Tonometry

Tonometry is the measurement of tension or

pressure . A tonometer is an instrument for
measuring tension or pressure
 Goldmann tonometer
A special disinfected prism is mounted on the tonometer
head and then placed against the cornea. The examiner
then uses a cobalt blue filter to view two green semi
circles. The force applied to the tonometer head is then
adjusted using the dial until the inner edges of these green
semicircles meet
 PASCAL TONOMETER
It uses a miniature pressure sensor embedded within a tonometer tip
The tonometer tip rests on the cornea with a constant appositional
force of one gram
When the sensor is subjected to a change in pressure, the electrical
resistance is altered and the PASCAL's computer calculates a change
in pressure in concordance with the change in resistance
OPHTHALMOSCOPY
It Can evaluate whether or not there is any optic nerve
damage by looking at the back of the eye (called the
fundus).
 Type of Ophthalmoscopy

Direct ophthalmoscope Indirect ophthalmoscope

The direct ophthalmoscope is An indirect ophthalmoscope, on

an instrument about the size of
a small flashlight (torch) with
several lenses that can magnify
up to about 15 times
the other hand, constitutes a light
attached to a headband, in
addition to a small handheld lens.
It provides a wider view of the
inside of the eye
 Hearing Aid

The first type of hearing aid invented by Harvey Fletcher while

working at Bell Laboratories.These aids consist of a case, an
earmold, and a cord. The case contains the amplifier
components. The case is about the size of a pack of
playing cards and is worn in the pocket or on a belt

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 Hearing Aid
hearing aid is an electroacoustic device which
typically fits in or behind the wearer's ear, and is
designed to amplify and modulate sound for the
wearer. Earlier devices, known as an "ear trumpet"
or "ear horn",were passive funnel-like
amplification cones designed to gather sound
energy and direct it into the ear canal.

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 All Hearing Aids Are Alike

1. Sound goes in the Microphone.

2. Sound gets amplified.
3. Sound comes out the Speaker into your Ear

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 Style

 Body
 Behind The Ear (BTE)
 In The Ear (ITE)
 In The Canal (ITC)
 Completely In the Canal (CIC)

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 Technology
 Analog: Settings and Sound are both processed via analog
technology.
 Digital Programmable: Settings are processed digitally,
Sound is processed via analog technology.
 Full Digital: Both Settings and Sound are processed
digitally.

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 Basic Parts
MICROPHONE
AMPLIFIER,
SPEAKER

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 Hearing Aid
 The hearing aid receives sound through a microphone, which converts the sound
waves to electrical signals and sends them to an amplifier. The amplifier increases
the power of the signals and then sends them to the ear through a speaker.

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 Hearing Aid Components
 One or many microphones. The microphone gathers sound and
converts it to electrical impulses. More than one microphone collects
sound from different areas.
 An amplifier is used to increase the strength of the impulses.
 The receiver transforms the electrical impulses back into sound waves
and redirects them into the ear of the wearer.
 A battery is needed to supply the energy source.
 A computer chip is found in programmable hearing aids.
 There are switches on the aid that turn the device on or off, allow for
phone usage or provide the ability to control volume.

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 Features
 Volume Control
 Telecoil
 Multiple Microphone Directionality
 Compression
 Clipping
 Direct Audio Input
 FM
 Programmability
 Speech Enhancement/Noise Reduction
 Frequency Shifting
 Earmold/Vent
 Remote Control

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Volume Control
 Some aids are preset and you can’t control the volume.
 Some manufacturers and dispensers think you don’t need
it.
 Not having a volume control is Ok for a few people who
really don’t need it or can’t manage it.
 Very useful to be able to control the volume to match the
situation.
 Control may be a wheel on the aid, or a remote control.

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 Telecoil  Alternate input source

Sound
 Listens to magnetic signal
Input instead of (or in addition to) the
Signal
sound.
 Magnetic signal can be from a
telephone, CD, TV, personal
ALD, headphone, loop
 Major advantage is improved
signal to noise
 Usually on BTEs; sometimes
on smaller, seldom on smallest
Magnetic
Input
Signal

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Multiple Microphone Directionality
 Front Facing Directional Mic
 Rear Omnidirectional Mic
 Aid Can Focus on Sounds in
Front and Diminish Background
Noise
 Selectable Modes
 Quiet situations: hear everything
 Noisy situations: block background
noise
 Manual or Auto Selection

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Direct Audio Input (DAI)
 Alternate input source
 Listens to electrical signal
instead of (or in addition to) the
sound.
 Electrical signal can be from a
telephone, CD, TV, or personal
ALD
 Major advantage is improved
signal to noise
 Boots available only for BTEs

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 Booted or Integrated FM
 Some Aids have FM receivers
either booted on (as shown) or
integrated into the aid.
 Some can be used with hand-held
transmitters or with fixed
transmitters which can integrate
TV and Telephone.
 Clean signal; bridges distance;
improves signal to noise ratio.

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 Speech Enhancement and Noise Reduction
 Speech Enhancement
 Enhance certain speech sounds (like consonants)

 Noise Reduction Processing

 Identify speech in the signal and separate it from noise

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 Diathermy

Diathermy means the use of

electricity to generate heat. 
                      
Diathermy
Shortwave Diathermy (SWD)
Shortwave electromagnetic (EM) radiation - radio
frequency waves
Therapeutic diathermy set at 27.12MHz
Pulsed SWD - a method of rapidly switching on and
off the EM field
Used to deliver heat and ‘energy’ to deeply situated
tissues
PSWD
Developed due to belief that non-thermal effects of
SWD existed, but masked by  heat
Same as SWD but pulsed - allows heat dispersal.
Large possible selection of treatment parameters -
optimum settings to be established
What is EM energy?
Electric field:
Exists between and around charged particles, e.g.
protons/electrons.
moving electrical charges = electric current
Magnetic field:
Magnetic force generated at 90° to the current
 Area where this force acts = magnetic field
Tissue Response
Shortwave EM energy  little effect on tissue itself,
but…….
SWD EM field creates tiny electric currents  a
magnetic field within tissues
i.e., both electrical and magnetic fields set up in human
tissue subjected to SWD
These fields  physiological effects
Production of SWD
 Patient made part of the electrical circuit by the use
of either:
1. An inductive coil - magnetic field radiated at right
angles to direction of current flow producing small
eddy currents in tissues
2. Capacitive type electrodes - SWD field is generated
between two electrodes and body part being treated
acts as dielectric
Methods of Heat Production
 Living tissue consists of 3 molecule /particle types:
1. Charged molecules (ions, Na+, some proteins)
2. Dipolar Molecules (water, some proteins)
3. Non polar molecules (fat)
1. Charged molecules/particles
Na+, some proteins
Attraction/repulsion forces between charged molecules
compel them to accelerate along the lines of electrical
force
Causes collisions & loss of kinetic energy
 heat production (most efficient)
2. Dipolar Molecules
H2O, some proteins
Positive orientated towards negative
Alternating field - produces rotation
 heat production (moderately efficient)
3. Non-Polar Molecules
Fat
Alternating field causes electron clouds to move back
& forth
Temperature  due to blood electrolytes - fat then
insulates heat
 heat production (least efficient)
Application of SWD
1.Inductive Method
 Circuplode/Flexiplode
 Deeper heating
 Coil within drum: 2cm spacing (towel between
drum and skin)
2.Capacitor method
 Plate electrodes: contra-planar / coplanar
 Superficial heating
 Distribution depends on:
 Size & position of electrodes
 Tissue types: (fat  conductivity)
 Tissue shape
 Electrode spacing: wider  even heating (2-4cm)
Dosage
Little evidence / agreement
Average power useful: pulse duration x pulse
frequency x peak pulse power
Evidence suggests that longer times with high
frequencies & short pulses most effective
Time 20-30min (empirical - ? habitual)
Therapeutic Effects
1. Thermal
 blood flow
  inflammation
  Collagen extensibility
  Joint stiffness
  Pain
  Muscle spasm
2. Athermal
 Possible  rate of soft tissue healing
  number & activity of cells in injured area
  haematoma reabsorption
  Swelling
  fibrin and collagen deposition/orientation
  nerve growth & repair
Patient Preparation
Explain - degree of heat, treatment aims
Warn to notify if any problems
Contraindications
Remove hearing aids
Expose area
SKIN TESTING
Positioning: dry area, *care with metal
Test - neon tube
Switch on, tune &  to desired intensity
Contraindications
Implanted pacemakers
Metal in tissues or external fixators
Lack of thermal sensitivity
Uncooperative patients
Pregnancy
Haemorrhaging areas (may be temporary increase in
bleeding during menstruation if pelvis irradiated)
Medical Applications of Lasers