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Audiometry Practical

Audiometry Practical. Dr Stefanus Snyman (snymans@new.co.za). What would you like to know?. The basics of audiometry. What to do beforehand  T he testing itself  Interpreting the audiogram  Follow up and action steps. What to do beforehand. 1. Who should get an audiogram?

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Audiometry Practical

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

  2. What would you like to know?

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

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

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

  6. 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 dBA • baseline audiogram • copy of employee’s ID

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

  8. Otoscopy

  9. Click here http://www.youtube.com/watch?v=cL__Tmu7OYY to see a Creative Commons video explaining how the ear works.

  10. An  annulus fibrosusLpi  long process of incus - sometimes visible through a healthy translucent drumUm  umbo - the end of the malleus handle and the centre of the drumLr  light reflex - antero-inferioirlyLp  Lateral process of the malleusAt  Attic also known as pars flaccidaHm  handle of the malleus http://commons.wikimedia.org/wiki/File:Anatomy_of_the_Human_Ear.svg

  11. Outer channel

  12. Outer ear

  13. Retraction

  14. Glue ear

  15. Perforation

  16. Otosclerosis / Grommet

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

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

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

  20. The test • Equipment • Audiometer(DME Guideline p 106) • Booth • Software • Qualified audiometrist / audiologist

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

  22. Interpreting the audiogram • Basics of audiometry • Frequency • Decibel • Speech

  23. Interpreting the audiogram • Basics of audiometry • Frequency • Decibel • Speech

  24. Interpreting the audiogram • Basics of audiometry • Frequency • Decibel • Speech

  25. Audiograms

  26. Sensorineural hearing loss

  27. Audiograms

  28. Degrees of hearing loss

  29. Normal hearing (see 4kHz shift)

  30. Audiograms

  31. CASE STUDY 2 BL: 1 Nov 2002 = PLH 1.1 SC: 1 Feb 2004 = PLH 14.1 Shift from BL = 13

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

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

  34. The quality of an audiogram • Findings with Physical Examination • Baseline audiometric data & PLH • Military Service; Hobbies • (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 10dB at 0,5; 1; 2; 3; 4kHz)

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

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

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

  38. Follow up and action steps • 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.)

  39. Thank you for lending me your ears

  40. 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-NonCommercial-ShareAlike 2.5 South Africa License. Please see http://creativecommons.org/licenses/by-nc-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

  41. Image References “Examining the ear” by user Amrefdls http://wikieducator.org/File:Examingear2.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/

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