1. Hearing Impairment Diagnostic Purposes and Treatment in Practice Prim. MUDr.Ivan Š ejna, CSc

2. Introduction Measure methods of hearing: »Subjective »Objective Before testing: -Otoscopy -Mikrootoscopy Goal and Result: Determine the Degree of Hearing Loss and Nature of Diseases (Pathology). Contribute to better Treatment

3. Anatomy

4. Structure and Function of the Organ of Hearing Conductive Part = Conductive Hearing Loss - External Ear - Middle Ear – Tympanic Membrane Ossicles - Liquid Filled Space Perceptive Part = Sensorineural Hearing Loss (H.L.) - Organ of Corti = Cochlear H.L. - Auditory Nerve = Neural H.L. - Hearing Pathway = Supracochlear H.L. - Cerebral Cortex = Central H.L. Conductive + Sensorineural = Combined H.L.

5. Whispering x Conversational Speech Tuning Force Weber´s Rinne´s Schwabach Gelle (Obsolete ?) Subjective Tests of Hearing without Special Devices

6. Tests of Hearing Subjective Hearing Thresholds - Air Conduction Thresholds - Bone Conduction Thresholds Audiometer – Electronic Instrument Generate Pure Tone Frequency 125 – 8000 Hz, Volume 0 – 110 dB and Noise. Performend in a Room Reasonably free of Noise Type of Hearing: - Conductive - Sensorineural -Mix Medico-Legal Methods according Fowler – Sabin

7. Tests of Hearing Subjective Speech Audiometry – Determined Understanding Highly Usefful for Diagnosis. Special Words from CD 50 % Correctly understood Word = Speech Receptual Thershold 100 % Correctly understanding Word = 100 % Speech Discrimination

8. Tests of Hearing Objective Impedance Measuremant TYMPANOMETRY A Tympanogram = Normal Middle Ear and Eardrum B Tympanogram = Fluid in the Middle Ear C Underpressure in the Tympanic Cavity STAPEDIUS REFLEX Changes: Present x Notpressent Decay

9. Test of Hearing Objective ERA – Evoked Response Audiometry Registration Electrical Charges Generated on Presentation of Sound in Cochlea ( Cochleography ) In Brainstem ( BERA, BAEP ) In Cortex ( CERA )

10. Test of Hearing Objective OAE – Otoakustic Emission The Ear, when stimulated can emit Sound (prof.Kemp). This Sound can be Measured when Hearing is Normal Usefful in Screening of Infants (Newborns)

11. Therapy Cerumen:Preferency of Otomikroscopic Menagement Sekretoric otitis: –endoskopic adenotomy –Transmyringing Drainege (Tubes) Chronic Otitis, otosklerosis: Otosurgery (Excelent Results )

12. Therapy Sensorineural H.L. Deafnes: Cochlear Implants (Condition: Functional Auditory Nerve) Sudden Hearing Loss: Corticoids + Vasoactive Drug Imidiately (in 24 hours) Progressive Sensorineural H.L.: Binaural Hearing Aids (Digital)

13. Presbyacusis Hearing Impaired Person (Seniors) = Bad Communication: Central and Periferal Hearing Threshold Hearing Pathway Psychological Difficulty Solutions (Therapy and Rehabilitation)

14. Summary Progres in Hearing Imparment: Testing + Treatment G.P: Otoscopy Whisper and Normal Speech Tuning Fork ENT: Audiometry: Bone and Air Conduction Thresholds Speech Audiometry Objective Audiometry Impedance Measurment (Tympanometry + Stapedius rfl.) Evoked Potentials, OAE Therapy: Digital Hearing Aids Cochlear Implant