Program

Your name here 4/15/2017

Diagnosing Hearing Loss Acoustics Seminar Catarina Hiipakka 28.01.2015

Part 1: Hearing Disorders

Some concepts Congenital Hereditary or genetic Acquired Pre- or Postlingual

Sensorineural Cochlea Auditory nerve Often hair cells, auditory neurons Threshold – where in cohlea Outer hair cells – common and mild to moderate Inner + Outer - severe Your name here 4/15/2017

Dead regions Don’t regenerate! No processing IC, neurons >50 dB Not a dead region. OHC loss

Outer Hair Cells Also: Loudness recruitment Your name here 4/15/2017

Sensorineural Hearing Loss High frequencies Diplacusis – more than one pitch Loudness recruitment Presbycusis – age “I hear, but I cannot understand” Time resolution Place theory Frequency theory Volley Principle PRESBYOPIA

Conductive Hearing Loss No distortion No frequency specificity Low level Comfort in loud sounds, places – paracusis willisii Your name here 4/15/2017

Tinnitus and Hyperacusis Who has it? Subjective Tinnitus Objective Tinnitus: Circulation, temporomandibular joint, muscles 6 to 30% chronic tinnitus 1 to 2.5% clinically affected life

Tinnitus and Hyperacusis 45% of tinnitus have hyperacusis 86% of hyperacusis have tinnitus Intolerance Your name here 4/15/2017

Other disorders Autosomal dominant inheritance Autosomal recessive inheritance Maternal infections, environment Head trauma Impacted cerumen Foreign bodies Otitis Otosclerosis Retrocochlear disorders (brainstem) Central auditory processing disorders Your name here 4/15/2017

Part 1: Wrap Up Sensorineural Hearing Loss Cochlear Dead Regions Outer Hair Cells Conductive Hearing Loss Tinnitus Others Your name here 4/15/2017

Part 2: Audiometry

Normal Hearing Minimum Audible Field Minimum Audible Pressure MAP Monaural earphones MAF Minimal audible Field – binarual in anechoic room Minimum Audible Pressure

The Audiometer Some extended audiometers to 8k and 16k

The Audiometer Supraaural earphones

Bone Conduction

More than an Audiometer!

Hearing Level dB SPL to HL Your name here 4/15/2017

Hearing Level Hearing loss at high frequencies example Normal (HL)

Audiometer Calibration ANIS/ISO Hearing Level – several standards

Audiometer Calibration

Audiometer Calibration -Bone Conduction And Biological Calibration Artificial mastoid/mechanical coupler Test close-up

Pure-Tone Audiometry 1kHz 2kHz 4kHz 8kHz 1k 500Hz 250Hz False positives, false negatives Manage “expectation” of sound Békesi audiometry automatic, controlled by listener. 1kHz 2kHz 4kHz 8kHz 1k 500Hz 250Hz

Pure-Tone Audiometry Your name here 4/15/2017

Results: Sensorineural and Conductive Hearing Loss Your name here 4/15/2017

Results Your name here 4/15/2017

Results: Considerations Standing waves at 8kHz Tactile responses Acoustical radiations (bone conduction) Collapsed ear canals Your name here 4/15/2017

Summing up: AUDIOMETRY Thresholds Level of hearing loss Sensorineural vs. Conductive Your name here 4/15/2017

Part 3: Other Diagnostic Procedures Your name here 4/15/2017

Acoustic Immittance Immittance: Impedance, Admittance

Acoustic Immittance 85dB 226 Hz probe tone Your name here 4/15/2017

Acoustic Immittance Tympanometry varying pressure Ossicular discontinuities Tympanometry varying pressure Eustachian tube disorders Scarred eardrums Otosclerosis Eustachian tupe – nasal pharinx Low freqquency example Middle ear fluid, Eardrum perforation Your name here 4/15/2017

Acoustic Reflex Your name here 4/15/2017

Acoustic Reflex Your name here 4/15/2017

Speech Audiometry Speech audiometer Thresholds for speech Speech detection Speech reception (SRT) Signal-to-noise ratio Words, syllables, sentences/several words Your name here 4/15/2017

Wrapping up Screening: Pure-tone air conduction Diagnosing: also bone conduction, tuning forks, questionnaire, speech reception, acoustic immittance (if conductive) And more… Your name here 4/15/2017

Today’s question How do you detect if a patient has conductive hearing loss? Your name here 4/15/2017