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Samenvatting Audiologie 1: Audiologie / Audiometrie
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Samenvatting Audiologie 1: Audiologie Audiometrie Complete samenvatting van de lessen en de cursus
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Hogeschool GentAudiologie 1
Audiologie / Audiometrie
2021-2022
,Contents
1. Het audiologische assessment .................................................................................................................................. 3
1.1. Anamnese ......................................................................................................................................................... 3
1.2. Otologische inspectie ........................................................................................................................................ 3
1.3. Audiometrische testen ...................................................................................................................................... 4
2. Het tonaal audiogram ............................................................................................................................................... 5
2.1. De gehoordrempel ............................................................................................................................................ 5
2.1.1. De gehoordrempel van normaalhorenden ............................................................................................... 5
2.1.2. dB Hearing Level ....................................................................................................................................... 6
2.2. De opbouw van het audiogram ........................................................................................................................ 6
2.3. De luchtgeleidingsdrempel ............................................................................................................................... 8
2.3.1. Index voor het gehoorverlies .................................................................................................................... 9
2.3.2. Graad van gehoorverlies ......................................................................................................................... 10
2.3.3. Vorm van het audiogram ........................................................................................................................ 10
Oncomfortabele luidheid (UCL) .................................................................................................................................. 11
2.4. Horen via beengeleiding ................................................................................................................................. 12
2.5. De beengeleidingsdrempel ............................................................................................................................. 13
2.5.1. Opmeten van de drempel ....................................................................................................................... 13
2.5.2. Weergave van de drempel ...................................................................................................................... 14
2.6.3. De Air-Bone-Gap ........................................................................................................................................... 16
2.7. Type gehoorverlies .......................................................................................................................................... 17
2.7.1. Conductief gehoorverlies ........................................................................................................................ 18
2.7.2. Neurosensorieel gehoorverlies ............................................................................................................... 18
2.7.3. Gemengd gehoorverlies .......................................................................................................................... 19
2.8. Samenvatting .................................................................................................................................................. 20
2.8.1. Symbolen................................................................................................................................................. 20
2.8.2. Beschrijving audiogram ........................................................................................................................... 20
3. Stemvorkproeven.................................................................................................................................................... 20
3.1. Proef van Schwabach ...................................................................................................................................... 21
3.2. Proef van Rinne ............................................................................................................................................... 21
3.3. Proef van Weber ............................................................................................................................................. 22
4. Afname tonale liminaire audiometrie ..................................................................................................................... 23
4.1. Voorbereiding ................................................................................................................................................. 23
4.2. Apparatuur ...................................................................................................................................................... 23
4.2.1. De audiometer ........................................................................................................................................ 23
4.2.2. Transducers ............................................................................................................................................. 24
4.2.3. Meetomstandigheden............................................................................................................................. 24
4.3. Luchtgeleiding ................................................................................................................................................. 25
1
, Stimuli ..................................................................................................................................................................... 25
Stimuli in het vrije veld ........................................................................................................................................... 25
Reactie van de patiënt ............................................................................................................................................ 25
Instructie test .......................................................................................................................................................... 25
Luchtgeleidingsdrempels ........................................................................................................................................ 26
Procedure drempelbepaling ................................................................................................................................... 26
Het volledige audiogram ......................................................................................................................................... 27
Oncomfortabele luidheid ........................................................................................................................................ 28
Sensation level ........................................................................................................................................................ 28
4.4. Beengeleiding.................................................................................................................................................. 28
Transducer .............................................................................................................................................................. 28
Van dB SPL naar dB HL ............................................................................................................................................ 29
Beengeleidingsdrempel .......................................................................................................................................... 29
Beengeleidingsdrempel bij een normaalhorende .................................................................................................. 30
Audiometrie: bepaling beengeleidingsdrempel ..................................................................................................... 30
Afname Toonaudiometrie ....................................................................................................................................... 30
4.5. Andere audiometrische dempeltesten ........................................................................................................... 31
4.5.1. Screening ................................................................................................................................................. 31
4.5.2. Hoogfrequente audiometrie ................................................................................................................... 31
4.5.3. Bekesy Audiometrie ................................................................................................................................ 32
5. Maskeren bij tonale audiometrie ........................................................................................................................... 33
5.1. Inleidende begrippen ...................................................................................................................................... 33
5.1.1. Overzicht van belangrijke begrippen en afkortingen.............................................................................. 33
5.1.2. Occlusie-effect (OE)................................................................................................................................. 33
5.2. Overhoren ....................................................................................................................................................... 33
5.2.1. Wat is overhoren..................................................................................................................................... 33
5.2.2. Sensation level bij overhoren.................................................................................................................. 34
5.3. Wanneer maskeren? ....................................................................................................................................... 35
5.4. Maskeersignaal ............................................................................................................................................... 35
5.5. Methode van Hood of schaduwmethode ....................................................................................................... 36
5.6. Hoeveel maskeren .......................................................................................................................................... 37
5.6.1. Minimaal maskeerniveau ........................................................................................................................ 37
5.6.2. Maximaal maskeerniveau ....................................................................................................................... 38
5.7. Samenvatting: de procedure voor maskeren ................................................................................................. 38
5.7.1. Stappenplan ............................................................................................................................................ 38
5.7.2. Symbolen....................................................................................................................................................... 38
5.7.3. Plaatsing koptelefoon ................................................................................................................................... 39
6.7. Maskeerdilemma ............................................................................................................................................ 39
2
, 1. Het audiologische assessment
1.1. Anamnese
De zorgvrager geeft info over zijn gehoor, ervaringen en/of de ondervonden hinder.
− Administratieve gegevens
− Sociale en psychosociale gegevens
o Beperkingen
o Participatieproblemen
− Medische voorgeschiedenis
− Audiologische voorgeschiedenis
o Onset gehoorklacht
o Audiologische interventies
− Vraaggesprek en observatie
Aantal vragen die je zeker moet stellen:
− Sinds wanneer ervaart de zorgvragen een auditieve beperking
− Is het gehoor vaan beide zijden even veel verminderd of is er een verschil tussen links en rechts? Zoja, wat is
het beste oor?
− Zijn er in het verleden reeds audiologische interventies geweest?
− Ondervindt de zorgvrager beperkingen bij bepaalde activiteiten?
− Ondervindt de zorgvrager praticipatieproblemen?
Observatie!
− Verstaat de zorgvrager alles vlot?
− Vraagt de zorgvrager vaak om iets te herhalen of is aan zijn mimiek zichtbaar dat hij niet verstond?
− Heeft de zorgvrager nood aan de ondersteuning van het lipbeeld?
1.2. Otologische inspectie
Onderzoek van de anatomische eigenschappen van het
gehoororgaan
Via otoscopie kan de uitwendige gehoorgang en het trommelvlies
onderzocht worden
− Vrije gehoorgang? → cerumenprop blokkeert geluid
− Staat van de gehoorgang? → ev kleine verwondingen
− Trommelvlies
o Gezond: gespannen, je ziet de hamersteel en licht van de otoscoop reflecteert
o Het trommelvlies geeft info over de conditie van het middenoor
▪ Bv bol trommelvlies – vocht
Structuren van midden- en binnenoor kunnen via medische beeldvorming in kaart gebracht worden (bv CT en MRI)
→ eerst audiometrische testen uitvoeren
Bij een unilaterale gehoorsdaling zal men via een scan controleren of er een tumor aanwezig is op de gehoorzenuw
3
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