Hearing diagnostics and rehabilitation

We were told about the peculiarities of hearing diagnostics and rehabilitation by audiologist Oleksandr Oleksandrovych Neizzhalyi. He, along with a team of specialists, is engaged in the examination and free fitting of hearing aids for the military of the Armed Forces of Ukraine who have war-related hearing impairments.

There can be many causes of hearing impairment. Among the most common are the following:

- Congenital deafness (associated with hereditary hearing loss, so-called genetic deafness)

- Deafness associated with birth trauma and early postnatal pathology (newborn jaundice, artificial lung ventilation, etc.)                              

- Hearing impairment resulting from viral diseases (such as influenza, herpes zoster, etc.)

- Hearing impairment associated with microbial agents in the setting of acute and chronic diseases of the ENT organs and ear.

- Hearing impairment associated with exposure to physical factors, such as noise, vibration, atmospheric pressure drop, and other occupational hazards.

- Head and neck injuries (traumatic brain injuries, mine-blast injuries, gunshot and shrapnel wounds).

Each type of injury to the auditory analyser has its own signs that need to be detected during the examination. Today, the most acute cause of hearing disorders is related to the consequences of military operations. These are so-called mine-blast injuries, which occur both in military personnel and in people who fall into the area of explosive devices.

These types of injuries, along with barotrauma (sudden descent into the water or ascent to a high altitude), can lead to exudative otitis media and, as a result, partial hearing loss. In this case, if not treated in time, persistent conductive hearing loss may occur. Sharp loud noises or blows to the ear can lead to a rupture of the eardrum, resulting in perforation or haemorrhage in the middle ear cavity.

The injured person needs immediate removal of excess fluid from the ear and time for the eardrum to heal. In certain cases, hearing loss can be accompanied by dizziness and impaired spatial coordination, which causes permanent loss of working capacity. 

Timely treatment and restoration of sound transmission through the middle ear structures leads to complete recovery. However, quite often, baroacoustic trauma or contusion is accompanied by pathological changes in the auditory nerve, which affects hearing sensations and requires early hearing prosthetics. The duration of hearing impairment is of great importance. Over time, the brain loses the ability and skills to understand speech and all sounds. This is due to a partial or complete loss of function in the auditory cortex.

A comprehensive hearing examination consists of the following stages:

- The first step is an initial examination of the hearing function: examination of the ear, measurement of the perception of whispered and spoken speech, and tuning fork tests using a set of tuning forks (how a person perceives sounds of different pitches).

- The next step is impedance audiometry, which allows you to check the mobility of the eardrum, auditory bones, and ear muscles, as well as check the functioning of the auditory tube and determine the presence of fluid in the eardrum cavity.

- The next step is tonal threshold, supra-threshold and speech audiometry.

The examination helps to determine the thresholds of hearing loss, presence of discomfort to loud sounds and speech intelligibility.

Based on the level of increase in hearing thresholds and speech intelligibility, hearing aids are selected. There are hearing aids with different possibilities of hearing loss correction. Today, the most commonly used hearing aids are those with artificial intelligence and neural connections of the 10-12th generation, with the ability to increase certain frequencies without amplifying other sounds, the perception of which is not impaired, with a high degree of protection of the ear from external influences (wind, sharp loud sounds).

Hearing aids with the most advanced sound processing analysis technologies and safe compensation of lost hearing functions are available in Ukraine, tailored to the unique needs of the patient.

Oleksandr Oleksandrovych's clinic provides services of diagnostics of hearing impairment, selection and fitting of hearing aids for military personnel participating in combat operations free of charge. 

The clinic takes into account the fact that the hearing aid must protect the patient's hearing analyser. If the patient wishes to return to the frontline, hearing aids must be able to protect the ear from harsh sounds and ensure that speech is clearly understood in difficult acoustic conditions.

Usually, bilateral hearing prosthetics is performed (binaural or bilateral):

- Binaural hearing prosthetics (when hearing aids communicate with each other, it is a model of a normal hearing organ, when two ears are united by the central nervous system)

- Bilateral (when each device works separately, and the person independently analyses the volume of sound around)

Binaural hearing care is more physiological. This provides sound volume, makes speech clearer, especially in the presence of noise and ambient sounds, helps you navigate in space, and supports an important hearing function - ototopy. This hearing function allows you to orientate yourself in space.

In case of unilateral hearing prosthetics, such a protective function is not performed by the hearing organ, and thus a person exposes himself to the risk of injury, especially on the road and at work.

The task of audiologists is to first correctly diagnose the level of hearing loss, select hearing aids that are optimal in terms of speech perception and perform their initial adjustment. The period of adaptation to hearing aids depends on the type of hearing loss and the duration of the disease and ranges from 3 to 9 months. Hearing aids are adjusted by a computer programme based on the examination results, by a specialist audiologist. Self-treatment is impossible, as it requires knowledge and professional skills.

Nowadays, technology makes it possible to control hearing aids via a mobile phone and, depending on the complexity, it is possible to use them as a Bluetooth headset.  All hearing aids are designed for a maximum of 5 years of use. This means that the patient and his/her hearing aids need regular maintenance and monitoring of the person's hearing. Hearing aids serve as a brain trainer. There are cases of hearing improvement after hearing prosthetics. This creates a need for early hearing prosthetics for military personnel who have hearing impairment. Thus, restoring hearing and enabling them not to lose their social communication skills.

A hearing aid is a mini computer and its cost depends on the complexity of the processor. Hearing aids from the world's leading manufacturers are available in Ukraine. The range covers all needs - from basic models to the most sophisticated premium models. 

Now every 10th patient of the clinic is a member of the Armed Forces of Ukraine. Charitable foundations provide soldiers with hearing problems with the most modern and sophisticated hearing aids, allowing them to be integrated into society, as not all communities have sufficient funding for free hearing prosthetics.