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 of the middle ear, an established diagnosis of otosclerosis, a history of skull trauma, activity in conditions production noise(mechanical assembly and forging 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, ear endoscopy, barofunction study 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). Determine tactile and pain sensitivity according to the zones of innervation of the branches 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 are performed in the area of ​​​​the 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. The deep parts of the ear canal and the tympanic membrane are examined using an ear funnel and a 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” according to the tone of the given sound test and 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. Should not touch the jaws auricle 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 hard against the tissues of the head, as this may cause painful sensation 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

Table 2. Hearing passport for impaired sound perception

Test SS reveals the presence of irritation of the peripheral nervous system of the hearing organ or the state of excitation of the auditory centers. The hearing passport contains tinnitus 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 of 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 auditory 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 during dissociation auditory ossicles as a result of trauma, perforation 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 involves 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 the total number of words presented. In Fig. Figure 5 shows examples of speech audiograms for various types of hearing loss.

Rice. 5. Speech audiograms for various types hearing loss: 1 - curve for conductive hearing loss; 2 — curve for the cochlear form of hearing loss; 3 - curve at mixed form 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

Research into the function of spatial hearing (ototopics) is aimed at developing methods topical diagnostics damage levels of 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 localization 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 the vertical plane is completely excluded, regardless of the frequency spectrum of the testing sound, while horizontal localization changes only depending on the asymmetry of the auditory function. In Meniere's disease it is noted permanent violation ototopics 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). It consists in the fact that when a sharp sound occurs, an involuntary deviation of the gaze towards the source of the sound 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 muscles 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 illustration 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 of the “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 to impact the eardrum with 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 for both diagnostic and therapeutic purposes. 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).

A more effective way to determine 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 - a 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 perform catheterization of the auditory tube, you need following tools(Fig. 8): Politzer balloon (7) for blowing 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 by 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 measurement absolute value input impedance, i.e. 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 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

Simple and affordable methods for testing hearing at home in infants and children early age

Why check your child's hearing?

Even a slight decrease in a child’s hearing can negatively affect speech development. Hearing impairment can be either temporary or permanent. In case of severe hearing impairment, without special help, the baby will not be able to master speech, since he cannot hear the adult or himself and cannot imitate speech. There are cases that a child loses hearing when he has already learned to speak (for example, at 2, 5 - 3 years). In this case, the baby may also lose speech if he is not promptly provided with special assistance teacher to preserve existing speech. Teachers of the deaf are involved in teaching children with hearing impairments.

Hearing may decrease as a result of hereditary diseases, infectious diseases (mumps, measles, scarlet fever), otitis media, severe flu, after treatment with antibiotics. A hearing test is performed by an otolaryngologist (ENT) in a children's clinic.

A baby's hearing should be tested in the first months of his life. Since the timing of the beginning of detection of the problem and timely pedagogical assistance depends on how well the child will develop.

An initial hearing test can be done at home. From this article you will learn simple and accessible methods for determining hearing in very young children, which can be used for home examination of a child’s hearing. These techniques can also be used by kindergarten teachers to clarify the causes of a child’s problems - to find out whether the child can hear or has behavior and speech problems because he has poor hearing. If problems are discovered, then the child must be shown to a doctor - an ENT specialist.

Hearing development in a baby: what you need to know about the hearing development of a child in the first year of life

In the first two to three weeks of life a hearing child flinches from loud sounds.

In the first three months of life baby, you can see how, in response to the sound, he develops auditory concentration (opens his eyes wide, stops moving, turns towards his mother). Such freezing of a child in response to a voice usually appears at the age of two to three weeks.

The easiest way to check this is when the baby is crying. If a child was screaming, and at that time you gave an unexpectedly long sound signal not far from the child (for example, you rang a bell), then he freezes, stops moving and becomes silent.

At 1-3 months, a well-hearing child perks up in response to his mother’s voice.

At one month, the baby turns in response to the sound of a voice behind him.

At three to six months The baby also opens his eyes wide in response to the sound and turns towards the sound.

From 4 months The child can first look with his eyes in the direction of the sound, and then turn his head in that direction. In premature babies, this reaction appears later. This is the first time such a reaction has been observed to my mother’s voice. Also, from 4 months, the baby turns his head towards the sounding toy.

Hearing child at 3-6 months does not like sharp sounds, flinches from them (for example, if someone suddenly calls the apartment), opens his eyes wide and freezes. May scream in response to a sharp sound or cry.

Indicator good development hearing also includes humming and babbling. At about 4-5 months of age and older, buzzing healthy child gradually develops into babbling. In response to the appearance of a nearby adult, the baby babbles intensely. At the age of 8-10 months, babbling develops and new syllables and sounds constantly appear in it (if an adult talks to the child, supporting his babbling). In a child with poor hearing, babbling appears, but does not develop further, since he cannot imitate an adult.

From six months a child can find a sound source (voice, bell, musical toy) located to the right, left, behind him (if he does not see the sound source and is guided only by hearing). In premature babies or children with hearing problems, this does not happen and remains at the level of an infant aged 3-6 months. That is, they react by opening their eyes wide, freezing, and screaming. But they can't find the source of the sound. They will learn this a little later.

This is very important: up to four to four and a half months, the development of a deaf or hard of hearing child is no different from the development of a hearing baby! All children - even deaf ones - go out! And then all children - including deaf children - move from humming to babbling. But from this moment on, a child with poor hearing begins to experience developmental delays. And these differences are growing sharply every month.

If a hearing loss was detected immediately and the baby was treated medical care and selected an individual hearing aid, and also perform exercises at home recommended by teachers of the deaf, then there will be no delay in the development of such a baby! His humming smoothly turns into babbling, babbling develops like that of an ordinary child. And the child masters speech naturally. The child hears speech, understands it, and begins to speak like his “ordinary” hearing peers. And by the age of three he is already talking with all his might, asking questions - in a word, he is an ordinary kid! The same cannot be said about deaf and hard of hearing children who were without help until they were three years old and therefore at three years old they are “mute”, that is, they do not speak at all! Although they have excellent potential for mental and speech development.

Therefore, it is very important to provide timely help to the baby. If it cannot be provided in your city, then you can always contact regional center or to the clinic large city. Because exactly The timing of the start of assistance for a hearing-impaired child is the most important factor. It is much more difficult to start helping a child master speech at three years old, when time has already been lost and he has not heard anything for three whole years!

And one more important point - in case of hearing problems in a child, parents usually think first of all about the doctor. But to help a child become a full-fledged person, such a baby really needs, first of all, teacher of the deaf! It is the teacher of the deaf who will teach you how to develop your hearing-impaired child, teach you educational exercises for him, advise you on how best to communicate at home with your baby, taking into account his characteristics, conduct classes and show you the games your child needs and teach you how to play them correctly at home. Developmental classes with a teacher of the deaf are the key to the normal development of a child. Just an operation (they now do operations that help deaf children begin to hear) without corrective classes with the child cannot fully help the child master speech. In the case of collaboration between the family, the teacher of the deaf and the doctor, it is possible to ensure that a child who is hard of hearing will speak and communicate fully and live a normal, full life.

Below in this article you will find:

Part 1 - a method for testing hearing in a child of the first year of life at home

Part 2 - a method for testing hearing in a child of the second or third year of life.

Part 1. How to test the hearing of a baby (child of the first year of life) at home

At home, you can check the hearing of babies (even in the first months of life) using pea test method. This method was proposed by the Institute for Early Intervention St. Petersburg. The method can be used by teachers and parents of children.

How to make materials for testing the hearing of a child of the first year of life.

Take four identical plastic jars from Kinder Surprise or old film.

The jars need to be filled like this:

Jar No. 1.

Jar No. 2.

Fill one third with buckwheat – kernels.

Jar No. 3.

Fill one third with semolina.

Jar No. 4.

Remains empty.

Why is this particular filler used to test hearing and why should it not be changed in this technique:

- shaking the peas creates a sound with an intensity of 70-80 dB, - shaking buckwheat creates a sound with an intensity of 50-60 dB,- shaking the semolina creates a sound with an intensity of 30-40 dB. If you will use jars repeatedly for testing children's hearing

and during the first year of life, then

change fillers after three months

. For example, if you conducted a pea test when your baby was three months old and want to repeat it at six months, then change the fillers in the jars.

Method of testing the hearing of a child of the first year of life at home

The hearing test is carried out by the baby's mother with another close adult. It is necessary to conduct a hearing test when the child feels well, well-fed, and healthy. It is better to do this an hour before feeding or an hour after feeding. You need to put the baby on a table or sit him in the arms of a close, well-known adult (for example, a grandmother who often looks after the child or the baby’s father). This adult - your assistant - needs to be warned not to move when you make sounds. Start talking affectionately to your child, drawing his attention to you. Now take in right hand

jar No. 3 (semolina), and in the left - jar No. 4 (empty). Shake the jars next to the baby's ears at a distance of 20-30 cm from his ears. The movements of your hands should be the same and symmetrical. Then swap the jars - take them

left hand

jar No. 3 (semolina), and on the right - jar No. 4 (empty jar).

Why is this particular sequence of using jars needed when testing a baby’s hearing and it cannot be changed. The fact is that the child quickly stops responding to the sounds he hears. Therefore, we begin the hearing examination with the “quiest” jar and only lastly take the “loudest” jar. If the child clearly reacts to a jar of semolina, then other jars may not be presented.

To more accurately evaluate the results of a hearing test, you need to consider two things: important nuances:

“It can take up to three to five seconds from the sound to the child’s reaction to it.” A new sound can be given only when the reaction to the previous sound has completely subsided.

— It is advisable to gently lay the baby’s head on the back of his head each time before a new sound (if he turned his head towards the previous sound).

How to interpret the results of a hearing test using the pea test:

— Up to 4 months baby reacts to jars of buckwheat and peas, and does not respond to the sound of a jar of semolina. This is fine!

— With normal hearing, a child over 4 months old has obvious indicative reactions to the sound of all three jars (semolina, buckwheat, peas). He turns his head or eyes towards the source of the sound.

— For hearing loss a child under 4 months either does not react at all to the sound of jars of peas and buckwheat, or either reacts or does not react.

- After 4 months, with hearing impairment, the child cannot determine the source of the sound. Or it doesn’t react to the sound of even one of the jars.

Reactions of a child of the first year of life to the sound he hears

Below is a list of the most informative for us, of course, reflex reactions of infants to sounds (if there are such reactions or one of these reactions to a sound in the “pea test,” it means that the baby hears this sound):

- blinking eyelids,

- trembling of the whole body,

- freezing (freezing) of the child,

- movement of arms and legs, spreading arms and legs to the sides,

- turning the head towards the source of the sound or, conversely, towards it (in the case of a sharp sound),

- frowning eyebrows, squinting eyes,

- sucking movements,

- change in breathing rhythm,

- wide opening of the eyes.

Note: If the child turns his head in the same direction every time, regardless of which hand the sounding jar is in, then this may be a sign of unilateral hearing loss. This baby needs an audiological examination.

Is it possible to carry out a pea test with a child after a year? No. After a year, a child will no longer react the same way to the noise of a jar, so the test will not be informative.

Exercises for the development of hearing and auditory concentration for children of the first year of life are given by month in the section of the site

Part 2. How to test a child’s hearing from one to three years old (at an early age)

A young child can react to sounds in the same way as an adult and can perceive and understand whispers well from a distance of six meters.

If a child of one and a half to two years old practically does not speak or speaks very poorly, then first of all, specialists check the child’s hearing. Since hearing impairment is a very common cause of problems with a child’s speech.

At home, we can check the hearing of a young child using a specially structured conversation with him. The methodology was developed at the Institute of Correctional Pedagogy of the Russian Academy of Education.

The first way to test hearing in a child 1-2 years old

Place in front of the child toys that are well known to him, the names of which he knows well. Remove everything unnecessary from the table with these toys so that nothing interferes or distracts your baby. Ask “give me the doll”, “show me the ball”, “where is the dog? Where is the dog’s tail?” “where is the doll’s mouth, eyes, nose,” etc.

First, ask requests and questions to the baby, standing next to the baby and speaking in a clear whisper. Then move away to a distance of 6 meters. First ask in a clear whisper. If the child does not hear, then turn it up louder (conversational voice volume).

If the baby was unable to fulfill your request, then go up to him and repeat it at a short distance from the baby in a conversational voice. Then move away again and repeat the same request in a whisper (This is done to make sure that the baby understands the content of the request).

How to interpret the results of a hearing test using this method:

A normally hearing baby will fulfill your requests given to him whisper from a distance of six meters. If he does not hear your whisper, but fulfills your requests only when you speak at a conversational volume from a distance of six meters, then it is better to recheck the baby’s hearing with specialists.

Young children are very spontaneous and active and do not yet know how to control their behavior. That's why It is not always possible to test their hearing using this method. Some children simply do not want to listen and show pictures, and a false impression arises that the child has poor hearing. But in fact, perhaps he simply did not want to complete the tasks - he was not interested. What to do? The second method of testing hearing in young children will help us.

How to check the hearing of a child aged 1-2 years: the second method

You will need an assistant to test your child's hearing. This could be the child's father, grandmother, grandfather, older sister or brother - that is, a person close to him, very familiar to him.

The mother takes the baby in her arms and sits down with him at the large “adult” table. There should be toys on the table (pyramid, inserts, cubes, buckets, etc.). Toys should be interesting for the child, but at the same time well known. That is, he should be passionate about them, but not to such an extent that he does not notice anything around him. It is not advisable to take a new toy for a hearing examination, since the baby may be so carried away by it that he simply does not pay attention to the sounds (remember yourself, when you are very passionate about something, you also do not always hear what is being said around you).

The baby, sitting in your arms, plays on the table with toys. Your assistant stands behind the baby at a distance of 6 meters from him and calls the baby by name in a whisper. If the child does not respond, then reduce this distance. Again the assistant calls the baby in a whisper. If there is still no reaction, let him call the child in a conversational volume voice.

After this, mother and baby continue to play with toys, and the mother’s assistant moves either to the left of the baby at a distance of 6 meters, or to the right of the baby at a distance of 6 meters (we alternate these positions in a random sequence). And it beeps from the quietest to the loudest.

List of sounds for hearing testing:

— musical toy-hurdy-gurdy (high-frequency sound),

- musical toy - pipe (mid-frequency sound),

- drum (low-frequency sound),

- unusual sounds (the rustling of a plastic bag, the sound of buckwheat, peas).

Tips for conducting a hearing test for young children using this method:

— Make intervals between sound signals at least thirty seconds.

— The child’s reaction to a signal is considered to be: turning the eyes or head towards the source of the sound.

— When a child turns towards a sound, a bright picture or toy is shown to him as encouragement.

— If the child does not respond to the sound, then the assistant reduces the distance to the child and slowly approaches the baby until he clearly reacts to the sound. Then you will need to double-check the reaction to this sound from the original distance of six meters.

We play and test the hearing of a young child.

The same technique can be used as a game with a child. Here's how it's done. First, we play with those toys that will be involved in testing the baby’s hearing:

- Barrel organ.

We demonstrate to the child how a barrel organ plays and how a doll dances to the sounds of a barrel organ. And when the organ stops, the doll hides behind a screen (the screen can be a large box). We call the doll with the child, and she again dances to the organ.

- Dudka. The car drives along to the sound of a pipe, and when the pipe stops, the car drives into the garage and stops. Invite your child to blow the whistle, call the car and show how the car began to drive again to this sound. And how she stopped when the pipe fell silent.

— — Drum (soft knocking). A toy bunny jumps to the beat of the drum. When the drum stops, the bunny hides. Play with your child with a bunny in the same way as playing with a doll and a barrel organ.

— After this, invite the child to listen to who is about to be called. From a distance of 6 meters behind the child's back, your assistant plays the organ. The child will turn towards this sound, and your assistant will show him the doll in response. We also try the sound of the drum and the sound of the pipe. Will the baby react? If yes, then we show him the car/bunny. Then we give the child a doll (lyalya), a dog (av-av) and a bird (pipipi). Playing with toys again

We suggest you guess who is calling him.

Your assistant takes these three toys and stands at a distance of 6 meters from the child, either to his left or to his right. He says in a clear whisper: “Aw-aw.” If the child turns towards the sound, then he is shown a dog. The other two onomatopoeias are also demonstrated.

In order for the baby to respond to sounds, it is better to first let him play with these toys, try their sounds, and get used to them. And only then conduct a hearing examination.

Interpretation of hearing examination results in the second way.

With normal hearing, the child reacts to sounds that are heard from a distance of six meters. He can also show toys that are well known to him, the name of which was whispered to him from a distance of six meters.

If a child reacts only to 1-2 sounds from the entire list from a distance of six meters, then it is better to have the child’s hearing checked by a specialist.

I wish you and your children health and joyful development! I hope that this article will be useful to you and I will be glad to see your comments.

See you again on the “Native Path”.

From paper, cardboard, fabric. How to do it and how to work with your child using a book.

Get a NEW FREE AUDIO COURSE WITH GAME APPLICATION

"Speech development from 0 to 7 years: what is important to know and what to do. Cheat sheet for parents"

Click on or on the course cover below to free subscription

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 certain frequencies.

IN outpatient setting audiometric testing is carried out in soundproofed rooms. The test results are presented in the form of a two-dimensional graph, from which you can determine the degree of hearing impairment and the type of hearing loss (conductive or neural). 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 auditory 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 levels intensity (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.

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 ear pathologies none. 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 help. strangers. To do this, experts suggest taking a simple test in which you need to honestly answer (yes/no) several questions:

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

If, after taking 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! During development infectious diseases associated with damage to the nasal mucosa, hearing acuity naturally decreases due to blockage of the mouth 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 the hearing organ 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.