Aktuelle audiologische Diagnostik

Abstract

Today's audiological functional diagnostics is based on a stock of hearing tests, whose large number takes account of the variety of malfunctions of a complex sensory organ system and the necessity to examine it in a differentiated manner and at any age of life. The objective is to identify nature and origin of the hearing loss and to quantify its extent as far as necessary to dispose of the information needed to initiate the adequate medical (conservative or operational) treatment or the provision with technical hearing aids or prostheses. Moreover, audiometry provides the basis for the assessment of impairment and handicap and for the calculation of the degree of disability. In the present overview, the current state of the method inventory available for practical use is described, starting from basic diagnostics over to complex special techniques. The presentation is systematically grouped in subjective procedures, based on psychoacoustic exploration, and objective methods, based on physical measurements: preliminary hearing tests, pure tone threshold, suprathreshold processing of sound intensity, directional hearing, speech understanding in quiet and in noise, dichotic hearing, tympanogram, acoustic reflex, otoacoustic emissions and auditory evoked potentials. Apart from a few still existing gaps, this method inventory covers the whole spectrum of all clinically relevant functional deficits of the auditory system.

Welche Qualität macht den Unterschied in der Cochlea-Implantat-Versorgung?

“…Until now, no test procedure could be established as the only method to be applied. In the following, three speech intelligibility tests will be presented that are most frequently used in German speaking countries [19,20].…”

“…The mentioned subjective test procedures should be completed by the following objective methods: -Tympanometry Tympanometry allows statements about the status of the middle ear (ventilation, eardrum perforation, fluid behind the eardrum, mobility of the ossicles) and is an essential standard examination of audiological diagnostics [1,20].…”

“…Today the assessment of otoacoustic emissions (auditory evoked active movements of the outer hair cells of the cochlea) is a standard examination of inner ear diagnostics. If they are measured, most probably a hearing threshold of more than 35 dB HL can be expected [20]. The rapidly performed test and the high sensitivity make OAE measurements an appropriate screening examination in the context of newborn hearing screening or in cases of non-compliant patients.…”

“…In children, objective hearing tests are particularly important because they are usually not able to provide reliable statements. In summary, there are many publications and instructions regarding high-quality performance of examinations [20,[29][30][31][32][33][34][35].…”

Management des Vestibularisschwannoms

“…Zugrundeliegend ist hier die Annahme, dass die Welle V der Click-evozierten FAEP vorwiegend im basalen Hörschneckenbereich generiert wird. Wenn in diesem Bereich die Hörnervenfasern vom Tumor nicht betroffen sind, hat diese retrokochleäre Störung keinen Einfluss auf die FAEP [75]. Mit den neueren Verfahren kann die Sensitivität zwar auf 95 % und die Spezifität auf 88 % gesteigert werden, für den klinischen Gebrauch sind diese Verfahren jedoch sehr aufwendig.…”