Hearing tests depending on age. Three surefire ways to test your hearing

Hearing testing is carried out by 2 main groups of methods: objective and subjective. Objective methods are based on the emergence of unconditioned reflexes. Subjective methods include acoustic and audiometric methods.

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Hearing assessment methods

Objective methods of hearing research do not require the direct active participation of the patient and are more often used in pediatric practice (in newborns and children under 3 years of age).

All newborn children undergo audio screening - the study of hearing by recording otoacoustic emissions.

An objective hearing test is used:

For diagnosis in disabled people, patients in a comatose state;
To resolve controversial issues of examination and rehabilitation.

The acoustic method includes hearing examination using spoken and whispered speech, and examination with tuning forks. The audiometric method is a hearing test using an audiometer. In the practice of an otorhinolaryngologist, both of these methods are used.

Indications for ear examination

Hearing is required to be checked during medical examinations for workers employed in noisy industries. The test is carried out first using the acoustic method and then using the audiometric method.

Hearing is required to be checked by the driver's commission.

In pediatric practice, if there are no hearing complaints, the doctor checks the child’s hearing when registering for kindergarten and school. If a patient (adult or child) complains of ear pain, congestion, or hearing loss, an otolaryngologist will conduct a hearing test before and after prescribing treatment.

Diagnosis of eardrums

Let’s imagine a situation: a person came to see an ENT doctor complaining of hearing loss. The doctor collected anamnesis, identified complaints, and performed an examination.

If there are no foreign objects or wax plugs, which often cause hearing loss, the doctor begins to check the hearing analyzer.

Video

Acoustic testing method

Spoken speech test. The doctor or nurse asks the patient to stand in a certain place in the office, cover one ear with a hand or cotton earplugs, turn toward the wall, or close his eyes. Why turn away or close your eyes? Many people, without knowing it, can “read” lips.
For the study to be reliable, this “auxiliary” maneuver must be excluded. When the patient is ready, the doctor comes close and speaks numbers or words in a loud and clear voice. Words and numbers containing both voiced and voiceless consonants are used: cup of tea/cat/mouse and house/girl/frog.

In children, phrases that are understandable to children are more often used, and in the study of adults, numbers are used. The doctor gradually steps back from the patient, continuing to speak until the distance between the doctor and the patient is 6 meters.

Then the same procedure is repeated with the other ear. 6 meters is the minimum distance at which a healthy ear can hear spoken and whispered speech.
Whisper speech test. After preparing the patient (the same as when testing spoken language), the doctor or nurse pronounces phrases and numbers in a loud, clear whisper, gradually moving away from the person being tested until the distance between them reaches 6 meters.
If the person being tested has a hearing of 6:6 for spoken speech and 6:6 for whispered speech, he is absolutely healthy in hearing and can be hired for any job, even in noisy production. If the hearing is impaired, and at least one ear can hear at a distance of less than 3 meters, such a patient cannot be allowed to work in noisy production and at heights.

When testing children, especially preschoolers, it is advisable to pronounce phrases that are familiar to them: names of animals, names fairy-tale heroes. You can not say a word, but ask your child a question that requires an answer, for example: “do you like candy?” etc. (joking check).
Tuning fork tests. Testing with tuning forks is usually used not during preventive examinations, but when dealing with complaints about one or more bilateral decline hearing A tuning fork is a musical instrument that produces a clear sound of a certain frequency.
In medicine, tuning forks with a sound frequency of 128 (C128) and 2048 (C2048) per second are mainly used. 3 tuning fork tests are used: Weber, Rinne, Schwabach.

Audiometric test method

Testing on the device is carried out using an audiometer. The device generates a sound signal of varying intensity (from 0 to 120 dB) at different frequencies (from 125 Hz to 8000 kHz).

First, air conduction is checked, then bone conduction. The hearing threshold is considered to be the perception of a signal with an intensity of 10 dB at a frequency of 125 Hz.

How is audiometry performed? First, air conductivity is checked - the person being tested is put on headphones and a sound signal of the same intensity at different frequencies is sent to each ear separately, then the intensity increases.

As soon as the patient hears a sound, even the quietest one, he presses the button. The signal is recorded by the audiometer operator and transferred to the audiometric form. Air conduction is recorded for each ear separately.

Then they measure bone conductivity - a special bone microphone is installed on the mastoid process (behind the ear), the principle of signal transmission is the same as when measuring air conductivity. Bone conduction is usually lower than air conduction, and there is a small interval between them on the audiogram.

In children's practice, audiometers are sometimes used that produce not just a sound signal, but a word specific for each frequency, constantly increasing the intensity of the sound.

Why does hearing decrease in diseases?

Hearing loss due to various diseases can be reversible or irreversible. Reversible changes are most often associated with inflammation of the cells of the outer, middle or inner ear, inflammation and narrowing auditory tube.

Irreversible changes are associated with the death of cells of the receptor apparatus or the auditory zone of the cerebral cortex.

The causes of hearing impairment can be divided into 2 large groups:

Violation of sound transmission;
Impaired sound perception.

Violation of sound conduction is associated with diseases of the sound-conducting apparatus:

External auditory canal (otitis externa, sulfur plug, foreign bodies of the auditory canal);
Middle ear (acute and chronic otitis media, exudative otitis media, tubootitis, myringitis);
Inner ear (labyrinthitis).

In these diseases, hearing is reduced due to the fact that sound does not travel properly through the ear canal, is not perceived by the eardrum, is not amplified by the chain of auditory ossicles, etc. Hearing changes due to sound conduction disorders are often reversible and go away after proper treatment.

Impaired sound perception is a more complex pathology, according to various reasons the functioning of the receptor apparatus of the inner ear and/or the auditory zone of the cerebral cortex suffers.

Such changes are caused by:

Trauma: traumatic brain injury, fracture of the temporal bone, barotrauma;
Infectious disease, especially in children: influenza, measles, rubella, tick-borne encephalitis;
Taking ototoxic drugs: gentamicin, other aminoglycosides;
Dysmetabolic disorders: microangiopathy in diabetes mellitus;
Age-related changes: as a result of atherosclerotic damage to the vessels of the head and neck, the blood supply to the inner ear suffers and senile hearing loss develops.

Hearing loss due to impaired sound perception is sometimes curable, but requires longer and more persistent treatment with specific drugs:

Neuro- and angioprotectors;
Preparations that improve tissue trophism;
Histamine receptor blockers.

How to test your hearing for the effectiveness of treatment

Improving hearing as a criterion for recovery can be taken into account in the treatment of diseases of the sound-conducting apparatus (otitis media/myringitis, etc.).

The course of treatment is usually 7-10-14 days, rarely more. And in case of recovery, the patient himself notes an improvement in hearing.

In case of damage to the sound-receiving apparatus, a reliable criterion for the effectiveness of treatment is considered to be improvement in hearing (according to the results of acumetry and audiometry) with repeated studies after 3 months of taking prescribed medications.

Possible consequences of hearing loss

A disease associated with hearing impairment is medically called hearing loss. It may vary in severity and cause. Hearing loss is temporary or permanent. It may be curable or progressive. Depending on the severity of the hearing loss and when it occurs, the impact on the patient's life will vary.

It is most difficult to determine hearing loss in a child. More often it manifests itself in the fact that there is no reaction to loud sounds. The child does not lose hearing completely, but he or she may not be able to hear part of the sound spectrum. This situation leads to slow development of speech. The child speaks poorly, has a small vocabulary, and does not respond to requests from adults.

If hearing loss is not treated for a long time, then destructive processes in the cerebral cortex. Gradually, the area responsible for hearing begins to decrease in size and completely atrophies. It is no longer possible to restore brain function to its original state.

At school age, this leads to problems during learning. Children with moderate and severe hearing loss are forced to study in schools. They are less adapted to independent living. A mild form of hearing loss often characterizes patients as inattentive, distracted individuals. It is often said about them that they only hear what they want. Every day is stressful for them; they have to listen to every word in order to get the full amount of information.

The most pronounced consequences are moderate and severe hearing loss, which cannot be treated or become advanced. With moderate severity of the disease, a person tries to take a defensive position, he participates less in public life, and begins to gradually isolate himself. In conversations, the patient either dominates or tries to avoid it.

The more severe your hearing loss becomes, the more difficult it is to hide it from others. In the absence of treatment, the patient limits social contacts and avoids public events. Distrust and hostility towards the world around us leads to paranoia and isolation. Sometimes aggression and anger towards loved ones manifests itself.

In cases of severe hearing loss and the absence of treatment for the disease, the consequences include complete destruction social life, alcoholism, drug addiction, as an attempt to escape from the surrounding reality. Ultimately, the patient faces a transition to the “deaf” world. If hearing problems are detected, it is necessary to promptly diagnose and begin treatment.

How much does a hearing test cost?

Diagnosis of hearing loss can be carried out in a city clinic at a medical pole or in a paid center. In the first case, the procedure will be free, but it may not meet the requirements of a particular situation.

A paid center can conduct a wider range of studies.

An examination by an ENT doctor is the first stage in identifying hearing problems. The doctor examines the auricle and examines the eardrum for damage. Conducts speech research. The cost of an appointment with a doctor, depending on the medical center, ranges from 1000 to 1500 rubles.
Study with tuning forks. This examination is necessary to detect air and bone conduction. A set of tuning forks with different tones is used for the study. The method is more subjective and depends entirely on the professionalism of the doctor. Its cost is about 500 rubles.
To determine the volume that a person hears, it is necessary to conduct speech audiometry. The study is carried out in a soundproof room. All results are recorded on tape. The cost is about 1000 rubles.
In serious cases where brain dysfunction is possible, an MRI is necessary. The cost of the examination is about 2000 rubles.
Electrocochleography is required to diagnose cochlear activity and auditory nerve. The cost is from 1200 rubles.

Price paid services Diagnosis of hearing loss will be different in different medical centers. Most low prices V government institutions providing paid services.

Where can you quickly and accurately check your hearing?

The very first hearing test is carried out on a newborn in the postpartum ward. If the first test was successful, but parents have doubts about the baby’s hearing, they should contact an ENT doctor at a city clinic. The doctor will conduct an examination and carry out the necessary tests.

If there is any suspicion of serious deviations he can issue a referral to specialized research institutes. There are 2 centers in Moscow.

NCC of Otorhinolaryngology. Located on Volokolamsk highway. The center provides all types of medical care for ENT diseases. The structure of the complex includes laboratories, research centers, clinic. We employ specialists of a wide range of profiles. At the NCC you can get advice, carry out full examination, implement surgical intervention.
Research Institute of Pediatrics. The Scientific Center for Children's Health of the Russian Academy of Medical Sciences is a broad-spectrum structure. It includes a clinic, a hospital, and a scientific department. The main task of the research institute is to provide medical care in all main areas.

All studies related to hearing loss can be carried out in paid diagnostic centers. There are these in every city. Main role It is not the name of the clinic that matters, but the training and professionalism of the doctor who will perform the procedure.

What does a hearing test tell you?

Hearing testing may be required at different ages.

Timely execution diagnostic studies gives its results.

In case of acute hearing loss, diagnosis is carried out in a hospital setting. Emergency complex treatment is also provided there. More often it is antihistamines, antibiotics, ear drops. Treatment is aimed at restoring hearing and eliminating the inflammatory focus.
With frequent diseases in children, especially if they are associated with the growth of adenoids, diagnosis is necessary to identify hearing impairment. The appearance of hearing loss is a direct indicator for surgical intervention.
Diagnosis of hearing loss caused by infectious diseases makes it possible to completely eliminate the source of infection and provide adequate treatment. Timely assistance prevents the progression of the disease. Hearing is restored completely.
For abnormalities in the development of hearing organs timely diagnosis allows you to take action in a timely manner. In some situations, surgery or hearing aids may be installed. Such an adjustment will allow the child to hear the entire spectrum of sounds, therefore, his speech and all parts of the brain will develop harmoniously.

Without diagnosis, hearing loss will gradually progress, which will lead to irreparable consequences in the patient’s life.

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 decreased hearing, tinnitus, and, less commonly, dizziness and headache, irritability, reduced speech intelligibility in a noisy environment and a number of others. Some patients indicate the cause of hearing loss ( chronic inflammation middle ear, established diagnosis of otosclerosis, history of skull trauma, activity in conditions of industrial noise (mechanical assembly and forge shops, aviation industry, work in an orchestra, etc.). From concomitant diseases patients may indicate that they have arterial hypertension, diabetes mellitus, osteochondrosis cervical spine spine, hormonal dysfunction, etc.

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

When talking with a patient, you should evaluate the nature of his speech. For example, loud and clear speech indicates the presence of acquired bilateral sensorineural hearing loss in the years when the articulatory function of the speech-motor apparatus was fully formed. Slurred speech with articulatory 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 completely ensures auditory control of one’s own speech. You should pay attention to “behavioral” signs of hearing loss: the patient’s desire to approach the doctor with the better hearing ear, placing his palm to his ear in the form of a mouthpiece, an attentive gaze directed at 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 auriculotemporal areas, endoscopy of the ear, study of the barofunction of the auditory tube and some others. Endoscopy of the nose, pharynx and larynx is performed according to generally accepted methods.

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

Palpation and percussion. With their help, skin turgor, local and distant pain are determined. If there are complaints of pain in the ear, deep palpation and percussion in the area of projection of the antrum, platform mastoid process, scales of the temporal bone, the region of the temporomandibular joint and the retromandibular fossa in the parotid region salivary gland. The temporomandibular joint is palpated when opening and closing the mouth to identify 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 upward and backward (in infants, posteriorly and downward) and at the same time moving the tragus anteriorly. Deep sections The ear canal and eardrum are examined using the ear funnel and frontal reflector, and the presence or absence of certain identifying signs and pathological changes (retraction, hyperemia, perforation, etc.) is noted.

Hearing function test

The science whose subject of study is auditory function is called audiology(from lat. audio- I hear), and the clinical area dealing with the treatment of hard of hearing people is called audiology(from lat. surditas- deafness).

The hearing test method is called audiometry. This method distinguishes between the concept acumetry(from Greek akouo- listening), which is understood as the study of hearing using live speech and tuning forks. For audiometry, electronic-acoustic devices (audiometers) are used. The assessment criteria are the responses of the subject (subjective reaction): “I hear - I don’t hear”, “I understand - I don’t understand”, “louder - quieter - equally loud”, “higher - lower” in the tonality of the sound test, etc.

As a threshold value auditory perception the accepted sound pressure is 2.10:10,000 microbars (μb), or 0.000204 dynes/cm2, at a sound frequency of 1000 Hz. A value 10 times greater is equal to 1 belu (B) or 10 dB, 100 times greater (×10 2) - 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 20th century For hearing research, tuning forks became widespread, the method of using which in otiatry was developed by F. Betzold.

Hearing test using live speech

Whispered, spoken, loud and very loud speech (“cry with a rattle”) is used as testing speech sounds (words) while the opposite ear is muffled with a Barany rattle (Fig. 1).

Rice. 1.

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

Hearing testing using tuning forks

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

Rice. 2.

When examining hearing with tuning forks, a number of rules must be followed. The tuning fork should be held by the stem without touching the jaws. The jaws should not touch the ear and hair. When studying bone conduction, the stem of the tuning fork is placed on the crown or forehead along the midline (when determining the phenomenon literalization sound a) or on the platform of the mastoid process (when determining playing time tuning fork). The stem of the tuning fork should not be pressed too tightly against the tissues of the head, since the pain that arises in the subject distracts him from the main task of the study; in addition, this contributes to the accelerated damping of vibrations of the tuning fork jaws. It should be borne in mind that sounds at 1000 Hz and higher are capable of bending around the head of the subject, therefore, with good hearing in the non-examined ear, the phenomenon may occur over-the-air interceptions. Overhearing can also occur during tissue conduction studies; it occurs if the ear being tested has perceptual hearing loss, and the opposite ear either hears normally or has a conductive type of hearing loss, such as cerumen or a scarring process.

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

1) identification of spontaneous irritation of the sound analyzer using the SS test ( subjective noise);

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

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

4) identification of certain correlations between the perception of low and high tones during air and bone conduction of sound for the 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 for sound conduction disorders

	Tests



	Kr with ratchet	Muting


	C to 128 (N-40 c)
	Schwabach experience
	Weber's experience
	Rinne's experience
	Bing's Experience
	The Jelle experience
	Lewis-Federici experiment

Table 2. Hearing passport for impaired sound perception

	Tests



	Kr with ratchet	Muting


	C to 128 (N-40 c)
Shortened	Schwabach experience
	Weber's experience
	Rinne's experience
	The Jelle experience

Test SS reveals the presence of irritation of the peripheral nervous system of the organ of hearing or the state of excitation of the auditory centers. In the hearing certificate, the presence of tinnitus is marked with a “+” symbol.

Live speech research. This study is carried out in the absence of extraneous noise. The ear being examined 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 hearing passport in meters, a multiple of 0.5: 0; “u rak”, which means “hearing at the sink”; 0.5; 1; 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 jaw at a distance of 0.5-1 cm at intervals of once every 5 seconds. The entry in the passport is made with the same frequency, 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 passport norm tuning fork.

Criteria for evaluating tuning fork tests of a typical hearing passport

For airborne sound transmission:

conductive (bass) hearing loss: decreased duration of perception of tuning fork C 128 with near-normal perception of tuning fork C 2048;
perceptual (treble) hearing loss: near-normal time of perception of the tuning fork C 128 and a decrease in the duration of perception of the tuning fork from 2048.

For tissue (bone) sound conduction (only tuning fork C 128 is used):

conductive hearing loss: normal or increased duration of sound perception;
perceptual hearing loss: decreased duration of sound perception.

Also distinguished mixed type hearing loss, in which there is a shortening of the perception time of the bass (C 128) and treble (C 2048) tuning forks with air sound transmission, and the bass tuning fork with fabric sound transmission.

Criteria for evaluating tuning fork tests

Schwabach experience (1885). Classic version: the stem of a sounding tuning fork is applied to the crown of the subject until he stops perceiving sound, after which the examiner immediately applies it to his crown (it is assumed that the examinee must have normal hearing); if the sound is not heard, this indicates 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 stem of the sounding tuning fork is applied along the midline to the forehead or crown of the head, the subject reports the presence or absence of lateralization of the sound. With normal hearing or with symmetrical hearing loss, the sound will be felt “in the middle” or “in the head” without clear lateralization. If sound conduction is impaired, the sound is lateralized to the worse hearing ear; if sound perception is impaired, it is lateralized to the better hearing ear.

Rinne's experience(1885). Using C 128 or C 512, the sounding time of the tuning fork during air conduction is determined; then the sounding time of the same tuning fork during tissue conduction is determined. 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 they say that " Rinne's experience is positive”, and in the hearing passport this fact is noted in the corresponding cell with a “+” sign. In the case when the sounding time during tissue sound conduction is longer than the sounding time during air conduction, it is said that “ Rinne's experience is negative", And a sign is placed on the hearing passport"-". A positive Rinne is typical of normal hearing with normal air and bone conduction times. It is also positive for sensorineural hearing loss, but at lower time rates. Negative “Rinne” is characteristic of a violation of sound conduction. In the absence of sound perception through air sound conduction, they speak of an “infinitely negative Rinn”; in the absence of bone conduction, they speak of an “infinitely positive Rinn”. “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 severe sensorineural hearing loss in the examined ear. In this case, to study hearing, the healthy ear is muffled with a Barany ratchet.

The Jelle experience(1881). Designed to determine the presence or absence of mobility of the stapes base and is used mainly to identify stapes ankylosis 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 ear canal. To conduct the experiment, use a low-frequency tuning fork with for a long time sound and a Politzer balloon with a rubber tube with an olive attached to its end. An olive, selected according to the size of the external opening of the auditory canal, is tightly inserted into the external auditory canal, and a sounding tuning fork is placed with the handle on the mastoid area. If the sound becomes quieter, they say " positive" Jelle's experience, if it does not change, then the experience is defined as " negative" The corresponding symbols are placed on the hearing passport. Jelle's negative experience is observed with dissociation of the auditory ossicles as a result of trauma, perforations eardrum and obliteration of the windows of the ear labyrinth. Instead of a tuning fork, you can use the bone telephone of an audiometer.

Pure-tone threshold audiometry

Tone threshold audiometry is a standard generally accepted method for studying auditory sensitivity to “pure” tones in the range of 125-8000 (10,000) Hz with air conduction of sound and in the range of 250-4000 Hz with 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 pure tone audiogram and its recording in a “hard copy” on a special form using a printer indicating the protocol data. The tone audiogram form uses red for the right ear and blue for the left ear; for air conduction curves - a solid line, for bone conduction - a dotted line. When conducting tone, speech and other types of audiometric studies, the patient must be in a sound-attenuated chamber (Fig. 3). Each audiometer is additionally equipped with a generator of narrow-band and broadband noise spectra for conducting research with masking of the non-examined ear. To study air conductivity, specially calibrated headphones are used; for bone conduction - a “bone telephone” or a vibrator.

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

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

With normal hearing, the air and bone conduction curves 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 hearing impairment. There are three main types of changes in the tone threshold audiogram: ascending, descending And mixed(Fig. 4).

Rice. 4. The main types of tonal threshold audiograms: I - ascending when sound conduction is impaired; II - descending when sound perception is impaired; III - mixed when sound transmission and sound perception are impaired; RU - cochlear reserve, indicating the potential possibility of restoring hearing to the level of bone conduction, provided that the cause of hearing loss is eliminated

Suprathreshold audiometry

Suprathreshold 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: identification phenomenon of accelerated increase in volume And adaptation reserves hearing organ, definition level of auditory discomfort, degrees 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 the 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, individual specially selected words containing low and high frequency formants are used as test sounds. The result is assessed by the number of correctly understood and repeated words as a percentage of total number presented words. In Fig. Figure 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 — curve for the cochlear form of hearing loss; 3 — curve for mixed hearing loss; 4 — curve for central type of hearing loss; a, b - different positions of the speech intelligibility curve for conductive type of hearing loss; c, d — downward deviations of the curves with a decrease in USD (in the presence of FUNG)

Spatial Hearing Study

The study of the function of spatial hearing (ototopics) is aimed at developing methods for topical diagnostics 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 subject's task is to determine the location of the sound source. The results are assessed by the percentage of correct answers. With sensorineural hearing loss, the accuracy of determining the localization of the sound source decreases on the side of the worse-hearing ear. The vertical localization of sound in these patients changes depending on the hearing loss for high tones. With otosclerosis, the ability to localize sound in vertical plane regardless of the frequency spectrum of the testing sound, while the horizontal localization changes only depending on the asymmetry auditory function. In Meniere's disease, there is a constant violation of ototopy in all planes.

Methods for objective hearing testing

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

Auditory reflexes

They are based on reflex connections between the hearing organ and the sensorimotor sphere.

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

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

Auropupillar reflex(G. Holmgren, 1876) consists of a reflex dilation and then constriction of the pupils under the influence of a sudden strong sound.

Frechels reflex(Froeschels). The point is that when sharp sound an involuntary deviation of the gaze towards the sound source occurs.

Tsemakh reflex(Cemach). When a sudden loud sound occurs, the head and torso tilt (withdrawal reaction) in the direction opposite to the one from which the sharp, strong sound came.

Sound motor reflexes of the muscles of the tympanic cavity. These unconditioned reflexes, arising in response to suprathreshold sound stimulation, have become widespread in modern audiology and audiology.

Auditory evoked potentials

The method is based on the phenomenon of generation of bioelectrical signals in the neurons of the auditory zones of the cerebral cortex. evoked potentials, arising from the sounding of the receptor cells of the spiral organ of the cochlea, and the registration of these potentials using their summation and computer processing; hence another name for 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 averaged evoked auditory biopotentials

Methods for examining the auditory tube

Examination 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.

Scopic methods

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

At epipharyngoscopy(posterior rhinoscopy) evaluate the condition of the nasopharyngeal orifices of the auditory tubes (hyperemia, senechias, damage, etc.), the condition of the tubal tonsils and adenoid tissue, choanae, vomer, and a retrospective view of the nasal passages.

Pneumootoscopy

The technique is carried out using a Siegle funnel (1864), equipped with a rubber balloon for exposing the eardrum to an air stream (Fig. 7).

Rice. 7. Siegle funnel with pneumatic attachment

With normal ventilation function of the auditory tube, a pulsed increase in pressure in the external auditory canal causes vibrations of the eardrum. If the ventilation function of the auditory tube is impaired or during the adhesive process, there is no mobility of the membrane.

Salpingoscopy

Modern optical endoscopes are used to examine the nasopharyngeal opening of the auditory tube.

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

Blowing the auditory tube. This method is used both with diagnostic and therapeutic purpose. For it, a special rubber balloon is used, connected through 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 nasopharynx cavity is blocked soft palate, and the pharyngeal opening of the auditory tube opens. At this moment, the balloon is compressed, and air pressure increases in the nasal cavity and nasopharynx, which, when normal functioning The auditory tube enters the middle ear. Instead of taking a sip of water, you can pronounce sounds, the articulation of which causes the nasopharynx to be blocked by the soft palate, for example, “also-also,” “ku-ku,” “steamboat,” etc. When air enters the tympanic cavity, a peculiar noise can be heard in the external auditory canal. 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 examinee. Listening is carried out while swallowing with the nose pinched ( Toynbee test).

More effective way determining the patency of the auditory tube is Valsalva maneuver, which consists of trying to exhale forcefully while holding your nose and lips tightly together. During this test, in the case of patency of the auditory tube, the examinee experiences a feeling of fullness in the ears, and the examiner listens with the help of an otoscope to a characteristic blowing or clapping sound. Below is a list of the most famous samples.

The principles of assessing the patency of the auditory tube by grade 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 swallow;
II degree - murmur is heard during the Toynbee test;
III degree - a murmur is heard during the Valsalva maneuver;
IV degree - noise is not heard during any of the listed tests. Complete obstruction is assessed by the absence of noise when performing the Politzer test with a sip of water. If it is impossible to determine the patency of the auditory tube using the above methods, resort to its catheterization.

Eustachian tube catheterization

To carry out catheterization of the auditory tube, the following tools are required (Fig. 8): Politzer balloon (7) for blowing out the auditory tube; Lutze otoscope (2) for listening to tinnitus 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. 8. Set of tools 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 comes into contact with back wall nasopharynx, turn it 90° towards the opposite ear and pull it until it comes into contact with the vomer. Then turn the catheter with its beak downwards 180° towards the examined auditory tube so that the beak faces the side wall of the nasopharynx. After this, the beak is turned upward 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 “grabbing” the end of the catheter. Next, insert the conical end of the balloon into the socket of the catheter and pump air into it with light movements. When the auditory tube is patent, a blowing noise is heard, and upon otoscopy after blowing, injection of the vessels of the tympanic membrane is detected.

Ear manometry is based on recording an increase in pressure in the external auditory canal, which occurs when the pressure in the nasopharynx increases and the auditory tube is patent.

Currently, research into the function of the auditory tube is carried out using phonobarometry And electrotubometry.

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

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

Modern impedance measurements include measuring the absolute value of the input impedance, i.e., the acoustic resistance of the sound-conducting system; registration of changes in 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 disorders of auditory function at the level of the first neuron. The main diagnostic criteria are: a) threshold value stimulus sound in dB; b) duration of the latent period acoustic reflex, reflective functional state the first neuron, from the onset of the sound stimulus to the reflex contraction of the ipsi- or contralateral stapedius muscle; V) nature of changes acoustic reflex depending on the magnitude of the suprathreshold sound stimulus. These criteria are identified when measuring the parameters of the acoustic impedance of a sound-conducting system.

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

Audiometry is a medical method for determining the level of hearing. When performing such testing, the degree of sensitivity of the hearing analyzer in relation to sounds is assessed different frequencies and intensity. In the hospital, hearing tests are carried out using special equipment. The advantages of acumetry are that it allows you to dose different sound signals. Due to this, it is possible to determine the threshold susceptibility for sounds of different frequencies. In hospital settings, testing is carried out in soundproofed rooms. Based on the results of such an examination, it is possible to identify not only a decrease in hearing, but also the type of hearing loss. But you don’t have to go to the hospital to have your hearing checked; you can check it yourself.

Check Features

When checking your hearing by a doctor in conditions medical institution not only a decrease in audibility is determined, but also pathological process, which flows in the sound analyzer. Using an audiometer, an otolaryngologist or audiologist examines the conductivity level of air and bone sounds. Experts distinguish several types of audiometry:

Speech. This method considered the simplest and most accessible. In this hearing test, the doctor determines the level of speech recognition. When checking audibility, the doctor pronounces words in a voice of different volumes, and the patient must repeat them.
Tonal. This acoustic testing method helps determine how well a person hears sounds of different frequencies and intensities.
Computer. This hearing test is considered the most accurate. It helps determine the susceptibility of the sound-conducting and sound-perceiving systems.

Speech and pure-tone audiometry are classified as subjective methods for testing hearing levels. During the test, 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 computer hearing test, different sensitive electrodes are connected to a person, which record activity in certain areas of the brain if the auditory analyzer responds to signals received from an external source.

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

Speech audiometry

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

To objectively check the level of audibility, the audiometrist must speak not just words, but entire phrases that consist of simple words that are understandable to everyone. It is not difficult to carry out such a test; the main thing is to choose a room in which almost no extraneous noise can be heard. The person being examined is placed on a chair in the middle of the room.

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

During such a test, the subject must clearly repeat what he heard. This testing allows you to determine hearing impairment.

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

Determination of survey results

If there are no pathologies, then the person can hear speech spoken in a whisper, the ticking of a clock and any sounds that are in the range of up to 25 dB. If sounds in this range are clearly audible, we can say with confidence that the hearing is normal. When determining the results, the following points are also taken into account:

If a person cannot fully understand speech spoken in a whisper from a distance of two meters, then degree 1 hearing loss can be suspected.
If you are unable to understand quietly spoken phrases from a distance of 6 meters, you can speak of hearing loss of the 2nd degree.
If the person being examined has difficulty hearing very loud speech spoken from a distance of 20 meters, then we can talk about stage 2-3 hearing loss.

If at home check If any hearing problems have been detected, you need to contact an otolaryngologist, who will conduct an additional examination and prescribe treatment.

Auditory audiometry is most often used not for accurately determining hearing acuity, but for correct adjustment hearing aid.

How to test your hearing yourself

It is quite possible to check the hearing on your own, without the involvement of 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 as follows:

Is ticking audible? wall clock and phrases spoken in a whisper?
Do you have 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?
Is it good to understand quiet speech from a distance of two meters?
Is the speech of your interlocutors well received?

If most of the answers indicate that hearing acuity is impaired, you should consult a specialist.

Carry out an audiometric examination when colds it is forbidden. At this time it happens severe inflammation nasopharynx, which leads to deterioration of the patency of the Eustachian tube, therefore, with respiratory diseases there is a natural decrease in the audibility of sounds.

To ensure the reliability of the results obtained, testing can only be done if you are feeling well.

Testing apps

Online audiometry can be used to test hearing acuity. These are special applications that work on different platforms 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:

Hörtest.
Mimi Hearing Test.
uHear.

If you don’t have a smartphone, you can check your hearing with an audiogram online using a computer, but for this you need to have headphones ready. Based on the results of such testing, we can say with confidence whether a person hears well or not.

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

Checking for small children

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

Checking the hearing level of a newborn child at home is not easy, but if there is any suspicious situation, parents should inform the pediatrician.

Before a month, it is almost impossible to determine how a child reacts to sounds. Babies begin to respond to different sounds only with one month old. Parents should closely monitor the development of the baby. Among the toys, you should definitely buy a musical carousel, rattles and various squeakers.

When testing a baby's hearing, the following methods are used:

Take a jar of baby puree and fill it with any cereal. Take turns rubbing the jar near the baby’s ears and observing the reaction.
Make a loud sound out of the child's sight. If the baby reacted, then the hearing is absolutely fine. It is important not to overdo it here, as the baby may get scared. loud sound and burst into tears.
You can quietly hum a melody or ring a bell next to your baby's ear. If he responds to all sounds, then there is no cause for concern.

By age 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 there is deterioration in hearing, then you need to consult a doctor. The specialist will determine the cause of this pathology and prescribe comprehensive treatment. It is worth considering that with early therapy, hearing can be restored partially or even completely.

When you want to choose headphones, you study their technical characteristics, which include, among others, the value o. This value is important because it reflects the technical ability of headphones to reproduce frequencies that a person can hear.

If a person’s hearing is not damaged, then he can distinguish sound at frequencies from 20 Hz to 20,000 Hz. However, this is ideally real life our range will be different, and what’s more sad, it will be narrower than the classic 20 Hz - 20000 Hz.

What does a person hear and what does hearing health depend on?

The older we get, the worse our hearing becomes. Like everything else in our body, hearing begins to perform its tasks worse with age.

Those who are already about 30 years old can hardly distinguish a sound at a frequency of 20,000 Hz; they simply do not hear it, because hearing began to deteriorate. This is not a disease and not something to seriously worry about, this is how our hearing organ works - it does not recover and only gets worse over time.

By the age of 40, you will most likely no longer be able to distinguish sounds at a frequency of 18,000 Hz or even 17,000 Hz, and by the age of 50 good result It is considered to hear a sound at a frequency of 15,000 Hz.

Of course, each person’s hearing is unique; someone even at 50 years old can hear a sound with a frequency of 17,000 Hz, while others cannot even hear 12,000 Hz.

As I said above, hearing is not restored. The design of the organ is such that special hairs are responsible for irritating the nerve endings, which move when exposed to sound, i.e. air. With age, some hairs die off, while others are irreversibly damaged by listening to loud sounds.

Yes, yes, hearing can be damaged simply by going to concerts frequently, or working as a construction worker with heavy equipment, like a jackhammer, without hearing protection.

Every day we subject our hearing to serious tests, and every day it gets worse. Even a trip on the subway without headphones with active noise reduction slightly worsens our ability to perceive sound every time, and this is irreversible.

Therefore, you need to think about health from a young age, without expecting a noticeable degradation of the ability to hear, because there is no turning back.

Online hearing testing

Well, enough theory, let's check how well you hear different sound frequencies.

For simplicity and clarity, there will be only 4 frequencies that will show your current capabilities.

The fact is that hearing degradation occurs from the edges of the audible range, provided that there is no injury to the eardrum or disease of the inner ear.

Thus, it is clear that if changes in hearing have begun, then you will begin to hear worse at the border of the possible, i.e. at a frequency of 20 Hz or 20000 Hz. And the narrower the range, the more your hearing is damaged.

If you hear sound at 20 Hz, then you are fine with the perception of the lower threshold and that’s great. This means that your hearing is in more or less good condition, but don’t rejoice ahead of time, let’s listen to the following sounds.

Sound at 250 Hz is very important for our life. A lot of sounds from the surrounding world, people and animals sound around this frequency, so if you hear it, then you can live a full, normal life. But if you can’t hear it, this is a reason to immediately consult a doctor; even very old people who have not had hearing injuries can hear this sound well.

Sound at 2 kHz here only for big picture, it should be heard by absolutely all people who have not had hearing injuries or serious illness. This is one of the most loaded frequencies, because Most instruments sound at this frequency. Also, quite a few high-pitched female voices use this frequency and therefore it is extremely important for human life.

This is a test piece that reproduces 16 kHz sound. According to statistics, not every person who has lived to be 30 years old can hear this sound. Therefore, if you cannot hear it well and you are over 30 years old, then no big reasons for frustration. Of course, it’s a pity that your hearing has begun to deteriorate, but you are not yet outside the norm and there is no particular reason to worry. Although, of course, going to a doctor and having your hearing tested using professional equipment would not be a bad idea.

Let me just say that I am now 34 years old and I hear sound at a frequency of 16 kHz clearly and distinctly. Perhaps I should praise myself that I hear a little more than my peers.

This is a test recording sound with a frequency of 20 kHz. According to statistics, not all people over 20 years of age can hear it, even if they have never had any injuries or diseases of the hearing organs.

If you are over 20 years old and have not heard anything, do not be upset, this, unfortunately, is normal.

Personally, I no longer hear this frequency, but I am already 34 years old and this is absolutely normal for my age, although, of course, a little sad.

Why hearing testing is important for everyone

Of course, our online hearing testing is quite cursory, in addition, it is carried out on your own personal equipment, which can cause distortions and interfere with the purity of the experiment.

However, even such testing may make you think about your hearing health. After all, if you are still young, but already have trouble hearing the 16 kHz frequency, then you probably need to see a doctor for a more serious approach to this problem.

Plus, this quick test shows that for people over 30, there's little point in worrying about not listening or having Bluetooth headphones as their primary headphones.

The fact is that codecs for wireless transmission of music from music save the bandwidth of the Bluetooth channel, thereby increasing the stability of data transmission. And if you are young and listen to records, then you should think about using quality wired headphones. But if you are already 40 years old or older, then the quality of music transmission via Bluetooth will be enough for you, because... Those frequencies that are artificially cut off during encoding, you most likely will no longer hear and will not feel the difference in sound quality.

As you can see, every cloud has a silver lining. Yes, we are all getting older every year, and our hearing is fading, but now we can listen to comfortable music without a twinge of conscience and not worry about the quality of music transmission; online hearing testing has clearly shown us that this no longer matters much.