Assessment of Hearing - Otolaryngology

What are the three types of hearing loss? 1. Conductive hearing loss – It is caused by any disease process that interferes with the conduction of sound from external ear to the stapediovestibular joint. The cause may lie in the external ear or the Eustachian tube in the form of obstructions or in the tympanic membrane in the form of perforation or in the middle ear in the form of fluids or in the ossicles in the form of fixation or disruption. 2. Sensorineural hearing loss - This is caused by lesions of the sensory type of the cochlea or of the cranial nerve 8 and its central connections of the neural type. When the hearing loss is due to lesions of cranial nerve 8, it is known as retrocochlear and when it is because of the lesions of the central auditory connections, it is referred to as central deafness. 3. Mixed hearing loss – In this kind of hearing loss, both sensorineural and conductive elements of deafness are present in the same ear. There is an air-bone gap that indicates the conductive element and impairment of bone conduction that triggers sensorineural loss. Mixed hearing loss is found in cases of chronic suppurative otitis media and otosclerosis. What four factors are important while assessing the auditory functions? 1. Type of hearing loss – whether it is conductive, sensorineural or mixed. 2. Cause of hearing loss – it may be congenital or traumatic or it could be infection or an auto-immune process. 3. Degree of hearing loss – It could be mild or moderate or it could be severe or total. 4. Site of the lesion – If it is conductive hearing loss, the lesion may be at the external ear or the tympanic membrane or it could be at the middle ear or the Eustachian tube. Tympanometry is helpful in finding the site of lesions. If it is a sensorineural loss, it is to be determined whether the lesion is cochlear or central or retrocochlear. Often special tests of hearing are needed to differentiate the types of these lesions. How is hearing tested? It is done through clinical or audiometric tests. What are the four major clinical tests of hearing? 1. Finger Friction Test – It is a quick method of screening and it involves rubbing and snapping the thumb and a finger by positioning them close to the ear of the patient. 2. Watch Test – A watch that clicks is brought close to the ear of the patient and the distance at which it is heard is measured. 3. Speech or Voice Tests – For the purpose of the test, the patient has to hear a conversation at a distance of forty feet in quiet surroundings. Its disadvantage is the lack of standardisation in intensity. 4. Tuning Fork Tests – They are done with tuning forks of different frequencies. The average frequency is 512 Hz. The tuning fork is activated by striking it gently against the examiner’s elbow or heel of hand. Tuning forks of lower frequencies than 512 Hz produce sense of bone vibration. A vibrating fork is placed vertically in line with the meatus to test air conduction and it is kept about two centimetres away from the opening of the external auditory canal. The sound waves are transmitted through the tympanic membrane. Middle ear and the ossicles to the inner ear. In order to test bone conduction, the foot plate of the vibrating tuning fork is placed on the mastoid bone. Cochlea is stimulated directly by the vibrations conducted through the skull bones. What are some of the important and clinically useful tuning fork tests? 1. Rinne – Air conduction of the ear is compared with its bone conduction. A vibrating tuning fork is placed on the patient’s mastoid and when hearing stops, it is brought besides the meatus. If he still hears, air conduction is more than bone conduction. Rinne’s test can be concluded as false negative in severe unilateral sensorineural hearing loss. The patient does not hear any sound of the tuning fork by air conduction but responds to bone conduction. 2. Weber’s – A vibrating tuning fork is placed in the middle of the forehead and the patient is asked in which ear he or she can hear the sound. Normally, it is heard equally in both ears. It is lateralized to the worse ear in conductive deafness and to the better ear in sensorineural deafness. 3. Gelle’s – It is a test of bone conduction and examines the effect of increased air pressure in ear canal on hearing. It is performed by placing a vibrating tuning fork on the mastoid while changes in air pressure in ear canal are brought about by Siegel’s speculum. What are the four types of audiometry tests and explain briefly, giving details about tympanometry as part of impedance test 1. Pure Tone Audiometry- Audiometer is used to produce pure tones, Their intensity can be increased or decreased by 5 dB steps and the amount of intensity that has to be raised above the normal level is a measure of the degree of hearing impairment at that frequency. It is charted in the form of a graph called audiogram. It is used to measure the degree and type of hearing loss, prescription of hearing aid and degree of handicap for medico-legal purposes 2. Speech Audiometry- The patient’s ability to hear and understand speech is measured. The two parameters used are speech reception threshold and discrimination score. 3. Bekesy Audiometry- It is a self-recording audiometry where various pure tone frequencies automatically move from low to high while the patient controls the intensity through a device that indicates Type 1 – Type V degree. 4. Impedance Audiometry- There are two tests that make up this category. They are tympanometry and acoustic reflex measurements. Tympanometry is based on a simple principle that dwells on when a sound strikes the tympanic membrane; some of its energy is absorbed while the remainder is reflected. It helps in finding the degree of compliance or stiffness of the tympanic membrane to show the health of the middle ear. Five types of tympanograms are Type A, Type As, Type AD, Type B and Type C with the range being Type A as normal and Type C as maximum compliance.

Attain a High Google Page Rank with Quality Backlinks

If you have the right strategy and the right tools, you can get your website on the first page of Google. It will all start with link building. Website backlinks are essential to get your hold on search engine rankings. It is worth it even if you have to pay thousands of dollars a year to the webmasters for their links. Posting on forums and blogs have to take secondary importance to the creation of a quality backlink. There are options available to you in the shape of back link and SEO services for a monthly charge to use their links. Setting up a blog is going to be important. Even if you have a website, an incorporated blog will enhance the presence of your website online. Each time Google changes its algorithms with an update related to website backlinks, there will be a buzz from many webmasters suggesting dead links. It is time to accept the fact that social links are replacing backlinks as the main metric index for website authority. There are five important things to consider before embarking on a link building exercise. 1. It starts with great and purposeful content. You need to think out good content. You require smart promotional strategies to get backlinks and achieve success. 2. You have to try and establish yourself as an authority by creating a blog. It is easy to create a blog but it is not easy to assert authority. You can achieve this by packing powerful biographical information on your blog sidebar or at the end of the blog posts. Targeting blogs is an easy way to get backlinks. 3. Doing original research is a good way to attract links. You can create a newsletter through email and use that to attract traffic to your new and original content. 4. Use video links on your website to share information and advice with the users of your website. 5. You can use a tutorial approach to guide visitors to your site one step at a time to do something and they will be impressed by that. You can use link building service to build back link assets that can work as promotional mediums. These can be linkable assets that can work within an image or a widget to make them more visible. There will a high likelihood of these links being clicked on. Informational graphics can serve powerfully with their size and they carry a big potential of virality as they capture the attention of the viewer instantly. A backlink from another site that points to your website is a mighty good vote of confidence. Use link building service to choose the same platform on the social media network that most of your prospects use. Remember that a loyal base of social media users will set up a great platform to promote the content on your web pages and will put you firmly on the path to attain a high page rank on the Google search engine.

Figuring out how to Market your Business

It is not enough to just get websites designed. There are many websites that are up and running. But the real question is, “How many people visit your site?” In the internet world of today, it is important to use the services of SEO Agencies Mumbai and take advantage of their search engine optimisation consultancy so that they can help drive the visitors to your website. Once you finish building a website, the next thing that you have to think is to achieve the maximum return on your investment from that website. You have to figure out how you are going to market your business on the worldwide web. SEO in Mumbai will combine the best search engine optimisation strategies and get the equation right for you. SEO companies Mumbai has been busy practicing organic or natural search engine optimisation for over a decade now. With the right mix of social media marketing experience that they have and content marketing, agencies can deliver the desired return on investment for your company’s marketing budget. SEO Audits are necessary SEO in Mumbai has included in their consultancy the provision of SEO audits as well as link audits of many websites. They also handle the link cleaning services. It is very important to get a search engine optimisation and a link audit done on your website after the recent Google Algorithm updates like the Google Panda, the Google Penguin and Google Hummingbird. You might face a big reduction in the volume of organic search traffic if your website has not been compliant with the Webmaster Guidelines of Google even if you have not experienced a decrease in traffic to your website in the past. In addition to the audit, the link profile also has to be cleaned up. Expanding the Market Reach of your Brand If SEO companies Mumbai help your website get a high ranking on Google, Yahoo and Bing, your business may be on the way to skyrocket with more traffic and customers coming your way. Marketing on the internet needs a specialised set of skills and this is possible with SEO agencies Mumbai. Their experience can be used in a whole range of internet marketing services to make the websites successful by turning them into lead generators for the business. This is made possible by - • Boosting sales and generating new customers with the help of cost-effective and customised marketing. • Increasing the web visibility and the popularity of a website with a quality link marketing plan. • Messaging at the search engines with pay per click services. • Expanding the business with the largest networks in the world through social media marketing. • Eliminating the damage brought about by negative posts on the internet with reputation management solutions. The Importance of Search Engine Optimization The obvious benefit that you gain from the services offered by SEO companies Mumbai is the growth in the volume of traffic to your website. If there is no motivation for traffic to come to your website, there is no question of people buying anything from you. Search engine optimisation is the way to create that volume of targeted traffic for the website. It is not just bringing the visitors to you but also turning them into customers.

Sanskrit

Sanskrit is one of the oldest recognised languages that have existed in India for over seven thousand years. The Sanskrit language has been in use longer than any other language in the world. Even Greek and Latin are not used in their traditional context any more as Sanskrit is done. Sanskrit is also the root of a large number of languages including the primary languages of Europe, Iran and the Middle East. Sanskrit root words could be found in places as far as Hawaii. Sanskrit and its roots can be traced to the Indo-Iranian sub family of the Indo-European languages. Sanskrit came to India from the northwest and was brought in by the Mesopotamians and the Aryan civilisations. It was exported out of India by way of returning people to influence the other Indo-European languages. Whatever its origin, the language has flourished in India and is recognised as a principal official language. It has been the language that has been used by the elite class of people in India and in classic literature. Knowledge of Sanskrit through the ages exemplified a high intellectual and social status of a person in society in India. Sanskrit is one of India’s twenty two official languages and is regularly taught in schools. It is broadcast over All India Radio stations and is used mostly in religious and scholarly context. The word `Sanskrit’ means `Wholly Cultured’ and is considered one of the most sophisticated languages of the world. However, there have been no linguistic developments in Sanskrit, leading many linguists to feel that it may be turning into a dead language. It is, nevertheless, recognised as one of the great original cultural languages in the world. Sanskrit may be termed as a classical language of India. It is also a liturgical language of Hinduism, Buddhism and Jainism. Its position in South Asia is similar to that of Greek and Latin in Europe. It is popular among scholars in and outside of India. Without a proper understanding of the Sanskrit culture, knowledge of India and its traditions would be incomplete. Sanskrit is known for its beauty and clarity. It is also the most systematic language in the world. Much contribution has been made from all parts of the country for the growth of Sanskrit language. Pre-Classical and Classical Sanskrit There are two ages of Sanskrit. There is pre-classical or Vedic Sanskrit and the Classical or the Paninian Sanskrit. Vedic Sanskrit is the language used in the Vedas. There is a large compilation of Hindu philosophical and sacred texts. The Vedas were composed around 4, 500 BC. During these ages, Sanskrit did not have a written script. Sanskrit is the original language of the Vedas which were transmitted from the one who recited to the listener of mantras and shlokas. The Vedas were memorised and transferred orally from the guru (teacher) to the shishya (student). People had to understand the six Vedangas to study the Vedas. The Vedas cannot be studied without the six Vedangas. The first three are Shiksha (understanding of the letters and phonetics), Vyakarna (grammar) and Niruktam (root words and etymology). The latter three are Chandas (metrical system), Kalpa (rituals) and Jyotisha (astronomy and astrology). Shiksha deals with the spoken aspect of the language. It shows how to pronounce the letters of the aksharas or the alphabet. Shiksha divides the letter into three classes. They are swaras, vyanjanas and oushmanas. The letters differ from each other in their meanings depending on the effort and the duration of time for which they are used. Vyakarna is the heart of grammar and it describes meaningful word formations and sounds. Niruktam describes elementary root words that are used in the Vedas. Classification of words into groups of synonyms is an example. There are over hundred synonyms for just the word `water’ as given in Niruktam. The fourth Vedanga, Chandas, describes the formation of sentences in metrical form. Sanskrit offers about twenty Vedic metres and many more conventional metres unlike English that uses four basic metres. The remaining Vedangas, Kalpa and Jyotisha are connected with rituals and space and time. The classical Sanskrit followed the grammar rules that were set down by the esteemed ancient grammarian, Panini. These came about in the fifth century before Christ. Panini wrote a grammar treatise called `Astadhyayi’ (meaning Eight Sections). It was made up of almost four thousand sutras. The other ancient grammarians, Katyayana and Patajali, composed commentaries later on the Astadhyayi and added more grammar rules in their works that were Vartikas and the Mahabhashya. These three grammar works are collectively known as `Trimuni Vyakarana’. Starting from the Rigveda, which is the earliest Vedic text, to the later three Vedas that were the Samaveda, the Yajurveda and Atharvaveda right up to the Brahmanas and the Upanishads, the Vedic period was one of oral tradition. The three major Hindu philosophic concepts that are formulated in Sanskrit are Dvaita by Madhavacharya, Advaita by Shankaracharya and Vishishtadvaita by Ramanujacharya. Script Sanskrit began to be written down in the Classical Age around 400 BC. At various periods, many regional language scripts like Brahmi, Kharoshti, Gupta, Sharada, Devanagari, Bengali, Oriya, Kannada, Telugu, Tamil and Malayalam were used for writing Sanskrit. Mostly the Brahmi and the Devanagari were used. Currently, the Devanagari script is being used to write Sanskrit. This is a phonetic script like most other Indian scripts. Linguists feel that the structure of the Sanskrit language is near perfect. There are forty nine sounds in the Sanskrit script that are formed in five separate areas of our mouth. The letters are arranged scientifically so that the simple vowels come first, then the diphthongs and consonants in uniform groups depending on their point of pronunciation. All this makes for perfect phonetic accuracy. Each Sanskrit alphabet has a precise sound in every word. Every word in Sanskrit is derived from a root. Prefixes and suffixes are added to a root to create words. The grammar, the form and the word meanings are highly developed. Sanskrit is also known `Samskritam’. The name means complete and perfect. `Sams’ means entirely or wholly. `Kritam’ means created. When Sanskrit is used in the scriptures, the sound vibrations of each letter are created to have an effect on a person’s conscience. Sanskrit mantras are made with a combination of sound vibrations. When these mantras are recited, they have a particular effect on the mind and the psyche of a person. Sanskrit script has retained its purity. The structure and vocabulary have remained unadulterated over thousands of years of existence. Grammar Sanskrit’s grammar is regulated and is exact. Sage Panini’s Sanskrit grammar called `Astadhyayi’ was written over two thousand five hundred years ago. It gives us the details of how the language is structured and forms the basis for all modern grammar. Sanskrit has a very rich grammatical structure and a huge vocabulary. There are fifty one aksharas or letters. The aksharas retain their sound as an aspect of non destruction in the phonetic characteristics of the language. The aksharas retain their individual meanings in composed words. The basic unit is a word root. Words are derivatives. All roots are verbs. There is no real concept of proper nouns. All words are complete verbs and they do not depend on adjacent words for their meaning. It is the words in the sentence that will matter and not their order. These are the main reasons why Sanskrit is such a structured language. Linguists describe Sanskrit’s grammar as entirely context-free. Non-terminals can be rewritten without any regard to the context in which they occur. This structure was described in four thousand sutras by Panini. He is considered to be the father not only of Sanskrit grammar but also of computing machines. Literature As Sanskrit is the language of the Vedic culture, it has brought a treasure of literature and philosophy with it. The outstanding Puranas and the hundred and eight Upanishads are the essence of Vedic philosophy. Sanskrit literature has been around for more than two thousand years. Sanskrit language has a unique structure which is perfect. Many scholars have contributed to Sanskrit literature for thousands of years. Among the famous masterworks of Sanskrit literature are Ramayana written by Valmiki and the Mahabharata written by Vyasa. Mahabharata is one of the prime scriptures and is one of the longest literary epics in the world with over hundred thousand verses. It contains the famous Bhagavad Gita. Other important works are the Panchatantra written by Visnu Sharma, Arthashastra by Chanakya, poems and plays by the great Kalidasa and Surdasa, the Puranas and the Upanishads. There are treatises that are also available on astronomy, astrology and science. One of the oldest literatures in the world, the Vedas and the Puranas are still available in the same form that they have been written in at the beginning. There are many scholars who can interpret them today. Such interpretation comes not only by studying the ancient traditions but also through a steady process of assimilating knowledge from various disciplines by means of Sanskrit. Sanskrit and the Philosophy of Science Today, Sanskrit can be as modern as any other language. Its grammar is precise and well defined. Many academicians feel that it is the best language for use with computers due to its context-free grammar. The vocabulary of Sanskrit is taken from root syllables and is ideal for labelling new scientific and technological terms. Scientific principles have always been hidden in the verses of the Vedas and the Upanishads. The concepts and the principles that are found in current day astronomy and mathematics were all hidden in the compositions and treatises of many ancient Sanskrit scholars. The precise structure of Sanskrit offers a lot in the area of computational linguistics research. It is unique on account of it being the only known language that has a built-in scheme for pronunciation and grammar. Sanskrit is full of philosophy and theology related issues. There are many words within Sanskrit that convey different meanings of a concept that allows only one interpretation when studied with other languages. The language, therefore, has the ability to offer links between concepts using only the words.