Otorhinolaryngological diagnostic searches include audiology, vestibulology and phoniatrics.
- Hearing system examination
Polyclinic for the rehabilitation of listening and speech SUVAG is an institution that provides comprehensive care for people with permanent hearing impairments of all age groups in the Republic of Croatia. Therapy plan for hearing impaired people is based on a more precise diagnosis aimed at determining the strength and type of hearing impairment, functional status of the auditory system, etiology of impairment, as well as other illnesses and conditions that may affect hearing and speech. To this end, a multidisciplinary diagnostic program was developed.
Audiological diagnostics consist of standard audiological behavioral examinations, electrophysiological examinations, then specific examinations and examinations resulting from the verbotonal method and for the needs of rehabilitation by VT method and observation during rehabilitation. Over half a century, since the foundation of the institution, the program has been enriched and modernized according to new knowledge and technological achievements.
It is important to emphasize that none of “objective” examinations (ABR – Auditory Brainstem Response; MLR – Middle Latency Response; ASSR – Auditory Steady State Response) examines hearing, that is, hearing perception, but rather examines the response of certain structures of the auditory path to the sound stimuli – receptors or neural structures of different levels.
Functional approach to hearing impairment has led to the development of diagnostic procedures that are unavoidable due to the mode and test conditions. It is based on voice and speech tests, meaning physiological stimuli in a natural sound-insoluble space, suitable for patients of all ages and strengths. Functional listening diagnostics with the use of electroacoustic devices (Verboton G20, Electronic reverberator HE and SPL meter g 50) allows examination for the optimum listening field, detection of listening transfer, listening dynamics assessment, selective listening, integration time, sensitivity to room reverberation and it often detects interference that is not expressed in the optimum audiometric listening conditions, but significantly impedes speech communication in everyday life.
Accuracy and reliability of audiological diagnosis is the basis of adequate intervention – selecting appropriate hearing aids, adjusting it, determining indications for rehabilitation, its shape and frequency, types of procedures, and setting indications for the cochlear implant.
- Examination of the vestibular system
The vestibular system, apart from the peripheral vestibular sensory in the inner ear, also implies its numerous connections with other sensors, particularly in the area of the brainstem where it meets with visual, proprioceptive and auditory information, as well as motor reflexes that appear as an unconscious response to sensory stimulation with peripherals. These reflections are the basis of the research that we use in the everyday practice of vestibular sensitivity: vestibulocular reflex in nystagmography and VHIT (video head impulse test), vestibulocoli in vestibular evoked potentials (VEMP) and vestibulospinal in balance and stabilometry tests.
The role of the movement, and thus of the entire perceptual system that the movement is conditioned and modulated, has long been recognized in the verbotonal method which has given the momentum to the development of diagnostics and the study of the entire equilibrium system in which the vestibular sensation plays a central role.
Systematic dealing with vestibulology in the SUVAG Polyclinic resulted in the arrival of an increasing number of adult and older patients with primary balance and dizziness disorders. With subspecialist examinations, in the SUVAG Polyclinic may be required physical and electrophysiological testing and adequate therapy and patient’s clinical condition can be monitored.
- Phoniatric infirmary
In phoniatric infirmary work experts for the voice, speech and swallowing in children and adults. The ambulance is equipped with modern endoscopic rigid and flexible optical instruments for viewing the vocal tract. Depending on the phoniatrics report, patients are treated with functional therapy, medication therapy or, if necessary, surgical procedures are sent to a co-operative institution. Voice quality changes during therapy are monitored by subjective assessment, but also by various acoustic analysis programs.
Neuropediatric treatment attempts to clarify the etiology of the disorder – prenatal damage (complications in pregnancy, abuse of drugs/pregnancy, pregnancy), perinatal and postnatal disabilities. If we exclude the familial occurrence of the disorder, other discovered genetic causes are mutations of the FOXP2 gene, fragile X chromosome syndrome, microdelection syndrome, and the like. It is certainly necessary to exclude conditions requiring therapeutic therapy (epileptic encephalopathies, such as Landau Kleffner syndrome, ESES or metabolic diseases with central nervous system repercussion). In the present neuropathy treatment, it is commonly observed that the genetic family phenomenon of the disorder and the perinatal disorder is common, but the cause often remains unclear.
Neuropedial examination and teamwork often reveal several non-disturbed disorders in the same child, often with a specific speech and language development disorder, there is also minimal non-motor dysfunction, ADHD, sensory integration disorder and emotional disabilities. It is actually assumed that there is no “pure” minimal non-motor dysfunction, but is usually associated with one or more of these difficulties.
Verbotonal neurological diagnosis is part of the functional diagnosis of hearing, listening and/or speech impaired and includes:
a) A statement of personal, family and relative risk factors and indicators of the development of listening/speech development and the extent of rehabilitation; risk factors for cerebrovascular disease development.
b) Standard neurological examination (issue of other focal points).
c) The evaluation of the neurological maturity of the child according to the psychomotor dynamics scale, which includes the examination of the space-vision functions (sensorimotoric) and the comparison with the chronological age of the child.
For neurological examination (electroencephalography, visual and other evoked potentials, cerebral cartography), Doppler sonography and, if necessary, neuroimaging processing (CT, MRI) and for neurodegenerative examination (eg, electroencephalography, visual and other evoked potentials) other processing of other specialties.
In the physiatric infirmay, the diagnostic of motor function in children and adults is carried out by clinical examination and examination on the stabilometric platform. Children are evaluated for overall motor development in relation to the chronological age, especially the motor related to balance and the graphomotor capabilities. It has been noted that a large number of children with developmental difficulties, as well as some children with hearing impairment, have interference in the macro motor, the fine motor function, and the psychomotor organization.
Most adult patients in the pediatric outpatient clinic are patients with chronic instability, dizziness, and balance disorders of various causes that are being referred to a physicist after audiovision treatment to further balance maintenance. This function is tested by various static and dynamic tests, and it is objectified by testing on the stabilometric platform in a peaceful, Romberian position. A physician performs the examination, and vestibular exercises are performed under the supervision of a physiotherapist.
Psychiatric infirmary and psychological diagnostics
Psychiatric examination in the targeted population determines the existence of specific psychopathology. This also includes cognitive ability, tenacity and attention alertness, basic, basic mood and qualitative and quantitative affective disorders. In children with hearing and speech difficulties special attention is paid to verbal and nonverbal communication, peer relationships are evaluated, emotional responses are analyzed, and adaptation to changes. In order to awaken possible emotional reactions and react in the correct way, parents of children with disabilities are also involved in diagnostic and therapeutic processes.
The general goal of psychological diagnosis is to determine whether a person who is on the test is a candidate for inclusion in one of the treatments performed at the SUVAG Polyclinic and what kind of treatment and, if treatment is already being performed, what is its effect on school success, social, family and professional life. To answer these questions, psychological diagnostics use a variety of tests and apply different tests. In this way, they collect complete anamnestic data, evaluate the peculiarities of establishing a social contact, directing and maintaining attention, and behaving during an examination of emotional reactions in the various situations that the test situation imposes. In particular, psychomotor development and/or cognitive abilities are assessed, which gives the ability to determine the level of development of language skills in relation to general, nonverbal. When needed, further specific skills and skills such as graphomotor, perception, memory, etc. are also examined. In school children and adults, reading, reading comprehension, recitation and writing skills are examined. The psychological assessment uses standardized tests and various qualitative methods.