Ebook Clinical assessment of voice (2E): Part 2
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Ebook Clinical assessment of voice (2E): Part 2
Hearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2ing to match pitch, monitor vocal quality, and provide feedback and direction for adjustments during performance. The importance of good hearing among performing artists has been underappreciated. Although well-trained musicians are usually careful to protect their voices or hands, they may subject Ebook Clinical assessment of voice (2E): Part 2their ears to unnecessary damage and thereby threaten their musical careers. The ear is a critical part of the musician s '•instrument.'’ ConsequentlyEbook Clinical assessment of voice (2E): Part 2
, it is important for singers to understand how the ear works, how to take care of it. what can go wrong with it. and how to avoid hearing loss from pHearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2ology and previous works by the authors.1'2 and they will be reviewed only briefly in this chapter. Hearing loss may be hereditary or nonhereditary. and either form may be congenital (present at birth) or acquired. There is a common misconception that hereditary hearing loss implies the presence of Ebook Clinical assessment of voice (2E): Part 2the problem at birth or during childhood. In fact, most hereditary hearing loss occurs later in life. All otolaryngologists know families whose memberEbook Clinical assessment of voice (2E): Part 2
s begin to lose their hearing in their third, fourth, or fifth decade, for example. Otosclerosis, a common cause of correctable hearing loss, often prHearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2hild whose mother hadrubella during the first trimester of pregnancy or was exposed to radiation early in pregnancy may be born with a hearing loss. This is not of genetic etiology and has no predictive value for the hearing of the child’s siblings or future children. Hearing loss may occur because Ebook Clinical assessment of voice (2E): Part 2of problems in any portion of the ear. the nerve between (he ear and the brain, or the brain. Understanding hearing loss requires a basic knowledge ofEbook Clinical assessment of voice (2E): Part 2
the structure of the human ear.Anatomy and Physiology of the EarThe ear is divided into 3 major anatomical divisions: the outer ear. the middle ear. Hearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2from the auricle into the temporal bone, the external auditory canal The opening of the tube IS called the meatus.The middle ear is a small cavity in the temporal bone in which 3 auditory ossicles, (he malleus (hammer). incus (anvil), and stapes (stirrup), form a bony bridge from the external ear to Ebook Clinical assessment of voice (2E): Part 2 the inner ear (Figure 15-1). This bony bridge is held in place by muscles and ligaments. The tympanic membrane or eardrum stretches across the innerEbook Clinical assessment of voice (2E): Part 2
end of the external ear canal, separating the outer ear from the middle ear. The middleear chamber normally is filled with air and connects to the nasHearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2ber divided into 2 parts: (1) the vestibular labyrinth, which functions257258CLINICAL ASSESSMENT OF VOICEFigure 15-1. Cross section of the ear. The semicircular canals are part of the balance system.as part of the body's balance mechanism, and (2) the cochlea, which contains thousands of minute, sen Ebook Clinical assessment of voice (2E): Part 2sory, hairlike cells (Figure 15-2) responsible for beginning the electrical stimulation to the brain. The organ of Corti functions as the switchboardEbook Clinical assessment of voice (2E): Part 2
for the auditory system. The eighth cranial (acoustic) nerve leads from the inner ear to the brain, serving as the pathway for the electrical impulsesHearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2ated when a stone is thrown into a pond. The pinna collects these sound waves and funnels them down the external ear canal to the eardrum. The sound waves then cause the eardrum to vibrate. These vibrations aie transmitted through the middle ear over the bony bridge or ossicular chain formed by the Ebook Clinical assessment of voice (2E): Part 2malleus, incus, and stapes. The vibrations in turn cause the membranes over the openings to the inner ear to vibrate, causing the fluid in the inner eEbook Clinical assessment of voice (2E): Part 2
ar to be set in motion. The motion of the fluid in the inner ear displaces the hair cells, which in turn excite the nerve cells in the organ of Corti,Hearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2sation of hearing.Establishing the Site of Damage in the Auditory SystemThe cause of a hearing loss, like that of any other medical condition, is determined by obtaining a detailed history, making a thorough physical examination, and performing various clinical and laboratory tests. An audiogram pro Ebook Clinical assessment of voice (2E): Part 2vides a "map” of hearing and details the levels at which sound is detected at various frequencies. When a hearing loss is identified, an attempt is maEbook Clinical assessment of voice (2E): Part 2
de to localize the point along the auditory pathway where the difficulty has originated. Every attempt to determine whether the patient’s hearing lossHearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2particular. It is very difficult to distinguish sensory from neural lesions.Details of the otologic history, physical examination, and test piotocols are detailed in many otolaryngology texts. Medical evaluation of a patient with a suspected hearing problem includes a comprehensive history: complete Ebook Clinical assessment of voice (2E): Part 2 physical examination of the ears, nose, throat, head, and neck; assessment of the cranial nerves, including testing the sensation in the external audEbook Clinical assessment of voice (2E): Part 2
itory canal I Hitselberger sign); audiogram (hear-15. HEARING LOSS IN SINGERS AND OTHER MUSICIANS259Figure 15-2. Cross-section of the organ of Corti AHearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2ay include computed tomography (CT), magnetic resonance imaging (MRI), dynamic imaging studies such as single-photon emission computed tomography (SPECT), position emission tomography (PET), specialized hearing tests such as brainstem evoked response audiometry (ABR or BERA), electronystagmography ( Ebook Clinical assessment of voice (2E): Part 2ENG), computerized dynamic posturography (CDP). Oto-acoustic emissions, immittance measures, central auditory processing testing, and a variety of bloEbook Clinical assessment of voice (2E): Part 2
od tests for the many systemic causes of hearing loss. All patients with hearing complaints deserve a thorough examination and comprehensive evaluatioHearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2ontrary to popular misconceptions, not all cases of sensorineural hearing loss are incurable. So “nerve deafness" should be assessed with the same systematic vigor and enthusiasm as conductive hearing loss.Conductive Healing LossIn cases of conductive hearing loss, sound waves are not effectively tr Ebook Clinical assessment of voice (2E): Part 2ansmitted to the inner ear as a result of some mechanical defect in the outer or middle ear. The outer and middle ear normally enhance and transfer soEbook Clinical assessment of voice (2E): Part 2
und energy to the inner ear or cochlea. In a purely conductive hearing loss, there is no damage to the inner ear or the neural pathway; rather, the daHearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2nsorineural loss, because modern techniques make it possible to cure or at least improve the vast majority of cases in which the damage occurs in the outer or middle ear. Even if they are not improved medically or surgically, these patients stand to benefit greatly from a hearing aid. because what t Ebook Clinical assessment of voice (2E): Part 2hey need most is amplification. They are not bothered by distortion and other hearing abnormalities that may occur in sensorineural hearing losses.SomEbook Clinical assessment of voice (2E): Part 2
e more common types of conductive hearing loss may result from a complete or partial blockage of the outer ear. which will interfere with sound transmHearing Loss in Singers and Other MusiciansRobert Thayer Sataloff, Joseph Sataloff, and Brian McGovernSingers and other musicians depend on good heari Ebook Clinical assessment of voice (2E): Part 2f cotton swab or ear plug), infection, trauma, or tumor. Large perforations in the tympanic membrane may also cause hearing loss, especially if they surround the malleus. However, relatively small, central perforations usually do not cause a great deal of hearing impairment Hearing loss from middle Ebook Clinical assessment of voice (2E): Part 2ear dysfunction is the most common cause of conductive hearing loss and may cause a hearing decrease of up to 60 decibels. It may occur in many ways.Ebook Clinical assessment of voice (2E): Part 2
The middle ear may become tilled with fluid because of eustachian tube dysfunction. The fluid restricts free movement of the tympanic membrane and ossGọi ngay
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