Tonometry

Tonometry is the measurement of tension or pressure . A tonometer is an instrument for measuring tension or pressure

Goldmann tonometer
y 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
y It uses a miniature pressure sensor embedded within a tonometer tip y The tonometer tip rests on the cornea with a constant appositional

force of one gram y 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
y 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
An indirect ophthalmoscope, on 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

The direct ophthalmoscope is an instrument about the size of a small flashlight (torch) with several lenses that can magnify up to about 15 times

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
y 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. 2. 3. Sound goes in the Microphone. Sound gets amplified. Sound comes out the Speaker into your Ear

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

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Technology
y Analog: Settings and Sound are both processed via analog

technology. y Digital Programmable: Settings are processed digitally, Sound is processed via analog technology. y Full Digital: Both Settings and Sound are processed digitally.

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Basic Parts
y MICROPHONE y AMPLIFIER, y SPEAKER

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Hearing Aid
y 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
y One or many microphones. The microphone gathers sound and converts it to

y y y y y

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
y y y y y y y y y y y y

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
y Some aids are preset and you can·t control the volume. y Some manufacturers and dispensers think you don·t need it. y Not having a volume control is Ok for a few people who really

don·t need it or can·t manage it. y Very useful to be able to control the volume to match the situation. y Control may be a wheel on the aid, or a remote control.

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Telecoil
Sound Input Signal

y Alternate input source y Listens to magnetic signal instead

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

Magnetic Input Signal

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Multiple Microphone Directionality
y Front Facing Directional Mic y Rear Omnidirectional Mic y Aid Can Focus on Sounds in Front

and Diminish Background Noise y Selectable Modes
y Quiet situations: hear everything y Noisy situations: block background noise

y Manual or Auto Selection

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Direct Audio Input (DAI)
y Alternate input source y Listens to electrical signal instead of

(or in addition to) the sound. y Electrical signal can be from a telephone, CD, TV, or personal ALD y Major advantage is improved signal to noise y Boots available only for BTEs

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Booted or Integrated FM
y Some Aids have FM receivers either

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

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Speech Enhancement and Noise Reduction
y Speech Enhancement y Enhance certain speech sounds (like consonants) y Noise Reduction Processing y 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)
y Shortwave electromagnetic (EM) radiation - radio frequency

waves y Therapeutic diathermy set at 27.12MHz y Pulsed SWD - a method of rapidly switching on and off the EM field y Used to deliver heat and ¶energy· to deeply situated tissues

PSWD
y Developed due to belief that non-thermal effects of SWD

existed, but masked by o heat y Same as SWD but pulsed - allows heat dispersal. y Large possible selection of treatment parameters - optimum settings to be established

What is EM energy?
y Electric field:
y Exists between and around charged particles, e.g.

protons/electrons. y moving electrical charges = electric current
y Magnetic field:
y Magnetic force generated at 90° to the current y Area where this force acts = magnetic field

Tissue Response
y Shortwave EM energy p little effect on tissue itself,

but««. y SWD EM field creates tiny electric currents p a magnetic field within tissues y i.e., both electrical and magnetic fields set up in human tissue subjected to SWD y These fields p physiological effects

Production of SWD
y 1.

2.

Patient made part of the electrical circuit by the use of either: An inductive coil - magnetic field radiated at right angles to direction of current flow producing small eddy currents in tissues Capacitive type electrodes - SWD field is generated between two electrodes and body part being treated acts as dielectric

Methods of Heat Production
y 1. 2. 3.

Living tissue consists of 3 molecule /particle types: Charged molecules (ions, Na+, some proteins) Dipolar Molecules (water, some proteins) Non polar molecules (fat)

1. Charged molecules/particles
y Na+, some proteins y Attraction/repulsion forces between charged molecules

compel them to accelerate along the lines of electrical force y Causes collisions & loss of kinetic energy y p heat production (most efficient)

2. Dipolar Molecules
y H2O, some proteins y Positive orientated towards negative y Alternating field - produces rotation y p heat production (moderately efficient)

3. Non-Polar Molecules
y Fat y Alternating field causes electron clouds to move back & forth y Temperature o due to blood electrolytes - fat then insulates

heat y p heat production (least efficient)

Application of SWD
1. y y y

Inductive Method Circuplode/Flexiplode Deeper heating Coil within drum: 2cm spacing (towel between drum and skin)

2. y y y
y y y y

Capacitor method Plate electrodes: contra-planar / coplanar Superficial heating Distribution depends on:
Size & position of electrodes Tissue types: (fat q conductivity) Tissue shape Electrode spacing: wider p even heating (2-4cm)

Dosage
y Little evidence / agreement y Average power useful: pulse duration x pulse frequency x

peak pulse power y Evidence suggests that longer times with high frequencies & short pulses most effective y Time 20-30min (empirical - ? habitual)

Therapeutic Effects
1.
y y y y y y

Thermal
oblood flow q inflammation o Collagen extensibility q Joint stiffness q Pain q Muscle spasm

2. y
y y y y y

Athermal Possible o rate of soft tissue healing
o number & activity of cells in injured area o haematoma reabsorption q Swelling o fibrin and collagen deposition/orientation o nerve growth & repair

Patient Preparation
y Explain - degree of heat, treatment aims y Warn to notify if any problems y Contraindications y Remove hearing aids y Expose area y SKIN TESTING y Positioning: dry area, *care with metal y Test - neon tube y Switch on, tune & o to desired intensity

Contraindications
y Implanted pacemakers y Metal in tissues or external fixators y Lack of thermal sensitivity y Uncooperative patients y Pregnancy y Haemorrhaging areas (may be temporary increase in bleeding

during menstruation if pelvis irradiated)

Medical Applications of Lasers