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Hearing acuity is checked. Methods of medical and self-testing of hearing

A hearing test is a measurement of a person's hearing ability. There are two classes of methods for such measurements - subjective (psychoacoustic) and objective.

Subjective The method of hearing research is to study the reaction to sound stimuli that is directly displayed by the subject.

  1. Unconditioned reflex method The examination is used for children (infancy and infancy) and consists of checking unconditioned reactions that occur in response to sound stimulation. Such reactions include movements of the eyelids, pupils, eyes, limbs, sucking and swallowing movements, shuddering, turning the head towards the source of noise, grimaces, changes in the rhythm of breathing or heart contractions. All the reactions described above are a manifestation of the natural defense mechanism of any person, that is, an unconditioned reflex.

The unconditioned reflex method takes into account the characteristics of the child’s auditory functions, mental and physical development based on his age norms, and allows for a general idea of ​​the child’s hearing and the presence of possible disorders. The disadvantages of this type of research are the low degree of accuracy of the results due to the individual characteristics of the behavioral reaction, the rapid extinction of the reflex when the signal is repeated many times, and the overestimation of the sound threshold for the appearance of reflex reactions, which may result in a false positive result.

  1. Conditioned reflex The method is based on the development of conditioned reactions, that is, it assumes some kind of response from the subject (pressing buttons, moving or turning the head). Allows you to determine the frequency-specific hearing threshold in each ear separately.

Conditioned reflex audiometry is prescribed to children from 7 months to 3 years and is carried out in the form of a game using an acoustic center, on the screens of which animated pictures are shown. This creates a conditioned reaction to the sound in the child and forces him to turn to the monitor from which the sound should come (or press the corresponding buttons - for older children). The procedure often has ambiguous results, since it does not accurately determine the threshold of sensitivity, and the child’s behavior depends on his psycho-emotional state.

Hearing examinations of adult patients are carried out using audiometry - threshold (examines the degree of sensitivity to sounds at frequencies from 125 to 10,000 Hz), suprathreshold (assesses the ability to perceive and recognize signals of varying strengths - from very quiet to extremely loud) and speech (allows you to obtain information about the subject’s speech recognition ability).

A set of methods using a tuning fork . Thanks to a medical tuning fork, through a series of experiments it becomes possible to determine hearing acuity. Survey air conductivity involves placing the instrument in close proximity to the ear for a few seconds, then moving the device to the side (to avoid fatigue or tonal adaptation of hearing). Studying bone tissue conductivity include placing the instrument on the mastoid process, tragus, crown (experiments of Weber, Rinne, Bing, Federici, Schwabach, Jelle).

Subjective methods of hearing research are quite reliable, but they cannot be fully effective in cases of research in patients with mental retardation, nervous or mental disorders, emotional instability, or when simulating deafness. In addition, subjective studies at an early age provide an approximate picture, and other diagnostic tools are needed to confirm suspicions.

Objective research methods

Objective The research method consists of hardware recording of the electrical and sound signals that arise in different parts of the auditory system as a reaction to the action of a sound stimulus. The most commonly used diagnostic methods are impedance measurements, auditory potential methods, and otoacoustic emissions (OAE).

  1. UAE — registration of delayed otoacoustic emissions. The method consists of delivering sounds that reach the cochlear organ, and it, in turn, begins to vibrate in response, which is recorded by a highly sensitive microphone. If the emission (response vibrations) is not recorded, then the patient is diagnosed with hearing loss.
  2. Impedancemetry - a set of methods designed to establish conductive pathology (which include otitis media, plugs, atresia, perforation of membranes, etc.). The two most commonly used methods are:
  • tympanometry studies the acoustic conductivity abilities and mobility of the eardrum in response to air pressure in the ear canal. To carry out the procedure, a special earphone is inserted into the ear, delivering a certain sound and air flow, then the pressure changes, and the sound reflected from the membrane is recorded.
  • acoustic reflexometry examines the reflex contraction of the stapedius muscle, transmitted to the auditory ossicle and tympanic membrane. Reflex contractions are a reaction to sound, the level of which varies. The minimum level that causes a response is considered the acoustic reflex threshold. Essentially, this is a counteracting reaction of the nervous system to strong sound, which is a protective mechanism of the cochlear organ. Lack of response is a reason to suspect conductive pathologies.
  1. Method auditory evoked potentials (SVP) consists of exposure to sound signals, generating a response in the form of electrical activity in the sections of the auditory analyzer. Based on the rate of formation of activity, there are short-latency, medium-latency, long-latency evoked potentials , which are recorded using computer audiometry and potentials of the cochlear organ, measured using electrocochleography.

All of the methods described above are used in combination with others to test hearing abilities and accurately diagnose pathologies in patients of any age.

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 of certain frequencies.

In outpatient settings, audiometric testing is performed 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 the hearing 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 intensity levels (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.

Speech and pure-tone audiometry are among the subjective methods for studying hearing acuity, since during testing the specialist is guided by the testimony of the patient, who reports whether he hears the signals (speech) or not. A computer hearing test involves connecting special electrodes to the patient that record activity in certain areas of the brain if the auditory analyzer responds to signals coming from outside.

Speech audiometry

How to test your hearing at home? In the absence of special equipment that allows you to submit and record sound signals of a certain intensity and frequency, you can test your hearing organ using speech audiometry. This diagnostic method does not require medical equipment or additional devices. To determine the hearing sensitivity threshold of the subject, you will only need the audiometrist’s speaking apparatus.

The test results largely depend not only on the state of the auditory analyzer, but also on the breadth of the subject’s vocabulary.

To obtain a more objective assessment of the patient’s hearing threshold, the audiometrist should pronounce not individual words, but phrases consisting of a set of simple and understandable words. How should the test be carried out? It is advisable to carry out diagnostics in a room with a minimum amount of extraneous noise. In this case, the subject must sit in the middle of the room on a chair.

The audiometrist's actions should be as follows:

  1. move away from the subject 2-3 m and say a phrase consisting of at least 7-9 words in a whisper;
  2. at a distance of 6 m from the subject, quietly pronounce a set of individual phrases;
  3. From a 20-meter distance, pronounce the phrase in a raised voice.

During testing, the audiometrist must always ask whether the test subject can hear speech from a certain distance or not. In this way, you can roughly determine whether there is a hearing impairment or not.

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, there are no ear pathologies. 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 the help of 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 passing 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! With the development of infectious diseases associated with damage to the nasal mucosa, hearing acuity naturally decreases, which is due to blocking of the mouth of the 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.

Audiometry is a medical method for determining the level of hearing. When performing such testing, the degree of sensitivity of the auditory analyzer in relation to sounds of different frequencies and intensities is assessed. In the hospital, hearing tests are carried out using special equipment. The advantages of acumetry are that it allows you to dose different sound signals. Due to this, it is possible to determine the threshold susceptibility for sounds of different frequencies. In hospital settings, testing is carried out in soundproofed rooms. Based on the results of such an examination, it is possible to identify not only a decrease in hearing, but also the type of hearing loss. But you don’t have to go to the hospital to have your hearing checked; you can check it yourself.

Check Features

When a doctor checks his hearing in a medical facility, not only is a decrease in audibility determined, but also a pathological process that occurs in the sound analyzer is identified. Using an audiometer, an otolaryngologist or audiologist examines the level of conduction of air and bone sounds. Experts distinguish several types of audiometry:

  1. Speech. This method is considered the simplest and most accessible. In this hearing test, the doctor determines the level of speech recognition. When checking audibility, the doctor pronounces words in a voice of different volumes, and the patient must repeat them.
  2. Tonal. This acoustic testing method helps determine how well a person hears sounds of different frequencies and intensities.
  3. Computer. This hearing test is considered the most accurate. It helps determine the susceptibility of the sound-conducting and sound-perceiving systems.

Speech and pure-tone audiometry are classified as subjective methods for testing hearing levels. During the test, the specialist takes into account only the testimony of the person being examined, who says which sounds he hears and which he does not.

During a computer hearing test, different sensitive electrodes are connected to a person, which record activity in certain areas of the brain if the auditory analyzer responds to signals received from an external source.

The first symptoms of hearing impairment are frequent fatigue after communication, the inability to hear the interlocutor normally and speaking in high tones. A high-pitched sound on a TV, phone or alarm clock should alert you.

Speech audiometry

It is possible to test your hearing at home using speech audiometry. This research method does not require the use of special equipment and devices. To test your hearing, you simply need to hear human speech. But you need to understand that the results of such testing depend not only on the state of the hearing organs, but also on the vocabulary of the person being examined.

To objectively check the level of audibility, the audiometrist must speak not just words, but entire phrases that consist of simple words that are understandable to everyone. It is not difficult to carry out such a test, the main thing is to choose a room in which almost no extraneous noise can be heard. The person being examined is placed on a chair in the middle of the room.

  • He moves two meters away from the person being examined and whispers a phrase consisting of 8-9 simple words.
  • Moves away from the subject approximately 5 meters and quietly pronounces individual phrases.
  • From a distance of about 20 meters, he loudly pronounces a phrase consisting of simple words.

During such a test, the subject must clearly repeat what he heard. This testing allows you to determine hearing impairment.

When conducting speech audiometry, the person conducting the examination should ask the subject how well he hears phrases and phrases spoken at different distances.

Determination of survey results

If there are no pathologies, then the person can hear speech spoken in a whisper, the ticking of a clock and any sounds that are in the range of up to 25 dB. If sounds in this range are clearly audible, we can say with confidence that the hearing is normal. When determining the results, the following points are also taken into account:

  • If a person cannot fully understand speech spoken in a whisper from a distance of two meters, then degree 1 hearing loss can be suspected.
  • If you are unable to understand quietly spoken phrases from a distance of 6 meters, you can speak of hearing loss of the 2nd degree.
  • If the person being examined has difficulty hearing very loud speech spoken from a distance of 20 meters, then we can talk about stage 2-3 hearing loss.

If a home hearing test reveals any abnormalities, you need to contact an otolaryngologist, who will conduct an additional examination and prescribe treatment.

Auditory audiometry is most often used not to accurately determine hearing acuity, but to correctly adjust the hearing aid.

How to test your hearing yourself

It is quite possible to check the hearing on your own, without the involvement of other people. To independently check the operation of the hearing aid, a special test has been developed in which you need to clearly answer the questions posed. The list of questions is as follows:

  • Is it good to hear the ticking of a wall clock and whispered phrases?
  • Do you have problems with normal speech perception when talking on the phone?
  • Is it often necessary to ask again what the interlocutor said?
  • Has anyone noticed that the TV in the house is too loud?
  • Can you hear the birds singing outside the window?
  • Is it good to understand quiet speech from a distance of two meters?
  • Is the speech of your interlocutors well received?

If most of the answers indicate that hearing acuity is impaired, you should seek advice from a specialist.

An audiometric test cannot be performed if you have a cold.. At this time, severe inflammation of the nasopharynx occurs, which leads to a deterioration in the patency of the Eustachian tube, therefore, with respiratory diseases, there is a natural decrease in the audibility of sounds.

To ensure the reliability of the results obtained, testing can only be done if you are feeling well.

Verification Applications

Online audiometry can be used to test hearing acuity. These are special applications that run on different operating system platforms. To find out how well the organs perceive sounds, you should pass special tests developed by leading experts.

The most common programs for testing hearing acuity are:

  • Hörtest.
  • Mimi Hearing Test.
  • uHear.

If you don’t have a smartphone, you can check your hearing with an audiogram online using a computer, but for this you need to have headphones ready. Based on the results of such testing, we can say with confidence whether a person hears well or not.

You should check the audibility of sounds using computer programs in absolute silence, otherwise the examination results will not be accurate.

Checking for young children

It is very difficult to check the hearing of newborn babies without the involvement of a specialist. At this age, the child cannot speak yet, so ear pathologies are very easy to miss.

Checking the hearing level of a newborn child at home is not easy, but if there is any suspicious situation, parents should inform the pediatrician.

Before a month, it is almost impossible to determine how a child reacts to sounds. Babies begin to respond to different sounds only at one month of age. Parents should closely monitor the development of the baby. Among the toys, you should definitely buy a musical carousel, rattles and various squeakers.

When testing a baby's hearing, the following methods are used:

  • Take a jar of baby puree and fill it with any cereal. Take turns rubbing the jar near the baby’s ears and observing the reaction.
  • Make a loud sound out of the child's sight. If the baby reacted, then the hearing is absolutely fine. It is important not to overdo it here, as the baby may be frightened by the loud sound and cry.
  • You can quietly hum a melody or ring a bell next to your baby's ear. If he responds to all sounds, then there is no cause for concern.

By the age of three months, the child already recognizes his mother’s voice and reacts violently to it. Starting from six months, the child tries to reproduce sounds himself.

If there is deterioration in hearing, then you need to consult a doctor. The specialist will determine the cause of this pathology and prescribe comprehensive treatment. It is worth considering that with early therapy, hearing can be restored partially or even completely.

Group I - hearing research using live speech. This method is very valuable because it allows you to determine hearing acuity and speech intelligibility. These qualities are of primary interest to the patient. They are no less of interest to the researcher, since they have social significance, determine the professional suitability of the patient, the possibility of his contact with others, serve as an indicator of the effectiveness of the treatment methods used and a criterion for the selection of hearing aids, and are the main sign for judging the degree of hearing damage during work, military and forensic examinations. Hearing is examined using whispered and spoken speech. In this case, they use a set of two-digit numbers and words from the table of V.I. Voyachek with a predominance of bass or treble phonemes. Testing hearing with speech is the simplest method, which does not require speakers or equipment, but provides certain information for judging the level of damage to the auditory analyzer. So, if whispered speech is perceived very poorly (at the auricle), and spoken speech is perceived quite well from a distance of 4-5 cm, then there is reason to assume damage to the sound-receiving apparatus; If the patient distinguishes simple sounds—numbers and monosyllabic words—well, but does not understand phrases from the same distance, then this may indicate a pathological process in the area of ​​the auditory centers.

Group II - hearing research using tuning forks (tuning fork audiometry). This simple instrumental method has been known for over 100 years. There are different sets of tuning forks - small, consisting of 3 tuning forks (128, 1024, 2048 Hz), and large ones, consisting of 5,7 and even 9 tuning forks (16, 32, 64, 128, 356, 512, 1024, 2048, 4096 Hz ). Letters of the Latin alphabet are used to designate tuning forks. Tuning fork audiometry makes it possible to judge the nature of the impairment of auditory function, i.e., whether the sound-conducting or sound-receiving apparatus is affected in a given patient. Tuning forks are used to study air and bone conductivity, experiments are carried out by Weber, Rinne, Schwabach, Federici, Jelle, and based on them I make a preliminary conclusion about the nature of hearing loss - whether it is bass or treble. III troupe - hearing research using electroacoustic equipment (electroaudiometry). There are pure-tone audiometry (threshold and suprathreshold), speech audiometry, determination of auditory sensitivity to ultrasound, to high tones of the audible frequency range (above 8 kHz), identification of the lower limit of perceived sound frequencies. All these methods relate to subjective audiometry, i.e. folding ideas about the hearing function depend not only on its true state and the equipment used for research, but also on the ability of the subject to understand, react and respond to the signals given. In addition to subjective audiometry, there is objective audiometry. In this case, the answers do not depend on the desire or will of the subject. This is very important when studying hearing in young children, in military medical and forensic medical examinations. We will consider objective audiometry, which allows us to accurately establish the presence or absence of hearing, as well as clarify the nature of its impairment, a little later.

As for such audiometric methods as tone threshold, speech audiometry, determination of auditory sensitivity in an extended frequency range and to ultrasound, they make it possible to establish not only the nature of the damage to the auditory function, but also its location: receptor in the cochlea, nerve trunk, nuclei , subcortical and cortical

Audiometry is carried out using special electronic devices that reproduce vibrations of a certain frequency and intensity, and transforming devices - telephones, air and bone.

The results of a hearing test using tone threshold audiometry are recorded on special forms - audiograms. They have a zero level - the threshold of hearing sensitivity is normal, the frequencies at which hearing is examined are indicated on the abscissa axis - from 125 Hz to 8 kHz, and on the ordinate axis there is a decrease in hearing in dB. For most audiometers, the maximum intensity of the sound signal with air conduction is 100-110 dB, with bone conduction - 60-70 dB above zero level. The most common tests of suprathreshold audiometry are: determination of the differential threshold for the perception of sound intensity, the time of direct and reverse auditory adaptation, auditory discomfort and the index of sensitivity to short increases in sound. An audiometric study of tinnitus (if the patient has it) helps to clarify the nature and location of damage to the auditory analyzer to a certain extent. On the audiogram you can see a graphical recording of subjective tinnitus examined by the overlap method. In this case, the noise intensity in dB and its spectrum, i.e., frequency response, are established. Usually, when the sound-conducting apparatus is damaged, the noise is low-frequency, and when the sound-receiving apparatus is damaged, it is high-frequency. At our department, for many years we have been studying in detail pathological auditory sensations, i.e., tinnitus, in various pathologies, but mainly in non-purulent ear diseases. The results of the studies help to make a differential diagnosis, clarify the indications for surgery and choose the side of the operation, for example, for otosclerosis, in which painful tinnitus often bothers patients the most. Electroacoustic study of tinnitus serves to monitor the effectiveness of treatment - surgical and conservative, including various types of reflexology. The results of observations on the study of tinnitus in a significant number of patients (more than 4000) allowed us to summarize this material and present it in the form of a monograph.

For speech audiometry, a tape recorder is used, to which an additional device is adapted that allows you to change the intensity of the reproduced speech within certain limits. In this case, they use the standard speech of one person, to whom groups of words are read 10 -3-10 * 6 times each, with the same volume. In one group, words with phonemes of medium and high frequencies predominate, in the other - low ones. Typically, speech audiometry determines the threshold of 50% intelligibility and the level of 100% intelligibility of speech. Since this measures the percentage of speech intelligibility at various levels of its intensity, speech audiometry also refers to suprathreshold tests. When performing speech audiometry, an audiogram is also compiled. In people with hearing impairment caused by damage to the sound-conducting apparatus, the curve of increase in speech intelligibility repeats the shape of the curve in people with normal hearing, but is located from it to the right, i.e., towards higher intensities. When the sound-receiving apparatus is damaged, the speech intelligibility curve is not parallel to the normal curve - it deviates sharply to the right, often not reaching the 100% level. As the intensity of the speech supplied increases, intelligibility may even decrease. The study of auditory sensitivity to ultrasound has been widely used in the last 15-20 years. This is a very informative method that allows you to determine the nature and level of damage to the auditory analyzer (the threshold values ​​during bone conduction are used to judge the perception of ultrasounds with a frequency of up to 200 kHz and the phenomenon of their lateralization). There is also objective audiometry. We are talking primarily about recording auditory cortical and brainstem evoked potentials. The fact is that sound signals affect the spontaneous electrical activity of the brain, that is, activity that exists independently of external stimuli and is reflected in the electroencephalogram by certain curves. These curves are characterized by amplitude and periodicity. The parameters of the electroencephalogram change with the action of sounds. However, attempts to use changes in the electroencephalogram parameters themselves to establish the state of hearing were not successful and did not find application in audiological practice, although they are of great importance for physiological research. Modern electrophysiological assessment of hearing in clinical audiology is based on recording potentials in individual areas of the brain (cortex, brainstem) in response to an audio signal. Therefore, such potentials are called auditory evoked potentials. Typically, auditory evoked potentials are generated from the region of the apical point of the crown - vertex. To reproduce evoked potentials, short-duration sound signals—clicks—that do not have a tonal coloration, and longer sound pulses containing tones of different frequencies are used. In order to evaluate the results of a study using a computer, it is necessary first of all to average the evoked potentials, which is why such a study is called computer audiometry. The method of computer audiometry is complex - the limited tasks for which it is intended to solve make it advisable to organize such studies in special centers or institutes. However, the development of this method should lead to the development of a physiologically based and reliable method for objective assessment of hearing.

One of the methods for objective assessment of hearing is impedance tympano- and reflexometry. The method is based on recording the acoustic impedance, or resistance, that a sound wave encounters as it travels through the acoustic system of the outer, middle and inner ear. Impedance measurements are of primary importance for assessing the condition of the structures of the middle ear. The assessment is made by analyzing a tympanogram, which graphically shows the dynamics of acoustic impedance during an artificially created air pressure difference in the external auditory canal within ±200 mm of water. Art.

Group IV - study of hearing using unconditioned and conditioned reflexes to sound.

Of the unconditioned reflexes, first of all, two need to be named - auropalpebral and auropupillar, respectively, blinking and pupillary reactions to sound. An unconditioned reaction to sound occurs in a child from the first hours after birth. However, it is indicative, and therefore unstable, insensitive and quickly fading. But the auropalpebral and auropupillar reflexes help to resolve the question in a general form about the presence or absence of hearing in a child. It is only necessary to exclude the element of tactile irritation during the study, i.e., produce sound with a Barany rattle or tuning forks, and not with clapping hands.

2. Nuclei of the vestibular analyzer and their connections with other departments
central nervous system.

3. Nasal septum, its deformation; indications and types of operations for
nasal septum.

Deviation of the nasal septum is one of the most common rhinological pathologies. According to literature, it occurs in 95% of people. The reasons for such frequent deformation may be anomalies (variations) in the development of the facial skeleton, rickets, trauma, etc. Due to the fact that the nasal septum consists of various cartilaginous and bone structures, limited above and below by other elements of the facial skull, the ideal and combined development of all These components are extremely rare; it is the uncoordinated pace of development of the facial skeleton that determines one of the main reasons for its deformation.

Variations of the curvature of the nasal septum are very different. Displacement to one side or the other, S-shaped curvature, formation of ridges and spines, subluxation of the anterior part of the quadrangular cartilage are possible. The most common deformity is observed at the junction of individual bones and quadrangular cartilage. Especially noticeable curvatures are formed at the junction of the quadrangular cartilage with the vomer and the perpendicular plate of the ethmoid bone. It must be recalled that the quadrangular cartilage often has an elongated sphenoidal process, directed posteriorly, towards the sphenoid bone. The resulting deformations can take the form of long formations in the form of ridges, or short ones in the form of spikes. The junction of the vomer with the ridge, formed at the bottom of the nasal cavity by the palatine processes of both upper jaws, is also a favorite localization of deformities. It is impossible not to mention the insidious form of curvature of the nasal septum, which practical ENT doctors often underestimate. This is the curvature of the quadrangular cartilage in its anterior-superior section, which does not interfere with the view of most of the nasal cavity and even the posterior wall of the nasopharynx. However, it is this variation in the deviation of the nasal septum that can cause difficulty breathing. The latter is due to the fact that the inhaled air stream, having, as is known, not a sagittal direction from front to back, but forming an arc convex upward, finds in this place an obstacle to its movement.

Deformation of the nasal septum, causing disruption of the function of external respiration, determines a number of physiological abnormalities that were mentioned when considering the function of the nose.

In the nasal cavity itself, breathing defects reduce gas exchange in the paranasal sinuses, contributing to the development of sinusitis, and difficulty in the flow of air into the olfactory cleft causes a disturbance in the sense of smell. Pressure of ridges and spines on the nasal mucosa can lead to the development of vasomotor rhinitis, bronchial asthma and other reflex disorders (Voyachek V.I., 1953; Daynyak L.B., 1994).

Clinic and symptoms. The most important symptom of a clinically significant curvature of the nasal septum is unilateral or bilateral difficulty in nasal breathing. Other symptoms may include impaired sense of smell, nasal tone, and frequent and persistent runny nose.

Diagnosis. It is established on the basis of a combined assessment of the state of nasal breathing and the results of rhinoscopy. It should be added that the curvature of the nasal septum is often combined with deformation of the external nose of congenital or acquired (usually traumatic) origin.

Treatment. Only surgery is possible. The indication for surgery is difficulty breathing through one or both halves of the nose. Operations on the nasal septum are also performed as a preliminary stage preceding other surgical interventions or conservative treatment methods (for example, to remove a ridge or spike that interferes with catheterization of the auditory tube).

Surgeries on the nasal septum are performed under local or general anesthesia. They are technically complex manipulations. Damage to the mucous membrane in adjacent areas of the septum leads to the formation of persistent, practically irreparable perforations. Bloody crusts dry along the edges of the latter. Large perforations contribute to the development of atrophic processes, small ones cause “whistle” when breathing.

V.I. Vojacek proposed a general name for all operations on the nasal septum “septum operation”. In recent years, the term “septoplasty” has gained popularity.

Among the various modifications of septum operations, two fundamentally different methods should be distinguished. The first is a radical submucosal resection of the nasal septum according to Killian, the second is a conservative septum operation according to Voyacek. In the first method, most of the cartilaginous and bone skeleton of the septum is removed submucosally (simultaneously subperichondrial and subperiosteal). The advantage of this operation is its comparative simplicity and speed of execution. The disadvantage is the flotation of the nasal septum observed during breathing, which is devoid of most of the osteochondral skeleton, as well as the tendency to develop atrophic processes. With the second method, only those areas of the cartilaginous and bone framework are removed that cannot be redressed and placed in the correct median position. In case of curvature of the quadrangular cartilage, the disc is cut out by circular resection. As a result, the disc, which maintains connection with the mucous membrane of one side and has acquired mobility, is installed in the middle position

With very pronounced curvatures of the quadrangular cartilage, it can be dissected into a larger number of fragments, which also maintain connection with the mucous membrane of one of the sides.

Conservative methods of surgery on the nasal septum are more surgically complex interventions. However, their long duration and possible moderate reactive phenomena in the nasal cavity in the first weeks after surgery later pay off by preserving an almost complete nasal septum.

4. Professional selection for auditory and vestibular function, its
importance for various types of aviation, including space and
navy.

It consists in determining suitability for a particular type of work, a particular profession. Based on data on the structure and function of the VDP and ear, the question of which industry a person can work in, which he cannot work in, and suitability for service in the Armed Forces or in a certain branch of the military are decided upon. Vocational selection is carried out by identifying indications that should reflect the actual impossibility of performing specific work due to a certain health condition. Taking into account the state of health, the subject is given advice on choosing the most appropriate type of work activity, thereby providing professional consultation.

Where to get your hearing checked in Moscow? If you are interested in this question, please contact. The clinic has a diagnostic department equipped with modern equipment. With us you can go through the full hearing examination, check the condition of the outer and inner ear. Based on the diagnostic results, specialists will select corrective or maintenance therapy.

Causes of hearing loss

Hearing loss—the inability to perceive sounds—can be congenital or acquired. To rule out congenital deafness, infants in Moscow maternity hospitals are tested for hearing in the first days of life. For this purpose, the otoacoustic emission method is used. Then the ENT examines the baby at 1 and 3 months, then according to indications. As a rule, congenital pathologies are detected by the first year of life. Subsequently, such a child’s hearing is tested in Moscow clinics, where audiologists and speech pathologists conduct consultations.

The causes of acquired hearing loss can be:

  • long-term noise exposure,
  • ENT infections,
  • taking antibiotics,
  • head injuries,
  • foreign body or sulfur plug,
  • damage to the eardrum,
  • neurological disorders.

General research methods

To check the hearing of an adult in Moscow, you need to make an appointment with an otorhinolaryngologist. During the first appointment, the doctor will clarify the patient’s complaints and the following information:

  • factors that provoke
  • the period when you first began to hear poorly,
  • taking medications,
  • living and working conditions.

After this, the specialist will check the condition of the outer ear and conduct an examination of the respiratory system. If the disorders are associated with an inflammatory process in the nasopharynx or otitis media, treatment is prescribed. It is advisable to carry out further diagnostics only after completion of therapy.

Damage to the eardrum is also detected during the initial examination. You can undergo surgery to restore it in our medical center in Moscow. Please check with your ENT specialist for details during your consultation.

Special methods

In Moscow clinics where the necessary equipment is available, hearing can be tested in the following ways:

  • audiometry,
  • tympanometry,
  • impedancemetry.

Using audiometry, a specialist sets the hearing threshold and determines the frequencies perceived by a person. Impedance testing allows you to evaluate reflexes and the passage of sound waves through the eardrum. Tympanometry is performed to check the function and integrity of the middle ear.

All studies are carried out on an outpatient basis at a clinic in Moscow. A comprehensive diagnosis takes several hours. The tests are absolutely safe and painless, and are allowed for people of any age and health status. The results are delivered on the day of the examination. To interpret them, you need to make an appointment with an otolaryngologist.