess the degree of susceptibility of hair cells and possible disturbances in the sound-conducting and sound-receiving systems.

Methods for diagnosing hearing loss in adults.

Audiometry (tone threshold, game, speech, suprathreshold tests) - measurement of the test subject's ability to hear pure tones of various frequencies.

How is audiometry performed? The patient wears headphones through which a sound signal is sent. The patient's task is to press the button at the moment when he hears the sound. The essence of audiometry is to determine the quietest sound (perception threshold) at each frequency being studied that a person is capable of hearing. Audiometry is performed separately for the right and left ears.

Using two different telephones: air and bone, the nature of hearing loss is determined: sound conduction, sound perception is affected, or it is a hearing loss of a mixed type. If there is a conductive (sound-conducting) disorder, an additional study is prescribed - impedance measurement.

Research result. The results of the study are recorded on a special audiometric form, on which sound frequencies are plotted horizontally and sound intensity in decibels vertically. Using this graph, it is possible to determine the mechanism of hearing loss and inaudible frequencies. This type of diagnosis of hearing loss is subjective and is suitable when a hearing test is needed for adults and children over 4 years of age.

Impedansometry (includes tympanometry and acoustic reflexometry) is a method for examining the middle ear that does not require patient participation. Normally, the sound wave enters the outer ear and travels through the middle ear to the oval window of the labyrinth (inner ear). Deviations - damage to the eardrum, accumulation of fluid in the middle ear cavity, cicatricial changes, disruption of the integrity of the chain of auditory ossicles, changes in the Eustachian tube lead to disruption of the conduction of sound vibrations and a decrease in hearing acuity.

How is impedance testing performed? A probe is inserted into the patient's ear, through which a sound stimulus is applied and pressure changes in the external auditory canal. Reflexes that arise in response to stimulation are recorded graphically and digitally.

Research result. The data obtained allow us to assess the condition of the middle ear, eardrum and chain of auditory ossicles. They help in the diagnosis of diseases such as various types of otitis media, otosclerosis, damage to the auditory nerve, and auditory pathways. They are also necessary for the differential diagnosis of hearing loss (to determine conductive or sensorineural hearing loss).

A competent diagnosis of hearing loss will allow us to identify the type, degree and causes of hearing loss and, if necessary, develop a plan for further examinations, including consultations with doctors of other specialties (neurologist, otoneurologist, otosurgeon), as well as rehabilitation measures, including hearing aids. The above methods for diagnosing hearing are the basic and most modern. If necessary, additional studies may be carried out depending on each specific case.

How to test your hearing?

14.03.2018

Today, about 6% of the entire world population suffers from severe hearing loss, which means their quality of life is noticeably reduced, they cannot fully communicate and take part in social life without difficulty.

How do I know if I have hearing problems?

There are three key symptoms that accompany hearing pathology:

You began to frequently ask your interlocutor again. Most likely, your family and friends with whom you often talk will be the first to notice this.
You are worried about a feeling of stuffiness, tinnitus , like after a plane flight.
You suddenly suddenly stopped or began to hear worse in one or both ears .

If you experience at least one of the above symptoms, do not delay visiting an otolaryngologist.

If hearing loss occurs suddenly, consult a doctor : this may be a symptom of acute sensorineural hearing loss, a disease in which late contact with a specialist can lead to ineffective treatment and persistence of hearing loss.

Is it possible to check for yourself whether your hearing is okay?

The only thing you can do yourself is to conduct a speech hearing test. According to standards, a healthy person should hear a whisper at a distance of 6 meters in a quiet room. You can conduct an experiment right in your apartment: ask one of your relatives, moving 6 meters away from you, to whisper some phrase. If you can't hear or distinguish words, you probably have a hearing loss.

You can also use one of a number of computer programs that can determine how well you hear: they are downloaded into the gadget, and you conduct a self-examination.

However, all these methods cannot be considered equivalent to examination by a doctor . If you have any doubts, it is better to immediately consult an otolaryngologist.

If a person hears only when people lean close to him, is this already a pathology? Unfortunately yes. Hearing is a sensory organ of great social importance. Depending on how well we hear, the quality of our life and the degree of inclusion in society depends. Hearing near the auricle is socially unusable, but if you continue to hear at close range, then most likely an otolaryngologist-audiologist will be able to help you.

Why does a person hear worse?

There are three types of the disease, depending on where exactly the disorders are localized.

Conductive type: the functioning of the human sound-conducting apparatus (outer and middle ear) is disrupted. That is, not all sounds reach the inner ear.

Neurosensory type: the perception of sounds directly in the inner ear, where sound vibrations are transmitted to the nerve, is impaired.

Mixed type: the problem affects both sound-conducting structures (in most cases the middle ear) and sound-receiving structures.

Who should undergo audiometric screening?

You are recommended to undergo screening if you:

Recently received a traumatic brain injury, concussion ;
You are prone to frequent otitis media, suffer from chronic ear diseases;
You have grade 3 adenoids
Your age is 50 years or older;
You have been diagnosed with metabolic diseases ( atherosclerosis , diabetes mellitus );
Your work involves noise vibrations (electric train driver, call center operator, school teacher, musician);
You have a habit of listening to music loudly on headphones in a noisy room (for example, in the subway).

Please note: even if you do not have significant hearing complaints, you should get screened as soon as possible. Sometimes the violation does not immediately make itself felt, but it will already be noticeable based on the research results.

How to get an audiological screening?

You make an appointment with an otolaryngologist at our medical and rehabilitation . At the appointment, the doctor will rule out some causes of hearing impairment (the most common cause is wax plug). You may also hear worse due to inflammation (otitis media). Such diseases can be treated quickly and effectively, and your hearing will quickly return.

If doctor has not identified any obvious cause of your hearing loss, he or she will suggest that you undergo audiological screening.

What methods are used to test hearing during screening?

First of all, you will be examined using pure tone threshold audiometry.

How it goes: You go into a soundproof cabin or into a quiet, isolated room. They put headphones on you and give you a special remote control. The doctor delivers a sound of a certain frequency into the ear with gradually changing volume. Your task is to press the button at the moment when you just begin to hear sound , so the doctor will determine the threshold for the perception of sound at a given frequency. The study is carried out at different frequencies, first of one ear and then of the other ear.

Then this procedure is repeated, but you are put on a bone telephone - a special headband with a device that generates sound , which is installed in the area behind the ear.

What we learn: based on both tests - using headphones and a bone phone - the doctor receives an audiogram graph. It makes it clear in which ear the hearing is impaired, what the mechanism of the reduction is - a violation of sound conduction or sound perception, which frequencies are affected.

A healthy human ear perceives frequencies in the range from 16 to 20,000 Hz. Human speech occupies a range from 500 to 4000 Hz. In pure tone threshold audiometry, frequencies from 125 to 8000 Hz are applied to your ears : this allows us to detect hearing loss in both the speech and high-frequency ranges.

It happens that a person still hears well, but pathology has already appeared, and so far it manifests itself only at the highest frequencies. It is the high frequencies that we often stop hearing first.

This is how pure tone threshold audiometry is performed.

Another technique is tympanometry. This is an objective technique: here you are not required to record or note anything, everything is done by a device - a hearing analyzer.

How is it going? A small probe is inserted into your ear (a completely painless procedure), then sound , which changes the pressure in the external auditory canal. In this case, the eardrum is either pulled towards the ear canal or pressed inward. A normal situation is when you hear best at zero pressure.

What will we find out? The degree of compliance of your sound-conducting system of the middle ear: is the eardrum, auditory ossicles, and muscles that are involved in sound conduction working well?

Why and why? The most common and easily solvable problems are related specifically to the pathology of the middle ear. Tympanometry allows you to localize the pathology of the middle ear, for example, dysfunction of the auditory tube, rupture of the chain of auditory ossicles, the presence of fluid in the middle ear, etc.

Does hearing restoration take a long time?

It all depends on the nature of the pathology. Sometimes the pathology is corrected surgically (for example, with otosclerosis) - and then the patient feels the difference immediately after the operation .

Sometimes hearing must be maintained and regularly checked throughout life, because hearing loss tends to progress. If hearing loss causes problems in communication, you have to ask again all the time, you miss some important information, all this negatively affects communication at home and at work - you should think about hearing aids. According to numerous studies, the lack of compensation for hearing loss leads to a decrease in memory, operational thinking, and imbalance. A person can literally become stupid.

Is it possible to just buy a hearing aid at a pharmacy?

You cannot buy and start wearing a hearing aid yourself: each device has its own amplification power. The doctor himself will select the optimal device of the required power for you. Even after successful selection, it takes some time to adapt to a new source of sounds . At first, you may feel discomfort and headache, but in order to overcome the adaptation period, you need to wear the device regularly.

Hearing aids can be either external or internal (the so-called “artificial ear”) - they are especially relevant for young people who feel awkward about having to wear a noticeable hearing aid.

What can you do to preserve your hearing?

If your profession involves noise, follow safety precautions and be sure to use protective equipment when you are in a noisy room.
Maintain good hygiene while listening to music. Use noise-canceling headphones and don't play music at full volume. A non-hazardous volume is considered to be a volume at which you can hear your own voice.
At the first sign of hearing loss, contact your doctor .

Published in Premium Clinic Instructions

Self check

How to test your hearing yourself? If you wish, you can check the acuity of your own hearing without the help of strangers. To do this, experts suggest taking a simple test in which you need to honestly answer (yes/no) several questions:

do you hear the ticking of a clock or whispered speech?
Do you often have problems understanding speech on the phone?
Do your friends and relatives complain about constant asking questions?
How often do people tell you that you listen to the TV, audio player or radio loudly?
can you hear the birds singing outside the window?
Can you understand whispered speech from a distance of 2 m?
Don't you think that most of your interlocutors speak indistinctly?

If, after passing the test, the subject understands that most of the answers are not in favor of normal hearing acuity, you should seek help from a specialist.

Important! With the development of infectious diseases associated with damage to the nasal mucosa, hearing acuity naturally decreases, which is caused by blocking the mouth of the Eustachian tube. If an audiometric test is performed in this condition, the results will be unreliable.