1. Program

2. Your name here
4/15/2017

3. Diagnosing Hearing Loss
Acoustics Seminar
Catarina Hiipakka

4. Part 1: Hearing Disorders

5. Some concepts Congenital Hereditary or genetic Acquired
Pre- or Postlingual

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

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

8. Outer Hair Cells
Also:
Loudness recruitment
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4/15/2017

9. 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

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

11. 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

12. Tinnitus and Hyperacusis
45% of tinnitus have hyperacusis
86% of hyperacusis have tinnitus
Intolerance
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13. 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
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14. Part 1: Wrap Up
Sensorineural Hearing Loss Cochlear Dead Regions Outer Hair Cells Conductive Hearing Loss Tinnitus Others
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4/15/2017

15. Part 2: Audiometry

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

17. The Audiometer
Some extended audiometers to 8k and 16k

18. The Audiometer
Supraaural earphones

19. Bone Conduction

20. More than an Audiometer!

21. Hearing Level
dB SPL to HL
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4/15/2017

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

23. Audiometer Calibration
ANIS/ISO Hearing Level – several standards

24. Audiometer Calibration

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

26. 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

27. Pure-Tone Audiometry
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28. Results: Sensorineural and Conductive Hearing Loss
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29. Results
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4/15/2017

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

31. Summing up: AUDIOMETRY
Thresholds
Level of hearing loss
Sensorineural vs. Conductive
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32. Part 3: Other Diagnostic Procedures
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33. Acoustic Immittance
Immittance: Impedance, Admittance

34. Acoustic Immittance
85dB 226 Hz probe tone
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4/15/2017

35. 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
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4/15/2017

36. Acoustic Reflex
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4/15/2017

37. Acoustic Reflex
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38. Speech Audiometry Speech audiometer Thresholds for speech
Speech detection
Speech reception (SRT)
Signal-to-noise ratio
Words, syllables, sentences/several words
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39. Wrapping up Screening: Pure-tone air conduction Diagnosing: also
bone conduction,
tuning forks,
questionnaire,
speech reception,
acoustic immittance (if conductive)
And more…
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4/15/2017

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