Three surefire ways to test your hearing. Hearing test. Methods for testing hearing and diagnosing hearing impairment Lifehacker how to test your hearing

Is your baby acting strangely? Is the child distracted, does not always hear what you say to him? If children often suffered from infectious diseases, viral infections, inflammatory processes, then automatically they are at risk of hearing loss. Late development of speech, gaps in the pronunciation of such sounds as p, t, d, d, l - this is a reason to visit an audiologist.

Otolaryngologists recommend that even with a slight decrease in hearing in a child, contact a specialist. Perhaps this is the first sign of hearing loss. How to check the hearing of a child at home or in a medical institution?

So, you need to contact an audiologist if:

• A newborn 1-1.5 months does not react at all to noise and loud sounds;
• A baby at three months does not hear and does not respond to calls, the voice of his mother;
• The baby at six months has no babbling and cooing;
• Until the age of 3, the baby did not begin to talk.

Checking the auditory activity in children of two or three years is already quite difficult. This is due to the fact that at two years old, the surrounding sounds are not irritants for the child. Even children with normal hearing may not respond to the noise and loud speech of their parents. Therefore, the usual behavioral test performed at home will not work in this case.

It must be taken into account that the child may not turn to the parents in response to the source of the sound. Also, at two years old, children do not always turn around to speech urges or signals. In most cases, this is the norm, so you should not panic.

Determination of the quality of hearing is initially carried out at home. Parents can conduct a so-called behavioral test. It consists in the fact that the child must respond to an extraneous sound, which will act as a kind of irritant for him. Audiologists and otolaryngologists say that such tests can be performed on children from six months. In older children, the test is carried out in a playful way.

You can independently test the child's ability to hear by reacting to the mother's voice or to the noise from sound toys.

How to do it? To do this, you need to wait until the child falls asleep. After half an hour or an hour, it is necessary to determine whether the child fell into a light sleep or fell asleep deeply.

Look at the baby's eyelids. If they are closed, and under them the eyeballs still continue to move, then the baby is in a state of half-asleep. Next, you can pick up a children's toy with a squeaker and gently, without scaring the child, you need to squeeze and unclench it several times near the baby's ear.

If the baby's reaction followed, that is, he opened his eyes, sighed or cried, then you can assume that the child's auditory system is in order. If not, then you can try to do the same in the waking state of the baby, only come up behind the child and suddenly “squeak” with a toy. When the child stops responding to surrounding sounds, does not hear you, does not respond by name, then you need to contact an otolaryngologist.

Risk factors

It is necessary to pay attention to the auditory function of the baby if he has congenital malformations from birth: violations of the structure and work of the craniocerebral region, an external defect in the form of a cleft lip, and there has also been a mechanical injury to the auricle.

Babies born prematurely or those who are underweight are also at risk. Also, the degree of hearing loss can occur in children who were artificially ventilated in the first hours after birth.

Checking the quality of hearing in a child is required if he has been ill with measles, rubella, and thyroid diseases have also been diagnosed. Doctors recommend that a child's hearing be tested before the age of six months. The correct approach to diagnosis and treatment will allow timely elimination and prevention of possible deviations.

Hearing testing in newborns is carried out using a quick and painless procedure - screening. The analysis is carried out within 5 minutes. But, the nuance is that the child at this time should be at rest, namely sleep. But, do not worry and think about where to check your hearing and how to do it? Screening can be done at home or in a health facility. Hearing can be tested in children from 0 to 3 years of age.

The procedure consists of two parallel studies: a program called otoacoustic emission and computer audiometry. Absolutely all studies are carried out on new modern equipment.

The otoacoustic emission program is carried out as follows: a small earphone device is inserted into the ear, containing two sensors - a microphone and a telephone. The microphone must pick up all the signals that are sent by the phone.

Computer audiometry will allow the audiologist to understand how correctly the child's brain perceives speech and extraneous noise from the environment. During audiometry, several electrodes are attached to the child's head. If even a slight degree of hearing loss is detected, the child is sent for a full clinical examination.

Harm of the survey

Many parents believe that a newborn screening machine can harm their baby in some way. Is it so? The use of modern equipment makes it possible to determine minor hearing loss in newborns and prevent the formation of hearing loss. It has been proven that the development of those children who have a neurosensory form of hearing loss detected in time can go forward and do not differ from their peers in any way. But, it is necessary to make hearing aid up to a year.

Is the screening machine harmful and can it be uncomfortable? Doctors - audiologists and otolaryngologists argue that the device does no more harm than using a regular mobile phone near the child.

The screening device, like the phone, contains electronic elements that produce electromagnetic waves. But, since the procedure lasts for five minutes, it does not cause harm to health. The sound that the device makes is so quiet that the baby does not even wake up when he hears it.

Determining hearing function yourself

If you want to check your hearing yourself, then there are two ways to do this. The first is to pass an online test, which is offered by absolutely all modern hearing centers. Its essence lies in the fact that against the background of ambient noise, a recording with words will sound. You will need to listen to a fragment of the recording and click on the picture depicting the item being voiced.

You can also check your hearing by answering a few clarifying questions. They roughly sound like this:

• Can you hear the ticking of the second hand on the clock?
• Do you always hear the alarm signal?
• Do you hear your own voice in the recorder? (this can be checked by recording a small fragment of speech on the voice recorder in the phone).
• Do you always hear the interlocutor?
• Do you use a hearing aid?
• Do you listen to music loudly?
• Do you have difficulty crossing the road? Can you detect the noise of an approaching car?

Audiologists say that if a person answered the first four questions in the negative, then this is a serious reason for providing professional advice from a specialist. If a person uses a hearing aid and also answered “no” to these questions, then a second hearing aid will be required.

These methods include anamnesis, physical examination, hearing examination (acumetry, audiometry), additional research methods (radiography, CT, MRI).

Anamnesis

Patients suffering from hearing loss usually complain of hearing loss, tinnitus, less often - dizziness and headache, irritability, reduced speech intelligibility in a noisy environment, and a number of others. Some patients point to the cause of hearing loss (chronic inflammation of the middle ear, an established diagnosis of otosclerosis, a history of skull trauma, activities in industrial noise conditions (mechanical assembly and blacksmith shops, the aviation industry, work in an orchestra, etc.). Of the comorbidities, patients may indicate the presence of arterial hypertension, diabetes mellitus, osteochondrosis of the cervical spine, hormonal dysfunction, etc.

The purpose of the anamnesis of an audiological patient is not so much to ascertain the fact of hearing loss, but to identify its cause, to establish concomitant diseases that aggravate hearing loss, occupational hazards (noise, vibration, ionizing radiation), and past use of ototoxic drugs.

When talking with the patient, the nature of his speech should be assessed. For example, loud and clear speech indicates the presence of acquired bilateral sensorineural hearing loss in years when the articulatory function of the speech motor apparatus was fully formed. Slurred speech with articulation defects indicates that hearing loss occurred in early childhood, when basic speech skills were not yet formed. Quiet intelligible speech indicates a conductive type of hearing loss, for example, in otosclerosis, when tissue conduction is not impaired and fully provides auditory control of one's own speech. You should pay attention to the "behavioral" signs of hearing loss: the patient's desire to approach the doctor with a better hearing ear, putting his palm to his ear in the form of a mouthpiece, an attentive look fixed on the doctor's lips (lip reading), etc.

Physical examination

Physical examination includes the following techniques and methods: examination, palpation and percussion of the facial and auricular-temporal regions, endoscopy of the ear, examination of the barofunction of the auditory tube, and some others. Endoscopy of the nose, pharynx and larynx is carried out according to the generally accepted method.

At external examination pay attention to the anatomical elements of the face and its appearance: the symmetry of facial expressions, nasolabial folds, eyelids. The patient is offered to bare his teeth, wrinkle his forehead, close his eyes tightly (control of the function of the facial nerves). Tactile and pain sensitivity is determined by the zones of innervation of the branches of the trigeminal nerve. When examining the ear region, the symmetry, size, configuration, color, elasticity, state of tactile and pain sensitivity of its anatomical formations are evaluated.

Palpation and percussion. With their help, skin turgor, local and distant pain are determined. When complaining of pain in the ear, deep palpation and percussion are performed in the antrum projection area, the mastoid platform, the scales of the temporal bone, the temporomandibular joint area and the retromandibular fossa in the area of ​​the parotid salivary gland. The temporomandibular joint is palpated when opening and closing the mouth to detect clicks, crunches and other phenomena indicating the presence of arthrosis of this joint.

Otoscopy. When examining the external auditory canal, pay attention to its width and contents. First, they examine it without a funnel, pulling the auricle up and backwards (in infants backwards and downwards) and at the same time pushing the tragus anteriorly. The deep sections of the ear canal and the tympanic membrane are examined with the help of an ear funnel and a frontal reflector, while the presence or absence of certain identifying signs of it and pathological changes (retraction, hyperemia, perforation, etc.) is noted.

Hearing test

The science that studies the auditory function is called audiology(from lat. audio- I hear), and the clinical direction that deals with the treatment of hearing-impaired people is called audiology(from lat. surditas- deafness).

The hearing test is called audiometry. This method distinguishes the concept acumetry(from Greek. akouo- I listen), which is understood as the study of hearing with live speech and tuning forks. In audiometry, electronic-acoustic devices (audiometers) are used. The responses of the subject (subjective reaction) serve as evaluation criteria: “I hear - I don’t hear”, “I understand - I don’t understand”, “louder - quieter - equally loud”, “higher - lower” according to the tone of the sound test, etc.

The sound pressure equal to 2.10:10,000 microbars (µb), or 0.000204 dynes/cm 2 , at a sound frequency of 1000 Hz, was taken as the threshold value of auditory perception. A value 10 times greater is equal to 1 bela (B) or 10 dB, 100 times greater (×10 2) is 2 B or 20 dB; 1000 times greater (×10 3) - 3 B or 30 dB, etc. The decibel as a unit of sound intensity is used in all threshold and suprathreshold audiometric tests related to the concept volume.

In the XX century. for the study of hearing, tuning forks became widespread, the method of using which in otiatry was developed by F. Bezold.

The study of hearing "live" speech

Whispered, colloquial, loud and very loud speech (“cry with a ratchet”) is used as testing speech sounds (words) when the opposite ear is muffled with a Barani rattle (Fig. 1).

Rice. one.

In the study of whispered speech, it is recommended to pronounce the words in a whisper after a physiological exhalation, using the reserve (residual) air of the lungs. In the study of colloquial speech, ordinary speech of medium volume is used. The criterion for assessing hearing in whispered and colloquial speech is distance from the researcher to the subject, from which he confidently repeats at least 8 out of 10 words presented to him. Loud and very loud speech is used for hearing loss of the third degree and is pronounced over the patient's ear.

Hearing test with tuning forks

When studying hearing with tuning forks, a set of tuning forks of different frequencies is used (Fig. 2).

Rice. 2.

When examining hearing with tuning forks, a number of rules must be observed. The tuning fork should be held by the leg without touching the jaws. Do not touch the branches of the auricle and hair. When examining bone conduction, the tuning fork leg is placed on the crown or forehead along the midline (when determining the phenomenon literalization sound a) or on the site of the mastoid process (when determining playing time tuning fork). The leg of the tuning fork should not be pressed too strongly against the tissues of the head, since the pain sensation that arises in this case distracts the subject from the main task of the study; in addition, it contributes to the accelerated damping of vibrations of the tuning fork branches. It should be borne in mind that sounds of 1000 Hz and above are able to bend around the head of the subject, therefore, with good hearing in the non-examined ear, the phenomenon over-the-air listening. Relistening may also occur in the study of tissue conduction; it occurs when there is a perceptual hearing loss, and the opposite ear either hears normally or has a conductive type of hearing loss, such as cerumen plug or scarring.

With the help of tuning forks, a number of special audiometric tests are carried out for differential diagnosis between perceptual and conductive types of hearing loss. It is advisable to record the results of all acumetric tests carried out using live speech and tuning forks in the form of the so-called auditory passport(Tables 1, 2), which combines five aspects of the study:

1) detection of spontaneous irritation of the sound analyzer according to the SN test ( subjective noise);

2) determination of the degree of hearing loss in relation to live speech according to the SR tests ( whispered speech) and RR ( Speaking). With a high degree of hearing loss, the presence of hearing is determined by the test "cry with a rattle";

3) determination with the help of tuning forks of the sensitivity of the organ of hearing to pure tones during air and tissue conduction of sound;

4) identification of certain correlation dependencies between the perception of low and high tones during air and bone conduction of sound for differential diagnosis of forms of hearing loss;

5) establishing the lateralization of sound by bone conduction to establish the type of hearing loss in the worse hearing ear.

Table 1. Hearing passport in violation of sound conduction

Table 2. Hearing passport for impaired sound perception

SSH test reveals the presence of irritation of the peripheral nervous apparatus of the organ of hearing or the state of excitation of the auditory centers. In the hearing passport, the presence of tinnitus is marked with a “+” symbol.

Living speech research. This study is carried out in the absence of extraneous noise. The examined ear is directed towards the examiner, the other ear is tightly closed with a finger. The results of the live speech study are recorded in the auditory passport in meters in multiples of 0.5: 0; “at cancer”, which means “hearing at the shell”; 0.5; one; 1.5 m, etc. The result is recorded at the distance from which the subject repeats 8 out of 10 named words.

When examining hearing with tuning forks, the tuning fork is brought to the external auditory canal with the plane of the branch at a distance of 0.5-1 cm with a frequency of once every 5 s. The entry in the passport is made with the same multiplicity, i.e. 5 s; 10 s; 15 s, etc. The fact of hearing loss is established in cases where the time of sound perception is shortened by 5% or more relative to passport norm tuning fork.

Evaluation criteria for tuning fork tests of a typical hearing passport

• With air conduction of sound:
• conductive (bass) hearing loss: a decrease in the duration of perception of the tuning fork C 128 with near-normal perception of the tuning fork C 2048;
• perceptual (treble) hearing loss: near-normal time of perception of a tuning fork C 128 and a decrease in the duration of perception of a tuning fork from 2048.
• With tissue (bone) conduction of sound (only C 128 tuning fork is used):
• conductive hearing loss: normal or increased duration of sound perception;
• perceptual hearing loss: a decrease in the duration of sound perception.

Allocate also mixed type of hearing loss, at which there is a shortening of the perception time of the bass (C 128) and treble (C 2048) tuning forks with air sound conduction, and the bass tuning fork with tissue sound conduction.

Criteria for evaluating tuning fork tests

Schwabach experience (1885). Classic variant: the leg of the sounding tuning fork is applied to the crown of the subject until he stops perceiving the sound, after which the examiner immediately applies it to his crown (it is assumed that the examiner should have normal hearing); if the sound is not heard, this indicates the normal hearing of the subject, if the sound is still perceived, then the subject's bone conduction is "shortened", which indicates the presence of perceptual hearing loss.

Weber's experience(1834). The leg of the sounding tuning fork is applied along the midline to the forehead or crown, the subject reports the presence or absence of lateralization of the sound. With normal hearing or with its symmetrical decrease, the sound will be felt "in the middle" or "in the head" without a clear lateralization. If the sound conduction is disturbed, the sound is lateralized into the worse hearing ear, if sound perception is impaired, it is lateralized into the better hearing ear.

Rinne experience(1885). With the help of C 128 or C 512, the sounding time of the tuning fork during air conduction is determined; then determine the sounding time of the same tuning fork during tissue conduction. Normally and with sensorineural hearing loss, the duration of sound perception with air sound conduction is longer than with tissue sound conduction. In this case it is said that " Rinne's experience is positive”, and in the auditory passport this fact is noted in the corresponding cell with a “+” sign. In the case when the sounding time with tissue sound conduction is longer than the sounding time with air conduction, they say that " Rinne's experience is negative", and a sign is affixed in the auditory passport"-". A positive "Rinne" is typical of normal hearing with normal air and bone conduction times. It is also positive in sensorineural hearing loss, but at lower time values. Negative "Rinne" is typical for a violation of sound conduction. In the absence of sound perception through air sound conduction, one speaks of an “infinitely negative Rinne”, in the absence of bone conduction, one speaks of an “infinitely positive Rinne”. “False negative Rinne” is noted when listening through the bone with the other ear if the hearing in this ear is normal, and there is a pronounced sensorineural hearing loss in the examined ear. In this case, to study hearing, a healthy ear is muffled with a Barani ratchet.

The Jelle experience(1881). Designed to determine the presence or absence of mobility of the base of the stirrup and is mainly used to detect ankylosis of the stirrup in otosclerosis. The experiment is based on the phenomenon of a decrease in the volume of a sounding tuning fork during bone conduction during an increase in pressure in the external auditory canal. For the experiment, a low-frequency tuning fork with a long sounding time and a Politzer cylinder with a rubber tube with an olive pointed at its end are used. The olive, selected according to the size of the external opening of the auditory canal, is firmly inserted into the external auditory canal, and the sounding tuning fork is placed with a handle on the site of the mastoid process. If the sound gets quieter, talk about " positive» experience of Gellet, if it does not change, then the experience is defined as « negative". The corresponding symbols are put down in the auditory passport. The negative experience of Gellet is observed in the dissociation of the auditory ossicles as a result of trauma, perforations of the tympanic membrane and obliteration of the windows of the ear labyrinth. Instead of a tuning fork, you can use the bone phone of an audiometer.

Tone threshold audiometry

Tonal threshold audiometry is a standard, generally accepted method for studying auditory sensitivity to "pure" tones in the range of 125-8000 (10,000) Hz for air conduction of sound and in the range of 250-4000 Hz for bone conduction of sound. For this purpose, special sound generators are used, the scales of which are calibrated in dB. Modern audiometers equipped with a built-in computer, the software of which allows you to record the study with display on the display tone audiogram and its fixation in a "hard copy" on a special form using a printer indicating protocol data. For the right ear on the form of a tone audiogram, red is used, for the left - blue; for air conduction curves, a solid line; for bone conduction, a dotted line. When conducting tonal, speech and other types of audiometric examination, the patient must be in a sound-damped chamber (Fig. 3). Each audiometer is additionally equipped with a generator of noise narrowband and broadband spectra for conducting research with the masking of an unexplored ear. To study air conduction, specially calibrated headphones are used; for bone conduction - "bone phone" or a vibrator.

Rice. 3. Audiometer; in the background is a sound-damped mini-camera

In addition to the threshold tone audiogram, modern audiometers contain programs for many other tests.

In normal hearing, the curves of air and bone conduction pass near the threshold line with a deviation at different frequencies within ± 5-10 dB, but if the curves fall below this level, this indicates a hearing impairment. There are three main types of changes in the tone threshold audiogram: ascending, descending and mixed(Fig. 4).

Rice. four. The main types of tone threshold audiograms: I - ascending in violation of sound conduction; II - descending in violation of sound perception; III - mixed in violation of sound conduction and sound perception; RU - cochlear reserve, indicating the potential for hearing to be restored to the level of bone conduction, provided that the cause of hearing loss is eliminated

suprathreshold audiometry

Above-threshold audiometry includes audiometric tests in which test tones and speech signals exceed the threshold of hearing sensitivity. With the help of these samples, the following goals are achieved: identifying slew rate phenomenon and adaptation reserves hearing organ, definition level of hearing discomfort, degree speech intelligibility and noise immunity, a number of other functions of the sound analyzer. For example, using the Luscher-Zviklotsky test, they determine differential intensity threshold in differential diagnosis between conductive and perceptual types of hearing loss. This test is presented as a standard test in any modern audiometer.

Speech audiometry

In this test, separate specially selected words containing low and high frequency formants are used as testing sounds. The result is evaluated by the number of correctly understood and repeated words as a percentage of the total number of words presented. On fig. 5 shows examples of speech audiograms for various types of hearing loss.

Rice. 5. Speech audiograms for various types of hearing loss: 1 - curve for conductive hearing loss; 2 — a curve at a cochlear form of relative deafness; 3 — a curve at the mixed form of relative deafness; 4 — a curve at the central type of relative deafness; a, b — different positions of the speech intelligibility curve in the conductive type of hearing loss; c, d — downward deviations of the curves with a decrease in USD (in the presence of FUNG)

Spatial Hearing Test

The study of the function of spatial hearing (ototopics) is aimed at developing methods for topical diagnosis of the levels of damage to the sound analyzer.

The study is carried out in a soundproof room equipped with a special acoustic installation consisting of a sound generator and loudspeakers located in front of the subject in the vertical and horizontal planes.

The task of the subject is to determine the localization of the sound source. The results are evaluated by the percentage of correct answers. With sensorineural hearing loss, the accuracy of determining the localization of the sound source is reduced on the side of the worse hearing ear. The vertical localization of sound in these patients varies depending on the hearing loss to high tones. With otosclerosis, the possibility of localizing sound in the vertical plane is completely excluded, regardless of the frequency spectrum of the testing sound, while horizontal localization changes only depending on the asymmetry of the auditory function. With Meniere's disease, there is a constant violation of ototopics in all planes.

Methods of objective research of hearing

Basically, these methods are used in relation to young children, persons undergoing an examination for the presence of auditory function, and patients with a defective psyche. The methods are based on the assessment of auditory reflexes and auditory evoked potentials.

auditory reflexes

They are based on reflex connections of the organ of hearing with the sensorimotor sphere.

Preyer's auropalpebral reflex(N. Preyer, 1882) - involuntary blinking that occurs with a sharp sudden sound. In 1905, V. M. Bekhterev suggested using this reflex in order to detect simulation of deafness. Various modifications of this reflex were used in N. P. Simanovsky's clinic. Currently, this reflex is used to exclude deafness in infants.

Aurolaryngeal reflex(J. Mick, 1917). The essence of this reflex lies in the fact that under the influence of an unexpected sharp sound, a reflex closing of the vocal folds occurs, followed by their dilution and a deep breath. This reflex in the expert sample is very reliable, since it refers to unconditional reactions that do not depend on the will of the subject.

auropupillary reflex(G. Holmgren, 1876) consists in reflex expansion, and then in the narrowing of the pupils under the influence of a sudden strong sound.

Freschels reflex(Froeschels). It consists in the fact that with a sharp sound there is an involuntary deviation of the gaze towards the source of the sound.

Tsemakh's reflex(Cemach). With a sudden loud sound, there is a tilt of the head and torso (removal reaction) in the direction opposite to that from which a sharp strong sound was heard.

Sound motor reflexes of the muscles of the tympanic cavity. These unconditioned reflexes, which occur in response to suprathreshold sound stimulation, are widely used in modern audiology and audiology.

auditory evoked potentials

The method is based on the phenomenon of generation in the neurons of the auditory zones of the cerebral cortex of bioelectric evoked potentials, arising from the sounding of the receptor cells of the spiral organ of the cochlea, and the registration of these potentials with the help of their summation and computer processing; hence the other name of the method - computer audiometry. In audiology, auditory evoked potentials are used for topical diagnosis of central disorders of the sound analyzer (Fig. 6).

Rice. 6. Schematic representation of the average auditory evoked biopotentials

Methods for the study of the auditory tube

The study of the auditory tube is one of the main methods for diagnosing diseases of both this organ and the middle ear and their differential diagnosis.

Scoping Methods

At otoscopy dysfunctions of the auditory tube are manifested by: a) retraction of the relaxed and stretched parts of the tympanic membrane; b) an increase in the depth of the cone of the tympanic membrane, due to which the short process of the malleus protrudes outwards (symptom of the “index finger”), the light reflex is sharply shortened or completely absent.

At epipharyngoscopy(posterior rhinoscopy) assess the condition of the nasopharyngeal mouths of the auditory tubes (hyperemia, senechia, damage, etc.), the condition of the tubal tonsils and adenoid tissue, choanae, vomer, retrospective of the nasal passages.

Pneumootoscopy

The technique is carried out using a Siegle funnel (1864), equipped with a rubber canister to influence the eardrum with an air jet (Fig. 7).

Rice. 7. Siegle funnel with pneumatic attachment

With normal ventilation function of the auditory tube, an impulse increase in pressure in the external auditory canal causes vibrations of the tympanic membrane. In violation of the ventilation function of the auditory tube or in the adhesive process, the mobility of the membrane is absent.

Salpingoscopy

To examine the nasopharyngeal mouth of the auditory tube, modern optical endoscopes are used.

Currently, to examine the auditory tube, the thinnest fiberscopes with controlled optics at the distal end are used, which can penetrate through the auditory tube into the tympanic cavity to conduct tubotympanic microfibroendoscopy.

Blowing out the auditory tube. This method is used for both diagnostic and therapeutic purposes. For it, a special rubber balloon is used, connected by means of a rubber tube to the nasal olive, which is inserted into the nostril and tightly clamped together with the other nostril. The subject takes a sip of water, during which the nasopharyngeal cavity is blocked by the soft palate, and the pharyngeal opening of the auditory tube opens. At this moment, the balloon is squeezed, air pressure rises in the nasal cavity and nasopharynx, which, during the normal functioning of the auditory tube, enters the middle ear. Instead of a sip of water, you can pronounce sounds, during the articulation of which the nasopharynx is blocked by a soft palate, for example, “also-also”, “cuckoo”, “steamboat”, etc. When air enters the tympanic cavity in the external auditory canal, you can hear a kind of noise. When listening to this noise, apply Lutze otoscope, which is a rubber tube, at the ends of which there are two ear olives. One of them is inserted into the external auditory canal of the examiner, the other - into the external auditory canal of the subject. Listening is carried out during a sip with a pinched nose ( toynbee test).

A more effective way to determine the patency of the auditory tube is Valsalva test, which consists in an attempt to exhale with a tightly clamped nose and lips. With this test, in the case of patency of the auditory tube, the subject has a feeling of fullness in the ears, and the examiner listens with the help of an otoscope a characteristic blowing or popping sound. Below is a list of the most famous samples.

The principles of assessing the patency of the auditory tube by degrees have survived to this day. A. A. Pukhalsky (1939) proposed to classify the state of the ventilation function of the auditory tubes into four degrees:

• I degree - the noise is heard with a simple sip;
• II degree - noise is heard during the Toynbee test;
• III degree - noise is heard during the Valsalva maneuver;
• IV degree - the noise is not heard in any of the listed samples. Complete obstruction is assessed by the absence of noise during the Politzer test with a sip of water. If it is impossible to determine the patency of the auditory tube by the above methods, they resort to its catheterization.

Eustachian tube catheterization

The following instruments are required for catheterization of the auditory tube (Fig. 8): Politzer balloon (7) for blowing the auditory tube; Lutze otoscope (2) for listening to ear noise that occurs when air passes through the auditory tube, and an ear catheter (Hartmann cannula) for direct blowing of the auditory tube by catheterization.

Rice. eight. A set of instruments for catheterization of the auditory tube: 1 - rubber balloon; 2 - otoscope - a rubber tube for listening to noise; 3 - catheter for direct probing of the auditory tube

Eustachian tube catheterization technique

The catheter is inserted along the common nasal passage with the beak down until it touches the posterior wall of the nasopharynx, it is turned 90° towards the opposite ear and pulled up until it touches the vomer. Then the catheter is turned with its beak down by 180° towards the studied auditory tube so that the beak faces the side wall of the nasopharynx. After that, the beak is turned upwards by another 30-40 °, so that the ring located at the catheter funnel is directed towards the outer corner of the orbit. The final stage is to search for the pharyngeal opening of the auditory tube, during which the ridges of this opening (posterior and anterior) can be determined. Getting into the hole is characterized by a feeling of "capture" of the end of the catheter. Next, the conical end of the balloon is inserted into the catheter socket and air is pumped into it with light movements. With the patency of the auditory tube, a blowing noise is heard, and during otoscopy after blowing, the injection of the vessels of the tympanic membrane is detected.

Ear manometry is based on the registration of an increase in pressure in the external auditory canal, which occurs when pressure increases in the nasopharynx and the presence of patency of the auditory tube.

Currently, the study of the function of the auditory tube is carried out using phonobarometry and electrotubometry.

Phonobarometry allows you to indirectly set the amount of air pressure in the tympanic cavity and control the state of the ventilation function of the auditory tube.

Impedance audiometry(English) impedance, from lat. impedio I resist, resist. Under acoustic impedance understand the complex resistance experienced by sound waves passing through certain acoustic systems and leading these systems into forced oscillations. In audiology, the study of acoustic impedancemetry is aimed at determining the qualitative and quantitative characteristics of the sound-conducting system of the middle ear.

Modern impedance measurement includes the measurement of the absolute value of the input impedance, i.e., the acoustic impedance of a sound-conducting system; registration of changes in the input impedance under the influence of contraction of the muscles of the tympanic cavity and a number of other indicators.

Acoustic reflexometry allows you to evaluate the reflex activity of the muscles of the tympanic cavity and diagnose auditory dysfunction at the level of the first neuron. The main diagnostic criteria are: a) threshold value stimulating sound in dB; b) latency period acoustic reflex, reflecting the functional state of the first neuron, from the beginning of the sound stimulus to the reflex contraction of the ipsi- or contralateral stapedial muscle; in) nature of change acoustic reflex depending on the magnitude of the suprathreshold sound stimulus. These criteria are identified when measuring the parameters of the acoustic impedance of the sound-conducting system.

Otorhinolaryngology. IN AND. Babiak, M.I. Govorun, Ya.A. Nakatis, A.N. Pashchinin

Good hearing plays a huge role in everyday communication. Defects or lack of hearing significantly impoverish the world of a person, deprive him of the opportunity to communicate, which often causes difficulties at home and at work. The causes of hearing loss and deafness are manifold. Hearing impairment can be congenital or may occur as a result of ear diseases. In addition, a defect in the perception of sounds may be due to a general illness of the body.

The choice of a hearing test method depends on what exactly needs to be determined: the perception of sounds by the auditory system, the degree of hearing loss, or the sensitivity of the patient's ear to sounds of various frequencies. In addition, when choosing a method, it is also taken into account which system is affected by the hearing loss.

Hearing test using whispering and speaking

Often this study is part of mandatory medical examinations, during which the general health of a person is checked. The doctor stands at some distance from the subject, while the patient is forbidden to look in the direction of the doctor. During the study, each ear is checked separately, for which the opposite ear is "turned off" by inserting a Barani ratchet into the external auditory canal. Then the doctor says the numbers in a normal voice and in a whisper. Conducting this simple study allows you to obtain preliminary data on the state of the patient's hearing. Hearing acuity is determined by the distance at which the subject hears the whispered or spoken speech of the doctor. For example, a person with normal hearing hears a whisper at a distance of 10 m. In addition, during the study of whispered speech, hearing loss can be detected, which manifests itself in a decrease in the sharpness of perception of high tones.

Hearing test with tuning forks

Hearing loss can be caused by damage to the middle ear (conductive hearing loss) or the inner ear (sensory hearing loss). Studies with tuning forks are carried out in order to identify damage to the system that transmits or perceives sound.

Weber's experience

This study is carried out to determine the lateralization of sound. The doctor puts a sounding tuning fork to the patient's crown so that his leg is in the middle of the head. Normally, the subject hears the sound of the tuning fork equally with both ears. With a unilateral lesion of the sound-conducting apparatus, the sound is lateralized into the diseased ear. Hearing damage by the type of sound perception disorder is accompanied by lateralization of sound in a better hearing ear.

Rinne experience

A sounding tuning fork is attached to the site of the mastoid process. After the perception of sound by the patient has ceased, the tuning fork is brought to the external auditory canal. With a positive experience of Rinne, there is a predominance of air conduction of sound over bone, with a negative one, vice versa. Rinne's positive experience indicates normal hearing, negative - about diseases of the sound-conducting apparatus.

The Jelly Experience

The experiment is carried out in patients with conductive hearing loss to detect impaired mobility of the stirrup. The doctor, blowing air with the help of a Politzer balloon, acts on the eardrum, then puts a sounding tuning fork to the mastoid process. If the auditory ossicles are mobile, then with increasing pressure on the tympanic membrane, the sound becomes quieter, and with decreasing pressure, it becomes louder. If the auditory ossicles are immobile, then the intensity of the sound does not change.

This study of hearing sensitivity using electroacoustic devices allows you to determine the hearing threshold and the sensitivity of the auditory organ to sounds of different frequencies.

Examination in children

Hearing testing in children is very important. Children with hearing impairments may lag behind in mental development, so hearing tests are an integral part of preventive examinations of children. Examination of children, as well as adults, is carried out by an otolaryngologist.

Even with a slight decrease in hearing, it is urgent to contact an otolaryngologist. Sometimes, with the right treatment, some types of hearing loss can be cured.

Audiometry is a medical method for determining the level of hearing. When performing such testing, an assessment is made of the degree of sensitivity of the auditory analyzer in relation to sounds of different frequencies and intensities. In the hospital, a hearing test is performed using special equipment. The advantages of acumetry are that it allows you to dose different sound signals. Due to which it is possible to determine the threshold susceptibility for sounds of various frequencies. In hospital conditions, the test is carried out in soundproof rooms. Based on the results of such an examination, it is possible to identify not only the deterioration of hearing, but also the type of hearing loss. But for a hearing test, it is not necessary to go to the hospital, it is possible to check it yourself.

Verification Features

When checking hearing by a doctor in a medical institution, not only a decrease in audibility is determined, but also a pathological process that occurs in a sound analyzer is revealed. Using an audiometer, an otolaryngologist or audiologist examines the level of conduction of air and bone sounds. Experts share several varieties of audiometry:

1. Speech. This method is considered the simplest and most affordable. With this method of hearing testing, the doctor determines the level of speech recognition. Checking the audibility, the doctor pronounces the words in a voice of different volume, and the patient must repeat them.
2. Tonal. This method of acoustic examination helps to determine how well a person hears sounds of different frequencies and intensities.
3. Computer. This hearing test is considered the most accurate. It helps to determine the susceptibility of the sound-conducting and sound-perceiving systems.

Speech and tone audiometry are classified as subjective methods for checking the level of hearing. During the test period, the specialist takes into account only the testimony of the person being examined, who says which sounds he hears and which he does not.

During a computerized hearing test, various sensitive electrodes are connected to a person, which record activity in certain areas of the brain if the auditory analyzer responds to signals from an external source.

The first symptoms of impaired hearing are frequent fatigue after communication, the inability to hear the interlocutor normally and talking in high tones. The high-pitched sound on the TV, phone or alarm clock should alert.

Speech audiometry

You can test your hearing at home using speech audiometry. This method of research does not require the use of special equipment and devices. To test hearing, you just need to hear human speech. But you need to understand that the results of such testing depend not only on the state of the hearing organs, but also on the vocabulary of the person being examined.

To objectively check the level of audibility, an audiometrist must speak not just words, but whole phrases that consist of simple and understandable words. It is not difficult to conduct such a test, the main thing is to choose a room in which extraneous noise is almost inaudible. The examined person is placed on a chair in the middle of the room.

• Departs two meters from the person being examined and whispers a phrase consisting of 8-9 simple words.
• Departs from the subject approximately 5 meters and quietly pronounces individual phrases.
• From a distance of about 20 meters, it loudly pronounces a phrase consisting of simple words.

With such a check, the subject must clearly repeat what he heard. This test allows you to determine the hearing loss.

When conducting speech audiometry, the person conducting the examination should be interested in the subject how well he hears phrases and phrases spoken at different distances.

Definition of survey results

If there are no pathologies, then the person hears well the speech uttered in a whisper, the ticking of the clock and any sounds that are in the range up to 25 dB. With good audibility of sounds in this range, it is safe to say that hearing is normal. When determining the results, the following points are also taken into account:

• If a person cannot fully understand a speech uttered in a whisper from a distance of two meters, then one can suspect hearing loss 1 degree.
• If you are unable to make out quietly spoken phrases from a distance of 6 meters, you can talk about hearing loss of the 2nd degree.
• If the person being examined does not hear very loud speech, which is pronounced from a distance of 20 meters, then we can talk about hearing loss of 2-3 stages.

If any abnormalities were detected during a home hearing test, you need to contact an otolaryngologist who will conduct an additional examination and prescribe treatment.

Hearing audiometry is most often used not to accurately determine hearing acuity, but to correctly adjust the hearing aid.

How to check your hearing yourself

It is quite possible to check the rumor on your own, without involving other people. To independently check the operation of the hearing aid, a special test has been developed in which you need to clearly answer the questions posed. The list of questions is:

• Is the ticking of the wall clock and whispered phrases well heard?
• Are there any problems with normal speech perception when talking on the phone?
• Is it often necessary to ask again what the interlocutor said?
• Has anyone noticed that the TV in the house is too loud?
• Can you hear the birds singing outside the window?
• Can quiet speech be understood well from a distance of two meters?
• Is the speech of the interlocutors well received?

If most of the responses indicate that the acuity of hearing is impaired, it is necessary to seek the advice of a specialist.

It is impossible to conduct an audiometric study for colds. At this time, severe inflammation of the nasopharynx occurs, which leads to a deterioration in the patency of the Eustachian tube, therefore, with respiratory diseases, a natural decrease in the audibility of sounds occurs.

For the reliability of the results obtained, testing can only be carried out if you feel well.

Apps to check

Online audiometry can be used to test hearing acuity. These are special applications that run on different platforms of operating systems. To find out how well the organs perceive sounds, you should pass special tests developed by leading experts.

The most common programs for testing hearing acuity are:

• Hortest.
• Mimi Hearing Test.
• uHear.

If there is no smartphone, then you can check your hearing with an audiogram online using a computer, but for this you need to prepare headphones. According to the results of such testing, it is possible to say with certainty whether a person hears well or not.

Checking the audibility of sounds using computer programs should be done in absolute silence, otherwise the results of the examination will not be accurate.

Checking for little kids

Checking the hearing of newborn babies is very difficult without the involvement of a specialist. At this age, the baby cannot yet speak, so ear pathologies are very easy to miss.

Checking the level of hearing in a newborn child at home is not easy, but parents should report any suspicious moments to the pediatrician.

Before a month, it is almost impossible to determine how a child reacts to sounds. Toddlers begin to react to different sounds only from the age of one month. Parents should closely monitor the development of the crumbs. Of the toys, you must definitely buy a musical carousel, rattles and various tweeters.

When testing hearing in infants, the following methods are used:

• They take a jar of baby puree and fill it with any cereal. Alternately shake the jar near the baby's ears and observe the reaction.
• In the zone of inaccessibility of the child's gaze, you need to make a loud sound. If the baby reacted, it means that there is absolute order with hearing. It is important not to overdo it here, as the baby may be frightened by a loud sound and burst into tears.
• Near the baby's ear, you can quietly sing a melody or ring a bell. If he reacts to all sounds, then there is no cause for concern.

By the age of three months, the child already recognizes the mother's voice and reacts violently to it. Starting from six months, the child tries to reproduce sounds himself.

If hearing loss is evident, then you need to see a doctor. The specialist will determine the cause of such a pathology and prescribe a comprehensive treatment. It should be borne in mind that with early therapy, hearing can be restored partially or even completely.

The apps below will help you understand if your hearing is normal. If the results are far from optimal, it makes sense to consult a doctor.

uHear

uHear determines the sensitivity of your hearing, as well as how well you adapt to the surrounding noise. The first test takes about five minutes, the second - no more than a minute. For each test, you will need headphones, and in the application you can choose their type - in-ear or overhead.

The test determines the sensitivity of each ear individually. This is achieved by reproducing noises of different frequencies and determining the upper and lower limits of your hearing.

Hortest

Hörtest for Android works the same way. You need to press the button every time you hear a sound in the headphones. I'm going to say the obvious, but don't fool yourself and push the button just to improve your test scores. You go through it for yourself.

Mimi Hearing Test

Mimi Hearing Technologies is a company that manufactures equipment for the deaf. If you have an iOS device, I would recommend taking this test. The application works in a similar way to the previous ones. Each time you hear a sound in your left or right ear, you need to press the Left or Right button, respectively. The result of the test is your age, based on hearing sensitivity. If it matches your actual age, great. If the difference is very large, then your hearing is not normal.