Yog tias koj hnov lus tsis hnov lus, koj yuav tsum mus ntsib kws kho mob. Nws tsis yog ib txwm ua tau rau tus neeg kom paub tseeb tias muaj kev ua haujlwm tsis zoo hauv ntau qhov chaw ntawm pob ntseg. Hauv tsab xov xwm no, peb yuav saib yuav ua li cas kuaj koj lub rooj sib hais kom raug.
Daim ntawv hla kev hnov lus yog lub rooj uas muaj cov ntaub ntawv los ntawm kev siv rab rawg thiab kev hais lus ntawm kev ua txhaum ntawm lub suab ntsuas ntawm cov neeg mob thiab cov neeg noj qab haus huv.
Basic concepts
Yog li, daim ntawv hla tebchaws auditory yog lub rooj nrog cov ntaub ntawv los ntawm kev hais lus kev tshawb fawb txog qhov tsis zoo ntawm cov kws tshuaj ntsuam xyuas hauv cov neeg mob. Thov rov qab rau xyoo 1935 los ntawm cov kws tshawb fawb Woyachek thiab Bohon, cov txheej txheem no tseem siv niaj hnub no. Nws yog siv los ua ib qho kev kuaj mob tseem ceeb los txheeb xyuas qhov tsis hnov lus hauv tib neeg.
Cov kws kho mob feem ntau siv cov kev tshawb fawb classical hauv daim ntawv ntawm rab diav rawg, rattles, ntxhi, hais lus sib tham, thiab tib lub sijhawm ntxiv kev soj ntsuam hauv hom kev sim ntawm Zhellet, Kutursky thiab Bint,uas tso cai rau kuaj pom kev lag ntseg tag nrho.
Cov txiaj ntsig ntawm kev ntsuas ntsuas ntsuas ntsuas tau nkag mus rau hauv daim ntawv hla tebchaws ntawm cov ntaub ntawv kho mob, tsis muaj lawv nws feem ntau tsis tuaj yeem txiav txim siab qhov tseeb, tshwj xeeb tshaj yog nrog kev txhim kho tsis hnov lus vim qee yam kab mob.
Cov kev cai yog dab tsi?
Txhua xyoo, cov kws tshaj lij hloov kho lub rooj no. Thaum daim ntawv hla kev hnov lus zoo li qub, nws feem ntau tsis hloov pauv, tsuas yog cov ntaub ntawv tshiab nkag mus rau ntawd. Txhawm rau ua lawv cov kev suav, lawv siv lub sijhawm nruab nrab ntawm lub suab nrov ntawm lub diav rawg rau kaum tus neeg noj qab haus huv hnub nyoog nees nkaum txog nees nkaum tsib uas tsis muaj qhov sib txawv ntawm lub suab pom thiab hais lus.
kos daim ntawv hla tebchaws
Raws li ib feem ntawm kev tsim lub rooj kuaj mob, kev tshuaj xyuas ib ntus ntawm tus neeg mob lub rooj sib hais tau ua tiav:
- Nrhiav kom paub qhov muaj suab nrov hauv tus neeg mob thaum kuaj lub cev.
- Qhov kev hnov lus tsis hnov lus yog tshuaj xyuas hauv kev ntxhi lossis sib tham.
- Nyob rau hauv qhov xwm txheej uas muaj kev xav tias lag ntseg tag nrho, ces kev sim nrog Barany's ratchet yog siv.
- Txiav txim siab huab cua thiab pob txha conduction ntawm ob qho tib si auditory analyzers ib zaug siv ib txheej ntawm kev sib tw.
- Nyob rau hauv xaus, raws li ib feem ntawm kev npaj ntawm auditory passport, cov kev sim ntawm Rinne, Weber thiab Schwabach yog ua tiav.
Tom ntej no, peb yuav pom qhov tseem ceeb ntawm kev kuaj mob hauv kev kuaj mob ntawm ntau yam pathologies, thiab peb yuav tham txog kev txiav txim siab lub rooj sib hais.
Table piav qhia thiab kuaj tus nqi
Cov ntaub ntawv tau txais tom qab kev kawm tau muab piv nrog cov ntawv hla tebchaws ntawm cov neeg noj qab haus huv. Raws li qhov kev sib txawv ntawm qhov sib txawv, qhov kev kuaj mob ua ntej tau tsim thiab tsim lub tswv yim tsim nyog rau kev kho lossis kho qhov sib txawv uas twb muaj lawm.
Txoj kev kuaj mob tso cai rau txheeb xyuas qhov ua rau ntawm kev txhim kho ntawm kev hnov lus tiv thaiv keeb kwm yav dhau los ntawm cov kab mob uas cov membranes tsis raug kev txom nyem thiab nyob twj ywm tsis zoo, piv txwv li, xws li cov ntaub ntawv nrog serous otitis media, otosclerosis., neuroma ntawm paj hlwb, Meniere's kab mob, thiab lwm yam.
Yuav ua li cas ntsuas koj lub rooj sib hais, nws yog ib qho tseem ceeb kom paub ua ntej.
tsis hnov lus
Nyob ntawm qhov xwm txheej ntawm qhov kev puas tsuaj uas tus kws tshuaj ntsuam xyuas tau dhau los, neurosensory thiab kev hnov lus tsis zoo yog qhov txawv. Nyob rau hauv thawj rooj plaub, raws li txoj cai, lub suab-conducting seem ntawm lub analyzers raug cuam tshuam, peb tab tom tham txog lub pob ntseg, auditory ossicles thiab daim nyias nyias. Nyob rau hauv tus txheej txheem ntawm kev xeem nrog ib tug tuning diav rawg thiab hais lus nyob, cov neeg mob hnov lub suab nrog lawv mob pob ntseg. Kev ntsuam xyuas Rinne muab cov txiaj ntsig tsis zoo, vim tias lub suab kis tau los ntawm cov pob txha feem ntau zoo dua li huab cua.
Nyob rau hauv rooj plaub thib ob, lub suab pom ntawm lub ntsuas ntsuas ntawm cov hlab ntsha, cov ntu nruab nrab thiab pob ntseg sab hauv yuav raug cuam tshuam. Nyob rau hauv lub auditory passport nrog sensorineural tsis hnov lus, cov neeg mob pom tau hais tias suab zoo nrog lawv cov pob ntseg noj qab nyob zoo. Nws yog ib nqi sau cia hais tias nyob rau hauv cov ntaub ntawv no Rinne xeem yuav ua tau zoo, thiab huab cua conduction, nyob rau hauv lem, yog zoo dua li cov pob txha conduction.
Haring Passportotitis media
Nws yog qhov yuav tsum tau kos daim ntawv hla tebchaws thaum muaj otitis media. Nws ua rau nws muaj peev xwm ua qhov kev kuaj mob zaum kawg rau tus neeg mob, sau tshuaj kho kom raug thiab ua tiav kev rov ua tiav yam tsis muaj teeb meem ntawm kev soj ntsuam auditory.
Qhov kev kuaj no yog txhawm rau kuaj qhov sib txawv ntawm cov neeg tsis hnov lus. Nws yog raws li kev sib piv ntawm kev xaav ntawm lub suab ntshiab thaum lub sij hawm cov pob txha thiab cov huab cua conduction. Muaj cov txheej txheem tshwj xeeb ntawm cov cuab yeej tuning uas tso cai rau koj los tshawb fawb hauv ntau qhov sib txawv. Muaj tseeb tiag, rau kev xyaum txhua hnub, koj tuaj yeem muaj tsuas yog ob txoj hlua txuas hauv qab no:
- qis (128 cycles ib ob).
- siab, uas muaj ob txhiab thiab plaub caug yim oscillations ib ob.
Txhua txoj hlua yuav tsum muaj daim ntawv hla tebchaws, uas yog, cov ntaub ntawv hais txog lub sijhawm hauv vib nas this thaum lub sijhawm nws lub suab yuav pom los ntawm cov neeg noj qab haus huv.
Cia saib seb nws yog dab tsi thiab ua li cas audiometry ua tiav.
Xav paub ntxiv txog audiometry
Nyob rau hauv lub moj khaum ntawm kev kho mob otorhinolaryngology, cov txheej txheem thiab lub hom phiaj ntawm kev kuaj mob audiometric rau kev hnov lus tsis zoo yog siv. Cov ntsiab lus suav nrog qhov pib suab nrov audiometry thiab kev txiav txim siab ntawm qib ntawm kev hnov mob rhiab heev rau ultrasound. Tsis tas li ntawd, muaj kev ntsuas saum toj kawg nkaus, kev hais lus, cov yam ntxwv ntawm lub suab nrov, kev kawm txog kev tiv thaiv lub suab nrov ntawm lub rooj sib hais spatial nrog rau kev txiav txim siab ntawm cov spectrum. Subjective tinnitus.
Nws yog dab tsi - audiometry, qhov kev kawm no ua li cas, tsis paub rau txhua tus. Nws tuaj yeem ua tau nyob rau hauv ib qho kev ncua ntau zaus, nrog rau lub ntsiab lus ntawm cov kev txwv qis ntawm cov suab nrov zaus, suav nrog. Raws li ib feem ntawm kev txheeb xyuas suprathreshold, lawv tshuaj xyuas:
- Differential force perception thresholds.
- Sound zaus kawm.
- Rov qab hloov lub sijhawm nrog rau qib tsis xis nyob.
- Tshaj tawm ntawm qhov sib txawv ntawm qhov kev sib tham.
Nws yog ib qho tsim nyog sau cia tias ib qho ntawm cov dej num ntawm ntshiab-tone audiometry ntawm daim ntawv saum toj kawg nkaus yog los txiav txim qhov tshwm sim ntawm kev nce nrawm hauv ntim, tus yam ntxwv ntawm kev puas tsuaj rau lub cell receptor ntawm lub cev ntawm Corti. Lub hom phiaj ntawm kev kuaj mob audiological nyob rau hauv lub xub ntiag ntawm tsis hnov lus muaj xws li lub impedance system thiab kev kawm ntawm auditory evoked muaj peev xwm nrog otoacoustic emission.
Tonal pib audiometry yog txoj kev siv suab nrov tshaj plaws. Txhua qhov kev tshawb fawb audiological pib nrog nws, yog li txhua tus kws kho mob otolaryngologist yuav tsum paub nws cov txheej txheem thiab tuaj yeem ntsuas qhov tshwm sim.
Txoj kev tshawb no yog ua los ntawm kev siv lub suab ntsuas, uas sib txawv ntawm ib leeg hauv lawv txoj haujlwm, thiab tib lub sijhawm tswj hwm. Lawv muab cov txheej txheem sib txawv. Lub suab stimuli ntawm lub auditory system yog lub suab ntshiab nrog lub suab nrov (narrowband thiab broadband), uas yog tsim los ntawm lub tshuab hluav taws xob. Cov khoom siv audiometersib lub taub hau nrog ob lub xov tooj cua, pob txha vibrators, tus neeg mob khawm, lub microphone. Lawv muaj cov tswv yim tsawg zaus rau kev sib txuas ib daim kab xev los yog CD player rau kev tshawb fawb.
Qhov zoo tshaj plaws rau kev ua audiometry yog chav suab nrov (peb tab tom tham txog lub suab chamber), nrog lub suab nrov txog li 30 dB. Txog niaj hnub no, ntau lub suab nrov portable tau tsim. Hauv kev xyaum, nws tuaj yeem ua qhov kev kawm hauv chav ib txwm tsis cuam tshuam los ntawm cov suab nrov sab nraud (taug kev, tham hauv txoj kev hauv tsev, tsheb khiav ntawm txoj kev, thiab lwm yam).
Lub suab nkag siab qhov pib yog qhov tsawg kawg nkaus lub suab siab tawm tsam qhov kev hnov mob tshwm sim. Txoj kev tshawb no pib nrog lub pob ntseg uas hnov zoo dua. Thiab thaum tsis hnov lus asymmetry, txhua yam yog ua los ntawm pob ntseg sab xis.
Ntawm cov neeg noj qab haus huv, lub sijhawm tshuaj tiv thaiv rau lub teeb liab acoustic yog 0.1 thib ob, thaum cov neeg laus thiab cov neeg mob tsis hnov lus, lub sijhawm no nce ntxiv. Tus neeg mob kuaj tau muab cov lus qhia luv luv. Thaum lub sij hawm audiometry, tus kws tshawb fawb tuav lub microphone txuas nrog tus neeg mob txhua lub sijhawm los xyuas kom meej tias qhov kev soj ntsuam tau ua tiav.
Cov txheej txheem uas koj tuaj yeem kuaj koj lub rooj sib hais yog raws li hauv qab no:
- Thawj ntsuas qhov rhiab ntawm lub suab nrov, thiab tom qab ntawd siab dua frequencies.
- Ua tiav txoj kev kawm los ntawm kev ntsuas qhov pib ntawm lub suab qis. Cov teeb liab tau muab, raws li txoj cai, los ntawm 0 dB mus rau qhov siab tshaj qhov pib nrov. Qhov no yog ua kom tus neeg mobmuaj peev xwm ntsuam xyuas qhov xwm ntawm lub teeb liab qhia.
- Ntxiv mus, lub ntim ntawm lub suab tam sim ntawd txo qis mus rau qib tsis hnov tsw, tom qab ntawd qhov pib tau txiav txim siab ntawm qib ntawm cov suab nrov nrov, uas tau lees paub peb zaug hauv 5 dB cov kauj ruam siv lub khawm cuam tshuam.
Tus nqi ntawm txhua lub suab pib yog siv rau hauv audiogram.
Pab tau pathologies
tsis hnov lus tuaj yeem muaj ntau yam ua rau:
- Qhov tshwm sim ntawm kev ua txhaum ntawm lub suab yog ib qho mob uas tuaj yeem tshwm sim nrog perforation lossis caws pliav ntawm pob ntseg. Tsis tas li ntawd, qhov no tshwm sim tawm tsam keeb kwm ntawm cov txheej txheem inflammatory thiab nti nyob rau hauv lub tympanic kab noj hniav, nrog ib tug qog ntawm nruab nrab pob ntseg thiab auditory kwj dej, nyob rau hauv cov ntaub ntawv ntawm impaired mus los ntawm lub auditory ossicles. Tag nrho cov txheej txheem zoo li no tau koom ua ke los ntawm ib qho xwm txheej: lawv raug tshem tawm ntawm kev phais, yog li cov neeg mob no muaj sijhawm los kho lawv qhov hnov lus.
- Qhov muaj cov cerumen yog qhov yooj yim tshaj plaws thiab feem ntau ua rau tsis hnov lus. Tom qab tshem tawm cov plugs uas kaw lawv los ntawm cov kwj deg, lub rooj sib hais tau rov qab los sai sai.
- Qhov tshwm sim ntawm kev hnov lus tsis zoo nyob rau hauv daim ntawv ntawm kev puas tsuaj rau lub suab pom hauv pob ntseg, lub hlwb, lossis lub suab paj nruag. Qhov no yog ib qho mob hnyav heev pathology. Yog tias qhov kev puas tsuaj zoo li no tshwm sim tam sim ntawd thiab tuaj yeem tshawb pom tam sim ntawd, thawj ob peb teev lossis, nyob rau hauv qhov xwm txheej hnyav, hnub, tom qab ntawd rov kho lub rooj sib hais, raug kho kom raug, yog qhov ua tau. Nyob rau tib lub sijhawm, ib chav kawm tshwj xeeb kev saib xyuas kev kho mob yog nqa tawm,uas suav nrog tshuaj. Reflexology thiab barotherapy kuj tau ua. Thaum lub sij hawm poob, thiab qhov kev kuaj mob, dhau los, tsis tau raws sij hawm, tus neeg mob muaj feem tsawg heev ntawm kev rov ua kom tiav.
Yog li ntawd, thaum xub thawj siab ib muag, qhov tsis hnov lus yooj yim, yuav tsum tau kuaj mob sai thiab raug. Ua ntej tshaj plaws, nws yog ib qho tsim nyog los tshuaj xyuas lub pob ntseg nrog lub tshuab tsom iav lossis endoscope, uas yuav ua rau nws muaj peev xwm txheeb xyuas qhov hloov pauv me tshaj plaws hauv pob ntseg thiab kuaj xyuas kom raug. Kev ntsuam xyuas yog ntxiv nrog audiometry thiab tympanometry, uas muab ib daim duab tiav ntawm lub xeev ntawm lub rooj sib hais. Txhawm rau kom paub meej qhov kev kuaj mob, ntxiv rau, yuav tsum tau suav tomography ntawm cov pob txha ntawm lub cev, uas ua rau nws muaj peev xwm txheeb xyuas qhov kev hloov pauv ntawm cov pob txha hauv nruab nrab thiab pob ntseg.
Ntxiv rau, yog tias xav tias muaj kab mob hauv lub hlwb thiab lub paj hlwb, yuav tsum muaj cov duab sib nqus resonance. Tag nrho cov kev tshawb fawb no tau ua nyob rau hauv cov chaw kho mob niaj hnub no, feem ntau hauv kev kho suab thiab X-ray departments. Raws li cov ntaub ntawv tau txais, kev tawm tsam ntxiv tau txiav txim siab.
Hauv qab no peb yuav txiav txim siab cov kev sim rau kev hnov lus pom. Dab tsi yog?
Tests
Raws li ib feem ntawm kev sim Jelle, tus neeg mob tau muab lub suab nrov ntawm rab rawg rau ntawm lub taub hau. Nyob rau tib lub sij hawm, huab cua nyob rau hauv lub sab nraud auditory kwj dej yog condensed los ntawm ib tug pneumatic funnel. Thaum lub sij hawm ntawm huab cua compression, ib tug neeg uas hnov ib txwm hnov qhov txo qiskev xaav, qhov no yuav raug cuam tshuam ncaj qha rau qhov tsis zoo ntawm kev txav mus los ntawm cov txheej txheem uas ua rau impulses vim qhov indentation ntawm lub qhov rais ntawm lub vestibule ntawm stapes rau hauv lub niche.
Jelle kuaj hauv qhov xwm txheej no suav tias yog qhov zoo. Tawm tsam keeb kwm yav dhau los ntawm kev tsis sib haum xeeb ntawm kev sib tsoo (nrog otosclerosis), tsis muaj kev hloov pauv hauv kev xaav tshwm sim thaum lub sijhawm huab cua thickening nyob rau sab nraud auditory canals. Nyob rau hauv cov ntaub ntawv ntawm ib tug kab mob ntawm lub suab-perceiving apparatus, tib lub suab attenuation tshwm sim raws li nyob rau hauv tus qauv. Qhov kev sim yuav ua tau nyob rau hauv lwm txoj kev, thaum lub ossicular saw yog immobilized nrog lub teeb siab ntawm lub luv luv txheej txheem ntawm malleus nrog ib tug sojntsuam qhwv nrog paj rwb ntaub plaub.
Nyob rau hauv Federici qhov kev sim, lub qia ntawm lub suab nrov khoov diav rawg tau muab tso ua ke rau kev sib tsoo. Nyob rau tib lub sijhawm, nws maj mam nias rau hauv qhov kev mloog sab nraud, thiab, ntxiv rau, rau cov txheej txheem mastoid. Nquag, thiab nyob rau hauv lub xub ntiag ntawm tsis hnov tsw sensorineural, tus neeg mob perceives lub suab ntawm lub tragus ntau nrov. Tawm tsam keeb kwm yav dhau los ntawm kev hnov lus tsis zoo, qhov kev tawm tsam tshwm sim, thiab tom qab ntawd qhov kev paub dhau los ua qhov tsis zoo. Txhua qhov kev xeem, raws li txoj cai, xaus nrog ua tiav daim ntawv hla tebchaws. Qhov tshwm sim ntawm kev hais lus thiab kev tshawb nrhiav rab rawg yog sau rau hauv lub rooj sib tham.
Dab tsi yog kev tshawb fawb txog kev hnov lus tsis hnov lus?
Ib txoj hauv kev nrov los kuaj hauv tsev yog qhov kev sim tshwj xeeb. Txhawm rau nqa tawm, tus neeg mob yuav xav tau tus pab. Nws yuav tsum muaj kev hais lus zoo, nrog rau lub suab meej. Tus pab yog nyob ntawm qhov deb ntawm 6 meters ntawm qhov kev kawm. Ib tug neeg noj qab nyob zoo yuav hnov lawv nyeem cov ntawv nrov nrov li cas - ib qhopob ntseg pom lub suab nrov ntawm qhov deb ntawm 18-20 meters.
Air Conductivity Study
Raws li ib feem ntawm txoj kev kawm ntawm huab cua conduction, lub diav rawg yog coj mus rau hauv lub suab los ntawm sieving lub siab tshaj plaws dosed ntaus ntawm lub percussion rauj (nws yog tsim nyog sau cia hais tias tus ntses bass thaj tsam tuning diav rawg tuaj yeem coj mus rau hauv lub suab los ntawm kev ntaus tus qis. thib peb ntawm tus ncej puab). Cov cuab yeej raug coj los nrog cov ceg mus rau pob ntseg ntawm tus neeg mob, leej twg yuav tsum ceeb toom seb nws puas hnov suab. Tom qab ntawd nws raug coj mus rau qhov chaw sab nraud kom ze li sai tau, thaum tsis kov pob ntseg nws tus kheej, kom nws qhov axis (dhau hla ob lub puab tsaig) tuaj yeem ua ke nrog txoj kab ntawm pob ntseg.
Txhawm rau kom tsis txhob hloov pauv lossis ua suab nrov, yuav tsum nqa rab diav rawg rau pob ntseg txhua plaub mus rau tsib vib nas this. Txoj kev tshawb no ntawm cov pob txha conduction yog nqa tawm siv ib tug bass-suab nrov tuning diav rawg, ceg uas yog nruj nreem txuas mus rau nruab nrab ntawm cov tib neeg crown. Lub sijhawm ntawm kev nkag siab ntawm lub suab nrov ntawm rab rawg tawm tsam keeb kwm ntawm huab cua thiab cov pob txha conduction yog txiav txim siab hauv vib nas this (qhov no yog kev tshawb fawb ntau). Kev ntsuam xyuas zoo ntawm lub rooj sib hais plaub muaj ntau yam kev sim sib txawv.
Nws yog ib qho tsim nyog sau cia tias thaum lub sij hawm Rinne sim, qhov zoo tshaj plaws ntawm cov suab nrov ntawm cov pob txha tsawg kawg yog ob zaug ib txwm pom. Thiab nrog qhov tsis zoo, ntawm qhov tsis sib xws, cov pob txha predominates saum huab cua, uas feem ntau tshwm sim thaum lub suab ua lub cuab yeej puas. Nyob rau hauv cov kab mob ntawm lub tom kawg, raws li nyob rau hauv ib txwm lub xeev, ib tug rogdegree ntawm huab cua conduction tshaj pob txha.
Nyob hauv kev sim Schwabach, lub suab nrov ntawm rab rawg tau muab tso rau ntawm lub kaus mom thiab tuav kom txog thaum tus neeg tsis hnov lus. Tsis tas li ntawd, tus kws tshawb fawb (uas yog, ib tus neeg hnov lus zoo) muab lub diav rawg rau ntawm nws lub kaus mom. Nyob rau hauv cov kev tshwm sim uas nws tseem mus khaws lub suab ntawm lub twj paj nruag, ces rau cov neeg tshawb fawb xws li ib tug kev paub yog xam tau tias yog luv luv. Yog nws tsis hnov, qhov kev xeem ntawm cov ntsiab lus yog ib txwm.
Peb tau tshuaj xyuas tus nqi kuaj mob ntawm lub rooj sib hais daim ntawv hla tebchaws.
