J Ratyńska, M. Kurkowski, A. Szkiełkowska R Markowska H Skarżyński “Audiologic considerations in Tomatis testing”
Tomatis method belongs both to audiology and psychology. Although the listening test reveals great amount of information on patient’s listening profile and emotional status, one must not forget that the results of the test depend also on the physical state of the hearing organ. The aim of the presentation is to show how various kinds of hearing disturbances may affect results of the listening test. Medical implications for patient’s referral are discussed. Otologic examination (ear inspection) Although the aim of the listening test is to examine mostly the sensory part of the hearing organ, it should be remembered that pathologic processes situated in external and middle ear can affect the result of the listening test. One of the most frequent non-pathologic conditions is cerumen which may obturate external auditory canal, and thus influence the result of the listening test. All patients referred for the listening test should be questioned for previous and present ear disease, ear operations, any type of hearing loss and even use of ear drops (which can affect the result of the test). Patiens should be also asked about their current health status. Even common cold may influence middle ear pressure in an otherwise healthy subject and thus interfere with the listening test. Optimally, all candidates for the listening test should be examined by an otolaryngologist before the test. Impedance audiometry Impedance audiometry is a frequently performed test which assesses external and middle ear status. Impedance audiometry generally consists of two subtests; tympanometry, the aim of which is to measure impedance of the middle ear, and acoustic reflex measurements. The most common application of tympanometry are middle ear pressure measurements. Middle ear pressure can be altered by different conditions, from common cold, to adenoid hypertrophy which is frequent in children. The listenig test is very sensitive to middle ear pressure variations. Reversal of the listening curves (air curve below bone curve) may suggest a listening disturbance, but may also be highly suggestive of external or middle ear problem. Pure tone audiometry (PTA) Procedure of performing pure tone audiometry is very similar to that of a listening test. All types of hearing loss detected by PTA (mostly caused by damage of the peripheral part of the hearing organ) can be reflected in the listening test. Cases of moderate and severe hearing loss can be easily suspected and identified on the listening test, even if no previous PTA results are available. Concuctive hearing loss will be seen in most cases as a reversal of the listening curves and sound localisation difficulties (responses lateralizing to the affected ear). In case of sensory hearing loss (caused by hair cell damage), displacement of bone and air curves is observed. However, mild sensory hearing lossess may constitute a diagnostic problem, especially if hearing loss overlaps with listening problem. Hearing loss as small as 30 dB HL may interfere with child’s school performance and can be falsely identified on the listening test as a listening problem. The case of a 12 y.o boy is presented, who was referred for the listening test due to diagnosis of dyslexia and school problems. Listening test revealed lowering of bone and air curves. The screening test with the use of transiently evoked
otoacoustic emissions was within normal. However, PTA examination revealed mild hearing loss of 35dB, which could be the main problem responsible for the boy’s school difficulties. Central auditory processing test battery Central auditory processing disorders (CAPD) are great diagnostic and therapeutic problem. Currently, increasing number of audiologic tests are available which may help to diagnose this kind of problem. In fact, CAPD are also the focus of the Tomatis Method, as the aim of the therapy is to improve auditory processing. Results of the basic audiologic tests in CAPD can be inconclusive. Listening test may be very helpful in identifying the problem. A case of a 10 y.o girl is presented. The girl was referred to an audiologist because she complained of unilateral hearing loss. However, the results of standard PTA, as well as of objective tests such as auditory brainstem response (ABR), otoacoustic emissions and impedance audiometry were normal. Therefore the patient was referred to the listening test, which revealed major listening problem (significant lowering of the curves) on the side of complaint. The girl was referred to further diagnostics. Dichotic Listening Test (DLT) is of great interest among Tomatis practicioners, as it is closely related to the Tomatis laterality test. However, although those two tests are complementary, they assess different functions and qualities. It is very useful to have a DLT result before administering Tomatis therapy, beacuse not in all cases lateralizing the patient’s listening towards right ear can be beneficial. Although rare, the cases exist when left ear laterality is optimal for the patient. An example of a stuttering patient with right-hemisphere speech and language areas location is described. Initial session of Tomatis was unsuccessful. Only after identifying the problem and appropriate balance shift, the patient’s speech fluency started to improve. There are also other central auditory processing tests which may add much information about the patient with the listening problem. Examples of those tests are Frequency Pattern Test (FPT), Duration Pattern Test (DPT) and cortical auditory potentials. Examples of aplication of those tests in candidates for Tomatis Therapy, as well as in monitoring of the patient’s progress are discussed.