This is a demonstratino of a basic hearing evaluation. The first thing you do any hearing evaluation is get a
case history from a patient. During a case history you build a rapport with
your patient by getting to know them and ask them some questions about their
personal history in regards to their hearing. So how's your hearing? It's pretty
good. My right ear's fine, but my left ear has been bothering me a little bit
lately. How has it been bothering you?
It's been hurting a little bit over the past week. It feels really full but I kinda have
a cold right now. Have you ever had any ear infections before? Yea, I get them all
the time about this time of year. Ok. Is it usually in the left ear or does it
happen in the right here too? It alternates- both ears. Ok do you tell your
doctor about these ear infections? Yeah, normally he puts me on an antibiotic
or something for them but I haven't been this time yet.
Ok have you ever had any holes in your ear drums or surgeries on your ears such
as tubes? No. ok, do you have any problems with ringing or buzzing in your ears? No.
Do you have any problems with dizziness or imbalance? No. Do you have
any family history of deafness? No. Have you ever been exposed to any loud noises? No,
not really.
Ok well what I'm gonna do now
is start the test and the first thing that i'm gonna do is take a look in your
ears. Let me know if you have any pain or tenderness while i'm taking a
look ok?
The next test that I'm gonna do is called tympanometry. It's a test that assesses how your middle ear is functioning and
how your eardrum is moving. You don't have to do anything for this test, you
just have to sit still and quiet for me okay? It kind of feels like you're going
up over a mountain. There'll be some pressure in your ear.
Same thing on the other side.
Alright, so we're finished with the parts of the test that happened out here so now we're gonna head into the
booth and finish our testing in there, ok? You can have a seat right here. This is the
soundproof booth where we conduct the testing. There are four different kinds
of transducers. The first one is sound field and that is the the stimuli comes
through speakers in the room.
Another transducer is the
headphones and this is for air conduction testing. Red goes on the right and
blue goes on the left ear.
Another air conduction testing is inserts. These are inserts again blue is left
and red is right, and they have special tips to go on them. They look like this.
So you just put this on. They're individual use tips that you roll down and then
insert into the patient's ear. The last transducer as the bone oscillator. It's a
headband. This is the part that goes against the mastoid bone the patient and
there's some slight tension, and this headband in order to keep the oscillator
on the patient's head and to couple with the patient's mastoid bone said there's
a good a good seal between the oscillator and the mastoid bone so
this'll vibrate and produce school vibrations that stimulate the cochlea
once you get into the into the booth and you have your patience he did you
instruct the patient what they have to do for the test so what I'm gonna have
you do is listen to some beats they're gonna be very quiet beach so I want you
to just click the button when you hear it here is the response button for you
so just click that button whenever you hear those beats ok
diagnostic audio murder this is college yes I 61 matter it's a two channel audio
matter there are different stimuli different transducers the different
stimuli are the tone or the mic and some external sources such as computers or CD
players the four different transducers that we have our headphones the bone
oscillator the sound field and inserts and then this is where you select left
or right here this not the controls the decibels and these buttons change the
frequencies and this button hurts and I do that the patient has headphones on so
I select and I made sure that it set up a thousand hurts so what I'm gonna do is
start with the better ear and she said that her left eye was bothering her so
we're going to start with the right here i mean instructor to press the button
when she hears the beeps and depending on her response that tells me where I
will president next ok we're going to get started now all you have to do is
press the button when you hear the people she is below where her threshold
is represent the town she didn't respond so I go up five decibels represent again
she did respond so I'd go down 10% again I go up five until she hears that she
did respond to that one more time and she responded
threshold a thousand hurts would be zero DBA chip to do the same thing to present
for each frequency so after this you go to 2000 hurts and then 4,000 and 8,000
and then 250 and 500 hurts and then you do the same thing on the left either you
also use the same downtown up five method for bone conduction but the only
frequencies tested for bone conduction are 500 1,000 2,000 and 4,000 official
pierre-jean audiometry we move on a speech audiometry into word recognition
and the way that you do this is you test 40 decibels above the pure tone average
appeared on average for her right ear as five decibels you to find the Pierce on
average you take the average of the thresholds at 500 1,000 and 2,000 hurts
prepared on average and her left ear is 30 decibels so if we if we start with a
ride here and take forty above her five decibel on average were gonna start 45
decibels and that's where we're going to present the list of words there are
several different lists of words but we are going to use the
and you six words and their spawn DS or two-syllable words you instruct the
patient to say to tell her what to do I'll do that right now and then we'll
begin testing ok we're gonna move on to having you listen to some sentences ok
you'll hear a woman's voice say something like say the word ball so all
you have to do is repeat that last word you ingest say ball ok and to set this
up we're going to use the external source the CD player so it's like that
we have the headphones and make sure we're going to test the right here first
he said for you five decibels and you thought appropriate track and then you
begin
each year and then you take the correct percentage out of a hundred and that's
your word recognition scores
I'm gonna have you listened to some peeps again but this time I'm gonna put
the headband on you ok and just repeat just hit the button like you were with
the beeps before is that ok explain all the results that we found came this
picture right here is called an audiogram kinda give us a picture of
your hearing levels these numbers across the top are the frequencies or pitches
so we have low pitches going up to high pitches and these numbers on the side or
decibels or or volume so we have stuff sounds down too loud sounds we say
anything from about here
up is normal hearing about 25 decibels are better so the red circles are your
right ear and the blue exes are your left ear and you can see that in your
idea or you have normal hearing all those points are above within normal
range and rear left year we have this mild to moderate laws and your bone
conduction scores those are from when I put the headband on those scores are
within the normal range so because those are in the normal range and using the
headphones was having that lost this is called a conductive loss and tells us
that the problem is either in your router or middle ear and I can show you
what that means on this small model that I have the ear
in the test that we took where we put some pressure in your ear your right ear
was normal with that test and you're left year had what we call a flat and
that's most likely caused by a problem in your middle ear because that's what
that test is assessing so it's more than likely caused by a fluid buildup and
your middle ear causing your eardrum to become stiff and moving so in this model
you can see that the sound has to go through your ear canal and then your
eardrum through the middle ear and into the inner ear right here this is where
the problem is with with your left ear because the bone conduction scores by
past all of this and went straight to the cochlea directly stimulate your
inner ear so we know that the problem occurs out here somewhere and threw out
a scorpion I looked in your years it was clear and the external ear so the
problems here and most likely caused by fluid like an ear infection that you
have experienced some of those before so because of this middle ear problem the
problem is occurring right here and that's usually treatable medically so
what all do is refer you to an ear nose and throat doctor so that they can look
at that and hopefully get back cleared up for you
these are the results from the temp manometry test that we did the test I
put some pressure on your ears this campaign and Graham
is corresponding with your right ear and this is what we call a type 8 a.m. this
is normal you have normal ear canal volume of 1.0% m/m peak pressure as it
0.5% meters and the pressure is zero deka Pascal's all those numbers are
within the normal range and then stamp anagram over here is what we got for
your left ear and you can see the flat line of cross the bottom this is called
a flat for type B tip and you have normal ear canal volume which is one
point zero cubic centimeters for you but there's no peak and there's no pressure
so this is most likely corresponding with problem and your middle ear such as
fluid causing that your drum to be stiffened and not move so that's why we
don't have that peak pressure in there do you have any questions about anything
that we've talked about today and have the results that we found