The main methods of hearing research include: Methods for studying the organ of hearing and the auditory tube. Hearing research methods

Audiometry is understood as a medical procedure for measuring the level of human hearing, which is characterized by the completeness of the biofunctional susceptibility of the human hearing analyzer and the occurrence of disorders in the anatomical structure. The term “audiometry” was formed by merging two words – the Latin audio (to hear) and the Greek metreo (to measure).

To test your hearing and conduct audiometry, you must consult with an ENT doctor.

Principle and features of the procedure

A person with healthy hearing perfectly perceives both spoken speech and speech that others pronounce in a whisper. But sometimes such sensitivity can decrease and a person stops hearing quieter speech or whispers. This occurs due to injuries, birth defects, professional activities that affect hearing, and illnesses. Hearing audiometry is used in medicine to assess the sensitivity of different tones of sounds.

The hearing audiometry technique helps to recognize the threshold for the perception of sounds in each individual patient at a certain point in time. The procedure is very simple and does not require complex equipment. All equipment used during audiometry is tuning forks and audiometers.

The main criterion for normal hearing is the ability to recognize a person’s whisper, which is pronounced at a distance of six meters from the ear being tested. When used during testing, an audiometer can reveal both the level of sensitivity of hearing perception and the location of the lesion in the body that interferes with the normal functioning of the hearing aid.

Audiometry is very simple. A sound signal necessary for the doctor to determine the state of frequency and strength is sent to the ear that is currently being examined. If the patient perceives the signal (that is, hears), he presses the button; if he does not recognize it, then he does not press it. This process perfectly characterizes the hearing threshold.

During computer audiometry, the patient must fall asleep. The day before, special sensors are fixed on his head that sense changes in the strength of brain waves. Using special electrodes, a computer helps to independently monitor all the patient’s brain reactions and build a diagram based on them.

Indications for the hearing level measurement procedure are:

chronic or acute deafness;
inflammation of the middle ear - otitis media;
the process of selecting a hearing aid for a patient;
checking the effectiveness of the therapy.

Audiometry has no contraindications. It can be performed at any time, and the patient does not experience any discomfort or pain. The process lasts about half an hour.

There are many types of modern audiometry, it can be:

tonal;
threshold;
computer;
speech;
objective;
game;
suprathreshold;
screening

Carrying out pure-tone audiometry

To more accurately measure the patient’s limiting threshold of sound perception, a specialist conducts hearing tests in the range from 125 to 8000 hertz. With pure-tone audiometry, it becomes possible to determine the minimum and maximum sound level values that are comfortable for the person being examined.

During this procedure, an audiometer is used, where, with the help of headphones that are connected to the device, a signal of a certain tone is sent to the auricle. If the patient hears the signal, he presses a special button, and if this does not happen, the tone of the signal increases. This happens until the signal becomes audible and the patient presses the button. This indicator is the lower limit of the patient’s hearing level. The maximum level is determined exactly according to the same scheme.

Pure-tone audiometry can be used for patients of any age, but the play form is more suitable for children. As a result of the study, the specialist receives an accurate and complete picture of the patient’s auditory parameters.

Features of the threshold technique

Threshold audiometry is performed using an audiometer. The minimum frequency of the device is 125 hertz, and then it will increase by a threshold with an increment of 67.5 hertz to the maximum frequency provided for by a specific audiometer model. A similar procedure is carried out in a soundproofed room. If such conditions are not created, then the specialist must take into account the impact of external noise on the test results. To smooth out such imperfections in the procedure, in-ear headphones are often used, which can increase the accuracy of studies to determine the level of hearing.

The advantages of in-ear headphones are the ability to reduce external noise, reduce the need to use masking sounds due to interaural relaxation, and eliminate the collapse of the external auditory canals. These advantages are especially important when working with newborns. The accuracy and regularity of repetition of the results suggests that this technique can be considered very reliable. At the same time, by analyzing the graph of individual air patency, the specialist has the opportunity to draw conclusions about the level of functioning of the middle ear and its condition.

In case of complete deafness, this technique does not allow one to immediately identify the affected area; to determine it, it is necessary to conduct additional suprathreshold tests. Among such methods, the Fowler or Langenbeck tests and various noise techniques are especially popular. These types of tests will clarify for specialists exactly where the damage is located - in the ear labyrinth, in the cells of the vestibule or auditory nerve.

Use of computer and speech audiometry

Computer audiometry is the most accurate method for determining hearing acuity. Computer equipment provides the patient with complete freedom of action and movement; he can relax and not focus on hearing certain sounds in a timely manner. The equipment itself is capable of determining all limit values, it operates absolutely painlessly and safely, therefore this method is widely used to make an accurate diagnosis even in newborns.

With speech audiometry, on the contrary, all actions are carried out exclusively by the patient and the doctor without the use of any technical means or devices. This is the earliest method for determining hearing threshold. The result of this procedure can be largely determined not by hearing, but by the intellect and vocabulary of the sick person. A similar technique can give different results when the audiometrist pronounces individual words or arranges them into sentences. Suggestions are always better received by patients and easier to differentiate.

Modern medicine practically does not use this technique. It is used today exclusively in cases where specialists need to test a patient to select a suitable hearing aid.

Features of objective audiometry

The objective technique is used in newborns and in the forensic field. It is based on the analytical features of the conditioned and unconditioned reflexes of the human body, which must respond to audio stimuli of different frequencies. Reactions of the body can be recorded using this method for reasons independent of the will of the organism being examined.

Among the unconditioned reflexes that are examined during objective audiometry, one can distinguish dilating eye pupils or the cochlear-pupillary reaction, closing eyelids at sudden sounds or the auropalpebral reflex, inhibition of sucking in a newborn at various sounds, contractility of the orbicularis oculi muscle, galvanic skin changes, reactions vascular system.

Modern objective audiometry is divided into acoustic impedansometry, which includes the process of recording the acoustic reflex, and tympanometry, electrocochleography, and electroencephaloaudiometry. In this case, tympanometry helps to assess the mobility of the eardrums, the chain of the bone part of the patient’s hearing aid, and using the acoustic reflex, the signal passing from the intra-ear muscles is recorded as a response to the impact on the patient’s eardrum. Electrocochleography allows electrical stimulation of the auditory nerve, and electroencephaloaudiometry demonstrates to the doctor the potential of the brain's auditory area.

Game technique

Game audiometry is used to a greater extent when working with children. Children cannot reflexively press lifeless buttons for a long time, so the method uses the principle of using game moments. For example, when a sound is heard and a button is pressed, a small patient will be able to see a new bright picture or some kind of game object, which will stimulate him to follow the audiologist’s commands.

In game audiometry, a tone audiometer is often used, which was once proposed by specialist Jan Lesak. The audiometer is a toy house with people, animals, and vehicles. The little patient is given a remote control in the form of a mushroom, with which he can perform certain actions under the right conditions. For example, in order to free a little man from captivity, a small patient must wait until he is asked to do so and press the appropriate button on the fungus. This is how the audiometrist understands that his signal was heard by the child. A similar technique is proposed by doctor Kosachev; there are also methods for determining hearing in young patients, tested by other specialists in the industry.

The importance of audiometry in children is reflected in the fact that with poor hearing levels, children also have a delay in speech development.

Technique of suprathreshold audiometry

A suprathreshold technique for testing hearing acuity was proposed and tested by Luscher. Thanks to this method, specialists today have the opportunity to evaluate the differential threshold of sound intensity - the index of small increases in intensity. This study is most often performed if there is a risk of an increase in the volume of lymph in the cavity of the inner ear (Meniere's disease), auditory neuroma (a benign neoplasm, the source of which is the auditory nerve). The technique of suprathreshold audiometry is used for unilateral hearing loss, but can also be used for bilateral hearing aid anomalies. In this case, a certain sound signal will be sent to each ear, which must correspond to the threshold norm of a particular hearing aid. For example, if on one ear the threshold value should be equal to 5 decibels, then on the second, the permissible value can be equal to 40. At the same time, the signal that is sent to the affected ear is gradually increased by 10 decibels, and the limiting sound value supplied to the healthy ear, they are brought into such compliance that it seems to the patient that a signal of the same intensity is being sent to both ears. This is how the tonality is equalized with a gradual gradation of one threshold equal to 10 decibels.

Application of screening audiometry

A medical audiometer today can be represented by three types of devices - outpatient, screening or clinical. The simplest device is a screening audiometer, which provides the specialist with a much wider field of possibilities during the procedure than the same outpatient device.

Tonal diagnostics of audibility is carried out in this case based on the sound conductivity of air masses. The screening audiometer is a mobile device; its functionality will allow the specialist to individually select the frequencies and tonality of the sounds produced. It is possible to test the patient both manually and automatically.

During testing, a parallel-connected otoscopic device will help assess the levels of audibility and sound comfort for the patient. Using a connected microphone, the doctor has the opportunity to contact the patient, and using a printer, there is a chance to receive an audiogram in printed form.

Office and procedure results

In order for audiometry results to be objective, the procedure should be carried out in a well-isolated room, where the parallel influence of external noise on the process is minimized. Also, the space where the examination takes place must be protected from electrical and magnetic waves.

The room should be free, especially with the speech method, and the distance from the patient to the doctor should be at least 6 meters. The best place for this diagnosis is a specialized acoustics chamber, which is adapted for audiometry.

After the procedure, the specialist receives several special graphs on biaxial planes. On the horizontal axis there are divisions expressed in hertz, and they characterize the frequencies of tones. The vertical axis shows the sound intensity in decibels. The sound perception of the right ear is shown on a red curve with circles, and the left ear is shown on a blue curve with crosses.

Tedeeva Madina Elkanovna

Speciality: therapist, radiologist.

Total experience: 20 years.

Place of work: LLC “SL Medical Group”, Maykop.

Education:1990-1996, North Ossetian State Medical Academy.

Advanced training:

1. In 2016, at the Russian Medical Academy of Postgraduate Education, she underwent advanced training in the additional professional program “Therapy” and was admitted to carry out medical or pharmaceutical activities in the specialty of therapy.

2. In 2017, by the decision of the examination committee at the private institution of additional professional education “Institute for Advanced Training of Medical Personnel”, she was admitted to carry out medical or pharmaceutical activities in the specialty of radiology.

Experience: general practitioner – 18 years, radiologist – 2 years.

The study identifies the minimum level of sound that a person can hear by measuring hearing thresholds for tones of different frequencies. Hearing thresholds are measured in decibels - the worse a person hears, the higher the hearing thresholds in decibels he has.

There is also speech audiometry, in which words are presented and their intelligibility is assessed in different conditions (in silence, in noise and other distortions). Currently, behavioral, psychophysical, electroacoustic and electrophysiological research methods are used to determine hearing in people.

All methods for studying the hearing organ in young children are divided into 3 groups.

Unconditioned reflex methods of hearing research.
Conditioned reflex methods of hearing research.
Objective methods of hearing research.

All techniques are informative when used correctly.

1. Unconditioned reflex techniques

In children under one year of age, the hearing status is checked by assessing unconditioned reflexes that arise without prior development. The child’s informative indicative reactions to sounds include the following:

auropalpebral reflex of ankylosing spondylitis (blinking and activity of the eyelids);
auropupillar Shurygin reflex (pupil dilation);
oculomotor reflex;
sucking reflex;
reaction of flinching, fear;
freezing reaction;
awakening reaction;
turning the head towards or away from the sound source;
facial grimace;
wide eye opening;
the occurrence of motor movements of the limbs;
change in the rhythm of breathing movements;
change in heart rate

These reflexes serve as a manifestation of a complex orienting reaction (motor defensive reaction) and the inclusion of an acoustic feedback loop. When using unconditioned reflex techniques, the age-related characteristics of auditory function and the psychomotor development of the child are taken into account.

Psychoacoustic techniques based on recording various components of the innate unconditioned orienting reflex make it possible to get a general idea of the presence of hearing in infants (up to one year).

Unconditioned reflex techniques, due to their easy availability, can be widely used for a screening system for identifying young children with impaired hearing, but they have a number of disadvantages.

The negative aspects of the unconditioned reflex technique include:

significant individual variation in behavioral reactions;
inconstancy, rapid extinction of the unconditioned reflex upon repeated presentation of the sound signal;
the need to present an inadequately high threshold for the occurrence of a reflex response (70-90 dB), which makes it more difficult to detect hearing loss up to 50-60 dB, which, in turn, leads to an increase in false-positive results.

Many authors believe that in young children (up to 2 years of age) and especially in children with pathology of the central nervous system, accompanied by a lag in motor development, along with psychoacoustic techniques, it is advisable to use objective electrophysiological methods of hearing research

Currently, when conducting audiological screening in young children in Russia, OAE (otoacoustic emissions) is used.

2. Conditioned reflex techniques

The second direction of pediatric audiometry is based on the development of conditioned reflexes. In this case, the most biologically significant unconditioned reflexes are used as the basic ones - defensive, food and operant on play or speech reinforcement. Operant conditioned reflexes involve the performance of some action on the part of the subject - pressing a button, movements of the hand, head.

The development of a conditioned reflex in response to a sound stimulus with repeated use of unconditional reinforcement is explained by the laws of conditioned reflex activity according to Pavlov. When a temporary connection is established between a conditioned (sound) and an unconditioned stimulus, one sound is able to cause one or another reaction.

Methods based on conditioned reflex connections also include:

conditioned reflex pupillary reaction;
conditioned reflex blinking reaction;
conditioned reflex vascular reaction;
conditioned reflex cochleocardial reaction (this reaction with reinforcement develops as a vegetative component to a number of stimuli;
galvanic skin response - the use of electric current that causes a change in skin potentials and others.

In children over 3 years of age and under 1 year of age, the results obtained were unsatisfactory, which was explained by a lack of interest in older children and the appearance of rapid fatigue in younger ones.

Negative points conditioned reflex techniques are:

inability to accurately determine hearing thresholds;
rapid disappearance of conditioned reflexes during repeated studies;
dependence of the study results on the psycho-emotional state of the child, difficulties in assessing hearing in children with mental disorders.

3. Objective methods of hearing testing

One of the areas of modern clinical audiology is the development and improvement of objective methods for studying hearing.

Objective research methods include techniques based on recording electrical signals generated in various parts of the auditory system in response to sound stimuli.

Objective methods for studying the functional state of the auditory system are progressive, promising and extremely relevant for modern audiology. The following objective methods are currently used: impedance measurement, recording of auditory evoked potentials (AEP), including electrocochleography, and otoacoustic emissions.

Let's look at each of the methods in more detail.

Acoustic impedance measurement

Acoustic impedansometry includes several methods of diagnostic examination: measurement of the absolute acoustic impedance, tympanometry, measurement of the acoustic muscle reflex (A.S. Rosenblum, E.M. Tsiryulnikov, 1993).

The most widespread assessment of dynamic impedance indicators is tympanometry and acoustic reflex.

Tympanometry is a measurement of the dependence of acoustic conductivity on air pressure in the external auditory canal.

Acoustic reflexometry is the recording of contraction of the stapedius muscle in response to sound stimulation (J. Jerger, 1970). The minimum sound level required to cause contraction of the stapedius muscle is considered the threshold of the acoustic reflex (J. Jerger, 1970; J. Jerger et al., 1974; G.R. Popelka, 1981). The acoustic reflex is a reaction of the nervous system to counter strong sound, designed to protect the vestibulocochlear organ from sound overload (J. Jerger, 1970; V.G. Bazarov et al., 1995).

The amplitude characteristics of the acoustic reflex of the stapedius muscle have found wide practical application. According to many authors, this method can be used for the purpose of early and differential diagnosis of hearing loss.

The acoustic reflex, closing at the level of the nuclei of the brain stem and participating in complex mechanisms for processing sound information, can respond by changing its amplitude in case of disturbances in the functional state of the organ of hearing and the central nervous system. When studying AR amplitude indicators depending on disturbances in the functional state of the central nervous system according to EEG data, it was found that their decrease is more often observed during phenomena of irritation of the cerebral cortex rather than its diencephalic-stem parts (N.S. Kozak, A.N. Golod, 1998) .

With damage to the brainstem, an increase in the threshold of the acoustic reflex or its absence may be observed (W.G. Thomas et al., 1985). If the acoustic reflex is realized in the auditory analyzer at a level lower than a certain pure tone threshold, the hearing loss is obviously functional (A.S. Feldman, C.T. Grimes, 1985).

The accumulated facts in the literature on tympanometry are almost exclusively based on the identification of five standard types proposed back in 1970 by J. Jerger, while in young children there is a polymorphism of tympanograms that does not fit into this classification.

It is necessary to note the significant value of tympanometry in the diagnosis of middle ear lesions in children of all age groups.

The value of the acoustic reflex for predicting hearing loss in children is still being debated. Most studies report the reflex threshold as the main criterion for impedance measurements (S. Jerger, J. Jerger, 1974; M. McMillan et al., 1985), but it is known that in children of the first year of life, threshold responses are unclear and unstable. For example, G.Liden, E.R. Harford (1985) noted that half of the children with hearing loss in the range of 20-75 dB had a normal acoustic reflex (as well as in children with good hearing). On the other hand, only 88% of children with normal hearing had an acoustic reflex that corresponded to the norm.

B.M. Sagalovich, E.I. Shimanskaya (1992) studied the results of impedance measurements in young children. According to the authors, many children in the 1st month of life had an absence of an acoustic reflex, even at a stimulus intensity at which the children wake up and a motion artifact appears in the recording (100–110 dB). Consequently, there is a reaction to sound, but it is not expressed in the formation of an acoustic stapedial reflex.

According to B.M. Sagalovich, E.I. Shimanskaya (1992), when screening diagnostics, it is inappropriate to rely on impedance measurements in children in the first month of life. They note that at the age of over 1.5 months, an acoustic reflex appears; the reflex threshold ranges from 85-100 dB. An acoustic reflex was recorded in all children aged 4-12 months, so impedance testing can be used as an objective test with a sufficient degree of reliability, subject to strict adherence to some special methodological conditions.

The question of using sedatives to eliminate motion artifacts in children, especially during screening diagnostics, remains very difficult (B.M. Sagalovich, E.I. Shimanskaya, 1992).

In this sense, their use is advisable, however, sedatives are not indifferent to the child’s body, moreover, the sedative effect is not achieved in all children, and in some cases it changes the threshold value and the amplitude of suprathreshold responses of the acoustic reflex (S. Jerger, J. Jerger, 1974; O. Dinc, D. Nagel, 1988).

Various drugs and toxic drugs can affect the acoustic reflex (V.G. Bazarov et al., 1995).

Thus, to correctly assess the results of impedance testing, it is necessary, firstly, to take into account the patient’s condition (presence of pathology from the central nervous system; use of sedatives), and secondly, to introduce age-related corrections, since in the process of maturation of the auditory system they can some parameters of the acoustic reflex of the stapedius muscle change (S.M. Megrelishvili, 1993).

The method of dynamic impedansometry deserves widespread implementation in audiological practice.

Auditory evoked potentials

The objectivity of the SVP registration method is based on the following. In response to sound influence, electrical activity arises in various parts of the auditory analyzer, which gradually covers all parts of the analyzer from the periphery to the centers: the cochlea, the auditory nerve, the nuclei of the brainstem, and the cortical sections.

The SEP recording consists of 5 main waves that arise in response to sound stimulation in the first 10 ms. It is generally accepted that individual ACEP waves are generated by different levels of the auditory system: the auditory nerve, cochlea, cochlear nuclei, superior olivary complex, lateral lemniscus nuclei and inferior colliculus. The most stable of the entire complex of waves is the V wave, which persists up to threshold levels of stimulation and by which the level of auditory loss is determined (A.S. Rosenblum et al., 1992; I.I. Ababii, E.M. Pruneanu et al., 1995, etc.).

Auditory evoked potentials are divided into three classes: cochlear, muscle and brain (A.S. Rosenblum et al., 1992). Cochlear SEPs combine the microphone potential, the summation potential of the cochlea, and the action potential of the auditory nerve. Muscle (sensorimotor) SEPs include evoked potentials of individual muscles of the head and neck. In the class of brain SEPs, potentials are divided depending on the latent period. There are short-, medium- and long-latency SVPs.

T.G. Gvelesiani (2000) identifies the following classes of auditory evoked potentials:

cochlear potentials (electrocochleogram);
short-latency (brainstem) auditory evoked potentials;
medium latency auditory evoked potentials;
long-latency (cortical) auditory evoked potentials.

Currently, a reliable method for studying hearing, which is becoming increasingly widespread, is computer audiometry, which includes registration of short-latency, medium-latency and long-latency evoked potentials.

Registration of CVEP is carried out in a state of wakefulness of the subject or natural sleep. In some cases, if the child is overly excited and has a negative attitude towards the study (which is observed more often in children with pathologies of the central nervous system), sedation should be used (A.S. Rosenblum et al., 1992).

The dependence of the amplitude-temporal characteristics of SEPs and their detection thresholds on the age of the child (E.Yu. Glukhova, 1980; M.P. Fried et al., 1982) is explained by the process of maturation of glial cells, differentiation and myelination of neurons, as well as functional inferiority of synaptic transmission.

The thresholds for recording short-latency auditory evoked potentials (SLEP) in one-year-old children approach those in adults, and long-latency auditory evoked potentials (LSEP) - by the age of 16 (Z.S. Aliev, L.A. Novikova, 1988).

Therefore, knowledge of the exact quantitative characteristics of CVEP, which are characteristic of healthy young children, is one of the conditions for diagnosing hearing impairment in childhood. KSVP can be successfully used in pediatric audiological practice with mandatory consideration of the age values of these parameters (I.F. Grigorieva, 1993).

The result of CVEP depends on the state of the receptors and centers in the brain stem. Abnormal curves may be due to damage to both.

G. Liden, E.R. Harford (1985) emphasize that the use of this method may give incorrect results, therefore, if an atypical CVSP recording is obtained in infants, the study should be repeated after 6 months.

Despite the 30-year history of the issue, the problem of correspondence between the results of registration of CVEP and subjective methods for determining hearing thresholds in hard of hearing children remains relevant to this day (A.V. Gunenkov, T.G. Gvelesiani, 1999).

A.V. Gunenkov, T.G. Gvelesiani (1999), having analyzed the results of examination of 81 children (from 2 years 6 months to 14 years), made the following conclusions.

Firstly, in the majority of children suffering from hearing loss, the subjective hearing thresholds are quite consistent with the data from the registration of CVEP.

Secondly, with mixed hearing loss, the discrepancy between objective and subjective thresholds is significantly higher than with sensorineural hearing loss. This is likely due to the fact that the conductive component not only increases the latency of the CVEP peaks, but also impairs their visualization.

According to B.M. Sagalovich (1992), electrical responses supplement or clarify information about the nature of disorders in the auditory system, but in practice it is more correct not to turn them into an analogue of subjective processes. While widely using the registration of SVPs, the author does not consider it correct to identify them with hearing. At best they can be considered the electrical equivalent of this sensation.

SEPs occur only to suprathreshold stimuli, while the goal of the study is to determine the minimum signal intensity at which a brain response can be recorded. The problem lies only in determining the relationship between subjective hearing thresholds and SVP thresholds.

The so-called long-latency SEPs correlate most with the concept of “hearing” (K.V. Grachev and A.I. Lopotko, 1993). Unlike KSVP, DSVP, i.e. cortical potentials have thresholds close to hearing thresholds. But this should hardly be regarded as an expression of hearing acuity (B.M. Sagalovich, 1992).

A.D. Murray et al. (1985), A. Fujita et al. (1991) also concluded that when using DSVP, recording thresholds coincide with hearing thresholds. Along with this, the authors clarify that the results of the study depend on the psycho-emotional state and sleep phase, therefore in practice the absolute values of latent periods of SEP are used, and not their ratios.

According to A.S. Rosenblum et al. (1992), DSVPs allow one to assess the state of auditory function in the entire range of speech frequencies, but show signs of “maturation”, i.e. the process of growing up, which is why difficulties arise in identification in children under the age of 15-16 years.

DVSPs have diagnostic value for identifying central hearing disorders. However, this technique has a number of disadvantages (K.V. Grachev, A.I. Lopotko, 1993; A.S. Feldman, C.T. Grimes, 1985):

their significant dependence on the physiological state of the subject;
his age;
the presence of difficulties associated with the influence of artifacts of biological and non-biological origin (long latency of potentials leads to significant instability of reactions);
Preliminary drug sedation of children distorts recordings of reactions from the cerebral cortex.

Therefore, it seems extremely difficult to study hearing in active and negatively-minded young children, since all types of anesthesia, with the possible exception of diphenhydramine and chloral hydrate, are unsuitable in these cases for one reason or another (K.V. Grachev, A.I. Lopotko, 1993).

Thus, SVP methods do not depend on the cooperativity of the subject and can be used to examine hearing in subjects of any age. In this sense, they are objective, at least to the same extent as reflexive techniques. However, they depend to a much greater extent on the qualifications of the researcher and, in this sense, only transfer the subjective diagnostic factor from the patient to the doctor (K.V. Grachev and A.I. Lopotko, 1993).

K.V. Grachev and A.I. Lopotko (1993) also believe that a general disadvantage of SVP diagnostics, in addition to the need for unique equipment, is the duration of the study. And the possibility of practically reducing the time required to perform tests does not yet have any visible prospects.

Of course, ideally, it would be advisable to combine several methods (registration of CVEP and impedance measurements), however, in practice this turns out to be very difficult for a number of reasons. Today, computer audiometry is used mainly in specialized centers, since registration of SVP requires rather complex, expensive equipment and, more importantly, specialization of otorhinolaryngologists in the field of electrophysiology. It is obvious that registration of auditory evoked potentials will not become a screening method in the near future (B.M. Sagalovich, E.I. Shimanskaya, 1992).

Thus, the use of various options for recording SEP and their characteristics in children of different age categories is currently the method of choice in the diagnosis of various hearing impairments and the most promising in terms of scientific research, which can provide more effective rehabilitation of this category of patients.

Electrocochleography

Electrocochleography data (registration of the microphone potential of the cochlea, the summation potential and the total action potential of the auditory nerve) make it possible to judge the state of the peripheral part of the auditory analyzer.

Recently, electrocochleography (EcoG) has been used mainly for the diagnosis of labyrinthine hydrops and as a basic technique for intraoperative monitoring. For diagnostic purposes, a non-invasive research option is preferable - extratympanic EcoG (E.R. Tsygankova, T.G. Gvelesiani 1997).

Extratympanic electrocochleography is a method of non-invasive recording of evoked electrical activity of the cochlea and auditory nerve, providing increased efficiency of differential and topical diagnosis of various forms of hearing loss (E.R. Tsygankova et al., 1998).

Unfortunately, the method is used in children, as a rule, under general anesthesia, which prevents its widespread use in practice (B.N. Mironyuk, 1998).

Otoacoustic emissions

The discovery of the OAE phenomenon was of great practical importance, allowing for an objective, non-invasive assessment of the state of cochlear micromechanics.

Otoacoustic emissions (OAE) are sound vibrations generated by the outer hair cells of the organ of Corti. The OAE phenomenon is widely used in studies of the mechanisms of primary auditory perception, as well as in clinical practice as a means of assessing the functioning of the sensory apparatus of the hearing organ.

There are several classifications of UAE. We present the most common classification (R. Probst et al., 1991).

Cspontaneous UAE, which can be recorded without acoustic stimulation of the hearing organ.

Called UAE, including:

1) delayed OAE – recorded after a short acoustic stimulus.

2) stimulus-frequency OAE – recorded during stimulation with a single tonal acoustic stimulus.

3) OAE at the frequency of the distortion product – recorded during stimulation with two pure tones.

The optimal time for this test is 3-4 days after birth.

It is known that the characteristics of BOAE change with age. These changes may be associated with maturation processes in the organ of Corti (i.e., at the site of generalization of VOEA) and/or age-related changes in the outer and middle ear. Most of the TEOAE energy in newborns is concentrated in a fairly narrow frequency band, while in older children it has a more uniform distribution (A.V. Gunenkov, T.G. Gvelesiani, G.A. Tavartkiladze, 1997).

A number of works have noted the negative aspects of this method of objective examination. The OAE caused is physiologically extremely vulnerable; the amplitude of the OAE is significantly reduced after intense noise exposure, as well as after tone stimulation. In addition, middle ear dysfunction also leads to a decrease in amplitude and a change in the frequency spectrum of the OAE and even to the inability to register it. Pathological processes in the middle ear affect both the transmission of stimuli to the inner ear and the return path to the ear canal. For audiological screening of children in the first days of life, it is advisable to use the TEOAE registration method, and when studying hearing in children in premature wards, it is preferable to use the TEOAE test.

It is known that TEOAE is characterized by significantly less pronounced adaptation than CVAD. Registration of TEOAE is possible only during relatively short periods of physical and vocal rest of the child.

Audiometry

As a result of pure-tone audiometry, an audiogram is obtained - a graph characterizing the state of a person’s hearing.

There is also speech audiometry, in which words are presented and their intelligibility is assessed under different conditions (in silence, in noise and other distortions).

Ear audiometry (acumetry) is a method for determining hearing acuity, which evaluates the degree of susceptibility of the auditory analyzer to sound waves of various frequencies and intensities. Audiometric studies are carried out using special electronic devices (audiometers). In comparison with other methods for determining hearing sensitivity, acumetry allows you to dose the intensity of sound signals. In this way, it is possible to determine the threshold sensitivity of the auditory analyzer to sound vibrations of certain frequencies.

In outpatient settings, audiometric testing is performed in soundproofed rooms. The test results look like a two-dimensional graph, from which you can determine the degree of hearing impairment and the type of hearing loss (conductive or neurosernorny). If necessary, you can conduct a test to check your own hearing sensitivity yourself.

Features of the examination

Hearing diagnostics, which is carried out in the office of an audiologist and otolaryngologist, makes it possible to determine not only the fact of hearing loss, but also the type of pathology in the hearing analyzer. Using an audiometer, a specialist examines the threshold conductivity of bone and air tones. Depending on the methods of recording auditory sensitivity and diagnostic methods, several types of audiometry are distinguished:

speech is the simplest and most accessible method of studying threshold hearing, in which a specialist determines the degree of speech recognition at different intensity levels (in decibels);
tonal - acoustic examination, during which the audibility of tones of various frequencies and intensities is determined;
computer is one of the most reliable ways to determine the auditory sensitivity of the sound-conducting and sound-perceiving system.

Speech and pure-tone audiometry are among the subjective methods for studying hearing acuity, since during testing the specialist is guided by the testimony of the patient, who reports whether he hears the signals (speech) or not. A computer hearing test involves connecting special electrodes to the patient that record activity in certain areas of the brain if the auditory analyzer responds to signals coming from outside.

Speech audiometry

How to test your hearing at home? In the absence of special equipment that allows you to submit and record sound signals of a certain intensity and frequency, you can test your hearing organ using speech audiometry. This diagnostic method does not require medical equipment or additional devices. To determine the hearing sensitivity threshold of the subject, you will only need the audiometrist's speaking apparatus.

The test results largely depend not only on the state of the auditory analyzer, but also on the breadth of the subject’s vocabulary.

To obtain a more objective assessment of the patient’s hearing threshold, the audiometrist should pronounce not individual words, but phrases consisting of a set of simple and understandable words. How should the test be carried out? It is advisable to carry out diagnostics in a room with a minimum amount of extraneous noise. In this case, the subject must sit in the middle of the room on a chair.

The audiometrist's actions should be as follows:

move away from the subject 2-3 m and say a phrase consisting of at least 7-9 words in a whisper;
at a distance of 6 m from the subject, quietly pronounce a set of individual phrases;
From a 20-meter distance, pronounce the phrase in a raised voice.

During testing, the audiometrist must always ask whether the test subject can hear speech from a certain distance or not. In this way, you can approximately find out whether there is a hearing impairment or not.

Interpretation of results

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

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

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

Self check

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

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

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

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

Special Applications

You can objectively assess the condition of your hearing using special applications for phones running on the Android or iOS platforms. How to test your hearing? To do this, you must pass an audiometric test developed by practicing audiologists and otolaryngologists. Based on the test results, the degree of audibility and the threshold of auditory sensitivity of receptor cells can be determined.

Some of the simplest hearing testing apps include:

I. "Hörtest";
II. "Mimi Hearing Test";
III. uHear.

If you don’t have a smartphone, you can take the test using a personal computer and regular headphones. From the resulting graphs, you can easily determine whether the hearing threshold is within normal limits or not.

Attention! If your tests are not displayed, but instead you see a blank area, then you need to install the latest version of Adobe Flash Player.

If the need arises to have their hearing checked, not everyone can promptly visit a specialist audiologist. Today, a hearing test can be performed without his participation; there are several methods.

Test No. 1 – hearing diagnostics using headphones

You can check your hearing yourself using a test. It only needs to be done with headphones. To obtain a reliable result, the test should be carried out in absolute silence.

You must click on the “Continue” button.
Next, the sound level is calibrated on a personal computer, as required by the program. It is important to complete the settings in advance, because no changes can be made during the test.
A brief instruction will appear on the screen, according to which the test taker must press the options “I hear” or “I can’t.”
After completing the test completely, the result will appear on the screen.

Test No. 2 – hearing test with an audiogram, or audiometry method

It is important to set the volume level correctly when performing this test. To hear the sound clearly, you must use headphones. This method allows you to graphically represent the degree of hearing loss, the ratio of hearing thresholds and the range of sounds of spoken language, the configuration of the audiogram and the type of hearing loss.

You need to calibrate the sound using a test signal. Various tones will then be output through the headphones. You won’t be able to hear them all, that’s normal. Increase the volume until a signal is heard. This test starts with a low frequency signal and ends with a high frequency signal.

Test No. 3 - what sound level in Hz can you hear?

A healthy person perceives waves in the range of 16-20 kHz - the audible range. Of course, with age some changes occur and the audible range decreases. Some people do not perceive certain frequencies. There are those that a person perceives not by hearing, but by touch; these are frequencies below 100 Hz. This happens due to the refraction of sound, so you can perceive sound that is not within the human audible range.

Using this hearing test, a person is able to determine the limits of the ear sensitivity threshold. Moreover, this method can be used to diagnose acoustic equipment. To configure it, an audio frequency generator is usually used.

	20 Hz – the sound resembles a hum, everyone feels it, no one reproduces it
	30 Hz – low sound
	40 Hz – audible, but very quiet
	50 Hz – heard by few people, sounds like a quiet hum
	60 Hz – heard by many people, even through poor and cheap headphones
	100 Hz is the limit of low frequencies, then the range of direct audibility begins
	200 Hz	– average frequency
	500 Hz
	1 kHz
	2 kHz
	5 kHz – high frequencies begin at this frequency
	10 kHz – if you can’t hear this, then you have serious hearing problems, you should consult a doctor
	12 kHz – if you can’t hear it, then this is the initial stage of hearing loss
	15 kHz – some people over 60 cannot hear this frequency
	16 kHz - this frequency is not heard by almost everyone after 60 years
	17 kHz – this frequency is not heard by many middle-aged people
	18 kHz – problems with this frequency arise with age-related changes in the ear
	19 kHz – limiting frequency of average hearing
	20 kHz is a frequency that only children can hear

If, as a result of the test, despite the fact that the subject is a middle-aged and healthy person, it turns out that he does not hear sounds above the 15 kHz mark, then it is time to visit a doctor, there are problems and they need to be solved. As a rule, impaired sound perception occurs with hearing loss. To avoid illness or at least delay the onset of hearing loss, it is recommended to reduce the duration of perception of loud sounds. In turn, hearing loss can be caused by a rupture of the tympanic cavity.

Hearing loss can be of two types, depending on which ear (inner or outer) is affected. In order to determine this, it is necessary to compare the hearing thresholds for air and bone conduction of sound. Let's get back to the test.

If the person being tested is mature or even elderly, these indicators can be considered normal, this is due to the fact that age-related changes have occurred in the body. Frequencies closer to 20 kHz are usually only heard by children. Age threshold - 10 years.

It is worth noting that there is such a thing as absolute pitch. This is the ability of a person to determine the pitch and name the notes heard without listening to the sounds. According to statistics, there is one person per 1000 people in the world with absolute pitch.

Video test for ability to catch frequency

This text introduces pure-tone audiometry. This is not just a test, but a video test with which you can determine the capabilities of each ear. The test tracks how the sensitivity of each ear individually changes over the years. Sounds are played at different frequencies. Afterwards the frequency must be increased. The extreme frequency that the test person will pick up will be an indicator of hearing age.

12 kHz - age less than 50 years;
15 kHz - you are under 40 years old;
16 kHz - the hearing of a person under 30 years old;
17 -18 kHz - you are under 24 years old;
19 kHz - hearing under 20 years of age.

In order for the result to be as reliable as possible, you should use high-quality headphones and watch videos in maximum resolution. The test can be performed on children.

Video test for the sharpest hearing in the world

Mobile phone applications

Today you can examine your hearing using gadgets. To do this, you just need to install the following applications on your phone.

uHear

The uHear app will allow you to find out your hearing sensitivity and determine how a person is able to adapt to the noise around them. To do this, you will need to take two tests; it will not take more than five minutes. A mandatory attribute is headphones, and you can choose any, the main thing is to indicate their type in the test. The testing principle is extremely simple: noises of various frequencies are reproduced, thus determining the hearing limit.

The test taker presses the button as soon as he hears the sound. This should not be a reflex, you must answer truthfully, you should not press a button in order to improve the result.

The operating principle is the same as that of Hörtest. If a person hears sound with his left ear, he should press the Left button, if with his right ear - Right. The result is very simple to read: a person’s age is estimated according to the sensitivity of his hearing. If it matches or borders on your real age, then everything is fine. If the difference is quite large, drastic measures need to be taken.

How else can you test your hearing?

Hearing acuity can be checked at home using a live speech hearing test. For this you will need a partner. The subject should take a comfortable sitting position and tightly cover one ear with his hand. The second person should whisper two-digit numbers. You need to move at least six meters away. With normal hearing, a person will understand the numbers mentioned from a given distance. Often, during a patient’s appointment, a similar phonemic hearing test is carried out by an ENT specialist.

You can undergo a tympanogram. During the procedure, it is forbidden to talk, move or swallow saliva. A probe is inserted into the ear, and then, using a special pump, air is pumped in, which is immediately sucked back out. Thus, the membrane begins to move and it becomes possible to evaluate the resulting pressure. The sound signal evaluates the reflection of sound from the membrane.

To study the level of hearing, a tuning fork with an oscillation frequency of 2048 Hz is also used. Using this examination, you can determine the condition of the sound-conducting and sound-receiving apparatus. The tuning fork should be brought as close to the ear as possible and held with your fingers. The result is assessed by a specialist.

In order to have your hearing checked, it is not at all necessary to immediately go to see a doctor. In addition to passing the tests described above online, you can find on the Internet many different questionnaire tests, which are a series of questions, based on the answers to which the program will make its conclusion regarding the quality of hearing. This option is suitable for those who do not have an obvious problem. Otherwise, you need to visit a doctor.

30.11.2014 Oleg Lazhechnikov 15

I have already described the procedure for passing all the examinations that children who have hearing impairments must undergo in the article.

Now I want to explain in simple language what kind of examinations these are. I'm not a doctor, so I immediately apologize for the unscientific explanations. I will briefly describe the essence. If I'm wrong, correct me.

So, there are two types of hearing loss:

— Conductive hearing loss
— Sensorineural hearing loss or sensorineural hearing loss (synonyms)

To better understand this entire topic, you will first have to study the structure of the ear. Pictures and descriptions are on Wikipedia. However, you will need to absorb a huge amount of other information, so get ready for this right away.

Conductive hearing loss can be treated (including surgically) and is associated with dysfunction of the outer ear, eardrum and middle ear. Occurs during various infections, injuries, traffic jams, etc.

Sensorineural hearing loss (SHL) has no cure (as is believed throughout the world) and is most often associated with a defect in the hair cells in the cochlea of the inner ear that stimulate the nerve that transmits signals to the brain, or in the worst case, with the nerve itself. In the case of this type of hearing loss, the child is given hearing aids (hearing aids are installed) and cochlear implantation is done closer to a year and a half. The latter makes sense to do only when the child has 4th degree hearing loss or complete deafness.

Degree of hearing loss

There is the first, second, third and fourth. The higher you go, the worse your hearing. Next comes deafness. The hearing thresholds for different degrees are as follows:

1 - from 26 to 40 dB
2 - from 41 to 55 dB
3 - from 56 to 70 dB
4 - from 71 to 90 dB
Deafness - 91 dB and above

That is, up to these values a person does not hear anything. It’s also bad that as the degree of hearing loss increases, the intelligibility of sound decreases and distortion appears, which means that only amplifying the sound in the hearing aid does not save the situation. In addition, at different frequencies (4 frequencies are tested as a standard), there may be different hearing thresholds or no hearing at all. Here at this link, you can listen to the same sound recording in several versions, when certain frequencies are cut off. This will make it clearer what kind of distortions there may be.

Hearing research methods

In total, there were 3 examinations that we did: UAE, impedance testing, computer audiometry. In government institutions, referrals are made free of charge, but in private clinics in Moscow they cost about 500/500/3500 rubles, respectively.

UAE

Stands for registration of delayed OtoAcoustic Emission. Sound vibrations are sent to the ear and a sensitive microphone records whether there is a response. That is, both the sound source and the microphone are inserted into the ear at once. The sound reaches the cochlea and the hair cells, and if they are in order, they begin to vibrate and the sound returns back to the ear canal, the response is recorded. And if the child has conductive or sensorineural hearing loss, then the emissions will not be recorded.

It takes about 10 minutes, depending on the child’s behavior.

Impedancemetry

Designed to identify conductive pathologies (otitis media, plugs, atresia, membrane perforation, etc.). There are several techniques, but, as a rule, two of them are used: Tympanometry and Acoustic Reflexometry.

Using tympanometry, acoustic conductivity is measured depending on the air pressure in the external auditory canal, or, in other simpler words, the mobility of the eardrum and the auditory ossicles associated with it is studied. An “earphone” is inserted into the ear and not only sound is supplied there, but also air (to create pressure). At different air pressures, it is measured how sound is reflected from the membrane.

Acoustic reflexometry allows, using an impedance meter, to register reflex contractions of the stapedius muscle, which are transmitted to the auditory ossicles and eardrum. If the reflex is registered, then there are no conductive pathologies.

It takes about 5 minutes.

Computer audiometry ASSR and KSVP

KSEP (or ABR) stands for recording of short-latency auditory evoked potentials. ASSR is a response to a constant modulated tone. Visually very similar studies, but their principles are different. Headphones are inserted into the ears and a certain sound is played, and sensors on the forehead and behind the ears record the reaction of the child’s brain.

As a result of ASSR, we have an audiogram with hearing thresholds in decibels at 4 frequencies: 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz (there may be more frequencies, depending on the device). As a result of the KSVP, we obtain a certain general threshold of hearing for a person.

After these studies, a diagnosis and degree of hearing loss (1,2,3,4) or deafness are made. Sometimes only one test is performed, sometimes both tests are performed. It takes from 40 minutes to two hours, depending on the type of examination. ASSR is done faster, since it usually tests two ears at once and simultaneously across all frequencies. In the case of CVEP, the child’s behavior is important, since even blinking can distort the results. Ideally, he should be asleep and in deep sleep. This didn’t work out for us, so we rocked him in our arms throughout the entire procedure and the examination took a long time. However, even with ASSR, the child should be in natural or medicated sleep, but it seems that his movements are not so important.

Audiometry is repeated after some time, as the degree of hearing loss may change.

All examinations can be completed free of charge at the audiology center. In Moscow, this is the audiology center on Vernadsky Avenue 9. But I would recommend duplicating audiometry in a private center, and also consulting with an audiologist to be sure of the diagnosis.

How we save on supplements and vitamins

Vitamins, probiotics, gluten-free flour, cosmetics, sports nutrition, we order on iHerb.com (use the link for a $5 discount). Delivery to Moscow is only 1-2 weeks. Much is several times cheaper than buying it in a Russian store.

Get $5 discount →