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The First Objective Audiometer (Wedenberg)
Cow Bell The First Objective Audiometer (Wedenberg)
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Subjective Component The patient
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Subjective Component The Operator
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Sound STR Tympanometry OAE ECoG 5ms BERA 10ms CERA 500ms CNV ERA S U B
J E C T I V E A U D I O M E T R Y Sound STR OUTER & MIDDLE EAR INNER EAR BRAIN STEM CORTEX CEREB- RUM Tympanometry OAE ECoG 5ms BERA 10ms CERA 500ms CNV ERA
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Hang STR Tympanometria OAE ECoG BERA CERA CNV ERA S Z U B J E K T Í V
A U D I O M E T R I A Hang STR KÜLSŐ és KÖZÉP FÜL BELSŐ FÜL AGY- TÖRZS CORTEX CEREB- RUM Tympanometria OAE ECoG BERA CERA CNV ERA
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Hang STR Tympanometria OAE ECoG BERA CERA CNV ERA S Z U B J E K T Í V
A U D I O M E T R I A Hang STR KÜLSŐ és KÖZÉP FÜL BELSŐ FÜL AGY- TÖRZS CORTEX CEREB- RUM Tympanometria OAE ECoG BERA CERA CNV ERA
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Hang STR Tympanometria OAE ECoG BERA CERA CNV ERA S Z U B J E K T Í V
A U D I O M E T R I A Hang STR KÜLSŐ és KÖZÉP FÜL BELSŐ FÜL AGY- TÖRZS CORTEX CEREB- RUM Tympanometria OAE ECoG BERA CERA CNV ERA
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Hang STR Tympanometria OAE ECoG BERA CERA CNV ERA S Z U B J E K T Í V
A U D I O M E T R I A Hang STR KÜLSŐ és KÖZÉP FÜL BELSŐ FÜL AGY- TÖRZS CORTEX CEREB- RUM Tympanometria OAE ECoG BERA CERA CNV ERA
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Hang STR Tympanometria OAE ECoG BERA CERA CNV ERA S Z U B J E K T Í V
A U D I O M E T R I A Hang STR KÜLSŐ és KÖZÉP FÜL BELSŐ FÜL AGY- TÖRZS CORTEX CEREB- RUM Tympanometria OAE ECoG BERA CERA CNV ERA
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Objectiv audiometry Evoked Responses Reflexes STR Acoustic response OAE Electric Response Audiometry: ERA ECoG ms BERA ms MLR ms Steadystate response CERA ms CNV ca. 2 sec
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Age-dependence in examinations
Type of examination ERA, OAE Stapedial reflex Reflexaudiometry Behaviour-audiometry Play-audiometry Pure-tone audiometry Speech-audiometry Supratreshold-audiometry
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Tympanometry, STR, MFT Tympanograms A-type B-type C-type Loudspeaker
Tone-generator A-type Airpump Equalizer Ampli-fier Voltmeter Earcanal-Probe Amplifier Microphon Voltage Controller Tympanometry, STR, MFT B-type C-type Normal Reflexdecay
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Loudspeaker Amplifier Tone-generator Air-pump Amplifier Equaliser Voltmeter Ear-canal-Probe Microphone Voltage Controller
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Pressure [dPa] Pressure [dPa] Pressure [dPa] Type A Type B Type C
![Pressure [dPa] Pressure [dPa] Pressure [dPa] Type A Type B Type C.](http://slideplayer.com/slide/14884838/91/images/14/Pressure+%5BdPa%5D+Pressure+%5BdPa%5D+Pressure+%5BdPa%5D+Type+A+Type+B+Type+C..jpg "Pressure [dPa] Pressure [dPa] Pressure [dPa] Type A Type B Type C.")
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Normal STR-decay Pathological STR-decay
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Hearing Pathway
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Photosummation
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Digitalis purpurea Finger Hut Fox glove Gyüszűvirág
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A/D Conversion AVERAGING AVERAGING
2048 sample Channels Analog signal AVERAGING 2048 sample averaging Digital data
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Minták száma Sampling Rate Mintavétel sűrűsége Number of Sampling
sample Sampling Rate 85 points 51 points 256 points Mintavétel sűrűsége Number of Sampling
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Sound stimuli Sound stimuli Click01 click10 click23
One-cycle Sinus Halve-cycle Sinus rectangular biphase Click01 click10 click23 Sound stimuli Sound stimuli STOP Sinus tone without modulatio risetime = 0 Wavolvaso Rising Plateau decreasing T.burst t.burst4 -> longer Ms/division
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Built in the computer Sound generator Ampli- fier Monitor/ Printer
AD-Conv Averager Ampli- fier Pre Amplifier
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ECoG
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Tchaikovsky B minor piano concerto Panpipe
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Amplifier Loudspeaker Tape recorder
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0.day Neomycin 4.day Neomycin 9.day Hearing aid
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SP less than half as AP is normal
SP more than half as AP is recruitment
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Advantages of ECoG: Exact information about the periphery No negative interaction of the general anesthesia Disadvantages of ECoG: Information is only about the periphery Invasive
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BERA (ABR)
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Intenzity-latency gram
BERA-thresholds
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Retrocochlear lesion I –V IPL 4.2 +/- 0.3 <4.5 normal
>4.5<4.65 suspect >4.6 RL Retrocochlear lesion
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Waves are successive missing
Retrocochlear lesion
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Recruitment
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Advantages of BERA : Exact information from the periphery No negative interaction of the general anesthesia Noninvasive Brainstem topo-diagnostic Precise objective hearing threshold (2-4 kHz) Drawbacks of BERA: Information is only from the periphery There is no frequency-specificity
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BERA
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MLR-Threshold MLR FFR BERA
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MLR BERA
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40 Hz Response
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Advantages of MLR : Noninvasive Frequency -specificity Drawbacks of MLR: Slight interaction of general anesthesia Threshold is not precise Time consuming
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CERA 500 ms
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Advantages of CERA: Noninvasive Frequency -specificity Drawbacks of CERA: Strong interaction of general anesthesia Threshold is not precise Time consuming
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CNV MMN
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ON-Responses all together
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BeforeTreat-ment After Treat-ment
SUDDEN DEAFNESS BeforeTreat-ment After Treat-ment AUDIOGRAM BERA DPOAE TEOAE
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OAE + BERA TUMOUR
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STEADY-STATE POTENCIALS AMFR
MASTER John&Picton1998 Steady-St. Resp
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David Kemp 1978
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Thank You Very Much for Your Attention!
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