Audiometry Practical Dr Stefanus Snyman snymansnew co za

Audiometry Practical Dr Stefanus Snyman (snymans@new. co. za)

What would you like to know?

The basics of audiometry What to do beforehand The testing itself Interpreting the audiogram Follow up and action steps

What to do beforehand 1. Who should get an audiogram? Ç Working in noise zone Ç Drivers Ç Risk to safety if poor hearing Ç Ear problems

What to do beforehand 2. What type of audiogram should be performed? Ç Baseline Ç Pre-employment Ç Periodic Screening Ç Monitoring Ç Exit Ç Diagnostic

What to do beforehand 3. Get a proper history on every candidate for testing • • • Personal info history period of exposure daily duration of exposure ? still exposed ? last exposed noise levels d. BA baseline audiogram copy of employee’s ID

What to do beforehand 4. Physical examination • • • Outer ear (otitis externa / wax) Tympanic membrane Middle ear

Otoscopy

Click here http: //www. youtube. com/watch? v=c. L__Tmu 7 OYY to see a Creative Commons video explaining how the ear works.

http: //commons. wikimedia. org/wiki/File: Anatomy_of_the_Human_Ear. svg An annulus fibrosus Lpi long process of incus - sometimes visible through a healthy translucent drum Um umbo - the end of the malleus handle and the centre of the drum Lr light reflex - antero-inferioirly Lp Lateral process of the malleus At Attic also known as pars flaccida Hm handle of the malleus

Outer channel

Outer ear

Retraction

Glue ear

Perforation

Otosclerosis / Grommet

What to do beforehand 4. Physical examination • • General ENT Otoscopy – Outer ear (otitis externa / wax) – Tympanic membrane – Middle ear • Rinne / Weber Tests (where indicated)

What to do beforehand 5. Out of noise requirements before a test • • • Baseline & Exit 16 h (no PPE) Diagnostic (24 h (no PPE) Other screening tests (PPE)

The basics of audiometry What to do beforehand The testing itself Interpreting the audiogram Follow up and action steps

The test X Equipment t Audiometer (DME Guideline p 106) t Booth t Software X Qualified audiometrist / audiologist

The basics of audiometry What to do beforehand The testing itself Interpreting the audiogram Follow up and action steps

Interpreting the audiogram X Basics of audiometry t Frequency t Decibel t Speech

Interpreting the audiogram X Basics of audiometry t Frequency t Decibel t Speech

Interpreting the audiogram X Basics of audiometry t Frequency t Decibel t Speech

Audiograms

Sensorineural hearing loss

Audiograms

Degrees of hearing loss

Normal hearing (see 4 k. Hz shift)

Audiograms

CASE STUDY 2 BL: 1 Nov 2002 = PLH 1. 1 SC: 1 Feb 2004 = PLH 14. 1 Shift from BL = 13

The quality of an audiogram X Determine the date the test was performed X Determine the type of audiogram (baseline, periodic screening, exit, diagnostic, etc. ) X Surname, Names, ID, DOB, age, Clock # of the employee X Employer & Date of employment

The quality of an audiogram X HISTORY, e. g. : t Current & Previous Noise levels and Exposure (dates) t Hearing Protection (Y/N/Sometimes) - since when? t Medication (ototoxic) t Colds, Allergies, Wax t Family history t Head injury t Ear discharge / infections t Previous diseases (TB, meningitis, etc. ) t Tinnitus

The quality of an audiogram X Findings with Physical Examination X Baseline audiometric data & PLH t Military Service; Hobbies X (If it is a baseline or diagnostic audiogram, determine which one of the 2 audiograms are the best (lowest PLH) – they should not differ with more than 10 d. B at 0, 5; 1; 2; 3; 4 k. Hz)

The quality of an audiogram X Current hearing threshold levels & PLH X Difference between baseline & current (PLH shift) t relevant comments: • If shift more than 15 d. B at 2, 3, 4 k. Hz • Schilings Category (optional) • Normal / Sensorineural / Conductive / Mixed – mild, moderate, severe, profound

The quality of an audiogram X Name, address, qualifications of person performing the test. X File audiogram – Archive old audios (40 years) X New Noise Level (noise zones, levels, exposure) every 2 years

The basics of audiometry What to do beforehand The testing itself Interpreting the audiogram Follow up and action steps

Follow up and action steps X Details of actions to be taken: • Inform patient • Warn / train patient • Inform employer • For further investigation (see OHMP, refer diagnostic, ENT, report to Compensation Commissioner or Inspectorate, etc. )

Thank you for lending me your ears

Creative Commons Audiometry Practical by Dr Stefanus Snyman School of Public Health and Family Medicine, University of Cape Town (2010) is licensed under a Creative Commons Attribution-Non. Commercial-Share. Alike 2. 5 South Africa License. Please see http: //creativecommons. org/licenses/bync-sa/2. 5/za/ for terms and conditions. All images created by external parties retain their original licenses (see image references on slides). Source work available at vula. uct. ac. za Permissions beyond the scope of this license may be available at www. healthedu. uct. ac. za or healthoer@uct. ac. za

Image References “Examining the ear” by user Amrefdls http: //wikieducator. org/File: Examingear 2. jpg (CC-BY-SA) Ear anatomy image by Chittka L, Brockmann (CC-BY-2. 5) http: //commons. wikimedia. org/wiki/File: Anatomy_of_the_Human_Ear. svg Anatomy of the ear ENT Audiometer by Mike Blyth (BY-NC-SA) http: //www. flickr. com/photos/blyth/1439068721/in/photostream/