Hearing and dizziness diagnostics Frankfurt

The hearing threshold is the perception limit of an auditory impression. This is the range in which the ear can still just perceive the sound of a certain frequency.

The hearing threshold depends on individual factors such as age, gender, ethnic origin, acute illnesses and previous illnesses.

The hearing threshold is not a physically defined quantity and can only be determined in comparison to a reference value. This is referred to as the "audiometric zero line", "audiometric zero" or "reference equivalent threshold sound pressure level".

Over the course of time, the audiometric baseline has been defined in different ways as a reference value for normal hearing. This is because its value has been adapted to better technical possibilities and new findings.

Hearing loss or hearing impairment rarely occurs suddenly. As a rule, hearing problems that do not arise from an acute infection develop gradually over a longer period of time. Affected patients often get used to their gradually worsening hearing, which is why the hearing loss initially goes unnoticed. In addition, the brain compensates for the hearing deficits for a long time. As a result, there are initially no or only a few disadvantages in everyday life. In many cases, even those around the patient themselves notice that they hear worse than before. However, there comes a point when the body can no longer compensate for the hearing problems so easily.

Patients who realise that they no longer hear as well as they once did often do nothing about it for a long time. They are ashamed, associate the hearing problems with a personal weakness and think that they will continue to cope with their current condition. For this reason, they put off seeing an ENT specialist for a long time.

However, this avoidance behaviour can lead to serious consequences: Over time, the brain learns to cope with certain sounds. If these sounds are then made "audible" again for the patient with a hearing aid, in many cases they can no longer interpret them correctly. They perceive them as excessively loud or even unpleasant.

There are three questions that you can answer for yourself. Of course, this is not the same as the diagnostics in our ENT practice in Frankfurt comparable, but gives you some initial pointers. These questions are

• Do you find it difficult to follow conversations without exerting yourself?
  Some patients notice that they have to concentrate more in order to follow conversations with one or more people.

• Do you have to turn the TV or radio up very loud to understand something?
  Hearing loss is also often noticeable when devices such as the TV or radio have to be turned up much louder than before.

• Do low background noises seem excessively loud to you recently?
  An indication of a hearing problem could be if low, humming noises seem much louder than before. Examples include the humming of the fridge or traffic noise behind a closed window pane.

The "cocktail party effect" (also known as the "cocktail party phenomenon") refers to our ability to block out ambient noise during a conversation. We therefore devote our full attention to the conversation. However, we still perceive the surrounding noises on a subconscious level and can analyse their meaning. For example, if our own name is mentioned in a nearby conversation group, we usually register this. This means that the processing of our sensory stimuli goes beyond the conscious content.

Our hearing organ is sensitive and complex. If hearing loss occurs gradually, the problem can originate from different structures of the ear: the outer ear, middle ear, inner ear or auditory nerve.

Hearing loss can be age-related, but can also be caused by excessive exposure to sound, infections, injuries, heredity or even poisoning.

As a rule, the higher frequencies are affected at the beginning. This can impair speech comprehension. This is because the higher frequencies are important for hearing soft consonants such as f, s, p and t. Depending on the type of hearing loss, other symptoms may also occur, such as sensitivity to noise, dizziness or ringing in the ears (tinnitus).

Affected patients usually do not realise that untreated hearing loss can have an impact on their psyche and overall quality of life. Symptoms such as chronic fatigue and exhaustion can also be associated with untreated hearing loss. Some sufferers find conversations so stressful that they withdraw and avoid social contact.

It is a natural process that our hearing ability declines as we age. Age-related hearing loss can begin between the ages of 45 and 65. External factors such as exposure to noise can accelerate or exacerbate the process. As a rule, both ears are affected.

This is caused by damage to the fine hair cells located in the cochlea. As a result, signals can no longer be transmitted as well to the auditory nerve. The first signs are, for example, no longer being able to hear the rustling of leaves and the ticking of a clock.

There are forms of hearing loss that can be inherited. In this case, they are usually caused by genetic mutations that affect the development and function of the ear. However, certain clinical pictures such as Usher syndrome are also possible. This is a hearing impairment. In addition to hearing loss or a complete loss of hearing, visual impairment also occurs due to degeneration of the retina.

The reasons for the increase in hearing loss are linked to an increasingly stressful lifestyle and "modern civilisation".

Our generally high standard of living and the possibilities offered by medicine mean that our life expectancy continues to increase. However, as we get older, the risk of becoming hard of hearing also increases.

Added to this are the factors of urban life: warning signals, traffic and construction site noise, industrial plants, etc. are permanent sources of noise that we can encounter anywhere and at any time. Added to this is music, which is listened to with headphones, especially by young people. Such constant exposure to noise can have negative effects on hearing. The problem is that the sensitive sensory cells in the inner ear cannot recover sufficiently. They can be permanently damaged and die prematurely.

Speaking of continuous noise: despite clear noise protection regulations, many workers are exposed to harmful noise levels without protection.

All these and many other factors can cause hearing problems and lead to hearing loss.

• Inflammation of the middle ear (otitis media)
  Inflammation in the middle ear can occur either unilaterally or bilaterally. It is caused by viruses or bacteria. It leads to an accumulation of fluid behind the eardrum. Inflammation of the middle ear is accompanied by symptoms such as headaches and earache, swelling, redness and (temporary) hearing problems.
• Glue ear
  Especially in babies and small children, fluid sometimes accumulates behind the eardrum. Initially this is thin and watery, but can become thick and sticky as it progresses. This can lead to a reduction in hearing ability until the glue ear has healed.
• Otosclerosis
  Otosclerosis is a disease of one of the three auditory ossicles: the stapes. Part of the small bone is altered, making it less able to vibrate. This impairs the transmission of sounds and noises from the outer to the inner ear. This can lead to hearing loss or even deafness. In some cases, otosclerosis can be treated by surgery. Alternatively, a hearing aid can be used.
• Acoustic neuroma
  A benign tumour on the vestibular nerve in the inner ear, known as an acoustic neuroma, can lead to tinnitus, hearing and balance disorders. The growing pressure on the brain can cause a loss of coordination. The acoustic neuroma can affect speech recognition and the ability to recognise sounds.
• Meniere's disease
  This is a disease of the inner ear that can be accompanied by dizziness, pressure in the ear, tinnitus and hearing loss. Unpredictable attacks can occur that last between two and 24 hours.
• Blast trauma
  A sudden, violent, very loud noise, such as an explosion, can trigger a so-called blast trauma. This causes damage to the eardrum and conductive hearing loss. As a rule, acoustic trauma subsides by itself. However, if it persists, it can cause hearing damage within a certain frequency range. This means that affected patients are permanently unable to hear high-frequency sounds, for example.
• Tinnitus
  Ringing in the ears, ringing in the ears, ringing in the ears: With tinnitus, the patient perceives an unpleasant whistling, buzzing, humming or hissing in the ear that is not caused by external sources of noise. It often occurs together with middle ear inflammation, otosclerosis, Menière's disease, eardrum perforations or acoustic trauma. Stress and the side effects of certain medications can also cause tinnitus. It can affect the ability to hear.
• sudden deafness
  In the event of a sudden hearing loss, the patient hears less well - or almost nothing at all - in one or, more rarely, both ears at the same time within a very short time. Sounds sound muffled or seem to those affected as if the volume has suddenly been turned down. They feel as if a foreign object or a thick piece of cotton wool is stuck in their ear. A sudden loss of hearing can also be accompanied by tinnitus and dizziness.

If you have a sound perception disorder, you have sensorineural hearing loss. This means that there is damage or functional weakness in parts of your inner ear. In rare cases, the auditory nerve or the relevant area of the brain may also be affected.

With sensorineural hearing loss, you still receive sound signals relatively well. However, you will perceive them differently. This is because the frequencies are lost to varying degrees. This effect begins with the high tones.

If you have a sound perception disorder, this will affect the structure, sound pattern and quality of the sounds/speech you hear.

• sudden deafness
• Diseases of the inner ear
• Infectious diseases that can also affect the inner ear (e.g. mumps, measles, scarlet fever, meningitis, AIDS, toxoplasmosis, Lyme disease)
• Noise above 120 dB
• Skull fracture with transverse fracture of the petrous bone
• Rupture of the membrane between the middle and inner ear with formation of a perilymphatic fistula
• Meniere's disease
• Multiple sclerosis
• Stress
• Side effects of certain medications (e.g. diuretics, chemotherapeutic agents, certain antibiotics)
• Poisoning (e.g. by carbon monoxide, mercury, lead)

• Natural ageing process
• Daily high noise exposure above 80 dB without hearing protection
• Acoustic neuroma
• Diseases of the auditory nerves
• Meniere's disease
• Metabolic diseases (e.g. diabetes, functional disorders of the kidneys, liver or thyroid gland)
• Arteriosclerosis
• Acquired disorder in the auditory centre (e.g. after a stroke or brain tumour)
• Complaints associated with the cervical spine
• Congenital malformations/disorders of the inner ear

In conductive hearing loss (also known as sensorineural hearing loss), the sound that arrives via the eardrum is not transmitted correctly from the middle ear to the inner ear. For this reason, you hear the sound signals more quietly. However, intelligibility is largely retained. If sound conduction is impaired, you will hear all pitches equally poorly.

• Foreign body
• Earwax plugs or increased earwax formation in the external auditory canal
• Water in the external auditory canal (e.g. after swimming or showering)
• Acute tube ventilation disorder (e.g. due to a cold with a blocked nose, if the air pressure changes too quickly when flying or diving, in the case of enlarged adenoids in childhood)
• Acute otitis media
• Injuries to the eardrum or middle ear
• Inflammation-related swelling of the skin in the ear canal
• Skull fracture with interruption of the ossicular chain

• Chronic otitis media
• Chronic tube ventilation disorder
• Otosclerosis
• Constrictions in the ear canal (e.g. due to scars or inflammation)
• Excessive bone growth in the ear canal
• Tumours in the ear canal or middle ear
• Congenital malformations/disorders of the outer or middle ear

Audiometry or audiometric tests are electro-acoustic hearing tests. Audiometry allows us to determine the degree and type of any hearing loss you may have.

We rely on your active co-operation for subjective hearing tests. Objective hearing tests do not require your direct involvement.

• Sound audiometry
  Tone audiometry is the most common examination in the field of audiometry. Tones of a certain frequency are generated on the computer. You hear these through headphones. We gradually increase the volume. You give us a signal when you hear the sound. We then test the bone conduction using a vibrating conduction receiver. We attach this to the section of bone behind your ear. The bone conducts the sound to the cochlea inside your ear. This makes the sound audible to you. We do not test both of your ears at the same time, but one after the other.
• Hearing distance test (speech distance test)
  The aim of the examination is to test the sound perception of your ears. To test the high frequency range, we whisper four-syllable number words (e.g. 21, 73, 99) one after the other from different distances. For the lower frequency range, we speak the number words at room volume. Your hearing is normal if you can hear the whisper from six to eight metres.
• Tuning fork test
  The tuning fork test helps us to differentiate between two types of hearing loss: impaired sound perception or impaired sound conduction. We place a vibrating tuning fork at various points on your head. We use the Weber test to check the bone conduction of both ears. We compare both ears with each other. If you hear the sounds equally loud on both sides, everything is fine. Using the Rinne test, we can compare how air conduction and bone conduction work in your ear. To do this, we first place the vibrating tuning fork on the bony process behind your pinna. When you can no longer hear any sound coming from the tuning fork, we hold the tuning fork to your ear. This allows us to check whether you can still hear a sound. By combining the two tuning fork tests, we can reliably distinguish between conductive and sensorineural hearing loss.

• Impedance measurement
  We use impedance measurement to test the pressure in your middle ear and the vibration behaviour of your eardrum. The examination provides us with information about the function and pressure conditions in your middle ear. This allows us to determine fluid accumulation or negative pressure in the middle ear.
• ABR
  Brainstem electric response audiometry (BERA) is an examination of your auditory nerve section up to the brain stem. If you have a functional hearing disorder or hearing loss, we can use the BERA test to determine the exact anatomical location of the disorder. We use a computer to measure electrical voltages of millionths to billionths of a volt that are generated in your inner ear and auditory nerve. This is done using electrodes that we attach to the skin on your head. We can also determine the reaction times of your inner ear and auditory nerve to a sound stimulus. Furthermore, we measure so-called muscle potentials that arise during muscular work. To do this, it is important that you relax. The changes in tension are displayed as a curve on the screen. We compare your measured values with the "norm". This allows us to make a diagnosis.
• DPOAE
  "Distortion product otoacoustic emissions are emitted by healthy sensory cells in the inner ear. We can measure them using a highly sensitive microphone in the external auditory canal. In this way, we can check the function of your outer hair cells. If the inner ear is damaged, this is the first thing to be restricted. We primarily use the DPOAE examination to diagnose and monitor the progress of inner ear diseases. We can compare the results of the measurement with the results of subjective audiometry and obtain additional information on the type and extent of hearing damage.

Video ENG is an indispensable tool for hearing and dizziness diagnostics in our ENT clinic in Frankfurt. It provides a detailed and precise examination of the vestibular organs, which is essential for the correct diagnosis and treatment of vestibular disorders. Video ENG offers several diagnostic possibilities:

• Recognising the causes of dizziness
  Dizziness can have many causes, such as diseases of the inner ear, neurological disorders or the side effects of certain medications. Video ENG can help to identify the exact cause.
• Diagnosis of vestibular neuritis
  This inflammation of the vestibular nerve can cause acute dizziness. We can use video ENG to assess the function of the affected nerve.
• Examination for Menière's disease
  This disease of the inner ear leads to recurrent attacks of vertigo, hearing loss and tinnitus. Video ENG supports the diagnosis and helps to monitor the progression of the disease.
• Assessment after head injuries
  After a head injury, the vestibular system may be impaired. The video ENG examines whether the vestibular system is affected and how severe the damage is.
• Review of therapy successes
  After therapeutic measures such as vestibular exercises or drug treatment, we can use video ENG to monitor the success of the therapy.

The video ENG is not usually painful. However, some of the tests, such as the calorific test, may cause a temporary feeling of dizziness or discomfort. These sensations are usually short-lived.

There are several things you can do before the video ENG in our ENT clinic in Frankfurt:

• Avoid alcohol and certain medications that can affect the results for 24 hours before the examination.
• Eat only light meals before the examination to avoid nausea.
• Bring a list of your current medication with you.