Services

Hearing Tests and Hearing Aid Evaluation

We have full services for hearing assessment of all age groups :(1yr to any age). After testing, if needed an ENT appointment may be made. If needed a hearing aid consultation is booked. Our team of audiologists discuss the findings and prescribe the best suitable hearing aids to the patient. We work with all the major manufacturers and our staff is well versed with the latest technology.

hearing assessment, testing

hearing assessment, testing2

The child (and typically the parent) is seated in a sound booth. Sounds of varying intensity are presented to the child via calibrated speakers or earphones. The sounds may consist of speech or music as well as specific frequencies that are critical to access (hear) the different sounds of speech. The audiologist looks for and records the child’s responses to the softest sounds presented and plots them out on a graph called an audiogram. Behavioral hearing tests include the following methods for the following developmental ages:

  • Visual Reinforcement Audiometry (VRA) for developmental ages of 6 months to 2 years: child turns to the sound stimulus and a puppet lights-up to reward (reinforce) the child’s listening behavior. vra
  • Conditioned Play Audiometry (CPA) begins to emerge around age 2 years and consistent between developmental ages of 2 to 3 years: a listening game that uses toys to maintain the child’s attention and focus to the listening task. For example, the child holds a block, waits and listens for the sound. When the child hears the sound, they drop the block in a bucket. This is no different than raising one’s hand in response to the sound, but the toys establish and maintains the child interested in the listening task for much longer than hand-raising alone. This “listening game” is demonstrated to the child by the audiologist, and once the child understands the game testing is underway.playaud
  • Conventional Audiometry consistently used in children ages 5 and older: child raises hand or provides verbal response (for example, “beep”, “I hear it”) in response to the sound stimulus.
Tinnitus is the perception of sound within the human ear in the absence of corresponding external sound. Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes: like hearing loss associated with exposure to loud sounds or any infections. Up to 17% of normal people can have tinnitus in their ears. Most of the people are not annoyed by it and can live normal life, but in some patients it becomes so severe that it affects the normal day to day routines or functions of the sufferer. In those case a comprehensive test battery is performed and to find out the cause of tinnitus and a strategy is adapted to help the patient cope with tinnitus. Reverse-My-Tinnitus-Review
Modern hearing aids are digital and use sound processing strategies to increase or decrease certain frequency of sounds and provide more speech clarity in noisy situations.
However, not every hearing loss is the same and not all hearing aids provide the same type of amplification. The prospective hearing aid user will be informed about the realistic benefit that a hearing aid may provide. A well fitted hearing aid will significantly improve an individual’s ability to communicate in their every day lives.

Dream family

This is the most simple, reliable method to assess hearing. The patient sits in a sound booth and is presented with a series of tones to determine the level of hearing. This serves as a baseline test for all the hearing and balance testing including hearing aid prescription and fitting. adult hearing test
Tympanometry is the measure of immittance of the eardrum; in other words how easy or how hard it is for sound waves to travel into the inner ear.

Acoustic Reflexes: Not only can your knee jerk but your ears have a reflex too! With high input sounds, the muscles reflex in your middle ear cavity is measured by the stiffness of the eardrum.

Immittance

This test takes advantage of small acoustical signals that emit from the outer hair cells located in the cochlea of the inner ear.
These signals can be recorded in the ear canal by a sensitive microphone and can give information regarding the cochlear portion of the inner ear. These are measured by non-invasive means of placing a probe in the ear canal and recording the responses to stimulus. This is a very good screening test for infants and non cooperative children.

ottoacoustics

Auditory evoked Brainstem potentials (BAEPs) are very small electrical voltage potentials which are recorded in response to an auditory stimulus from electrodes placed on the scalp. They reflect neuronal activity in the auditory nerve, cochlear nucleus, superior olive and inferior colliculus of the brainstem.This test provides objective information about the auditory nerve and its central connections. The main indication is to rule out the possibility of any retrocochlear pathology in cases of asymmetrical sensorineural hearing loss and tinnitus. In children it is sometimes used to determine the threshold of hearing.

ABR

This test provides objective information about the auditory system at the level of the inner ear. This is a simple and non-invasive test for the patient. A soft electrode is placed in the ear canal and a click stimulus is presented through foam earplugs. The test records the inner ear potentials and also can provide information about the auditory nerve and its central connections.
This is one of the diagnostic test for Meniere’s Disease and Endolymphatic hydrops. This is also performed as a Part of dizzy test battery.

Ecochg

Dizzy Test Battery and Treatment

Computerized Dynamic Posturography (CDP) is a unique assessment technique used to objectively quantify and differentiate among the wide variety of possible sensory, motor, and central adaptive impairments to balance control. As such, CDP is complementary to clinical tests designed to localize and categorize pathological mechanisms of balance disorders. CDP can identify and differentiate the functional impairments associated with the pathological processes.

This test evaluates the integration of three main sensory input of human balance system; Inner ear (Vestibule), Eyes, muscles and joints to the brain.

CDPhp

We believe in medical approach to your hearing and Balance disorders. WE have Two Visiting ENT specialists in the clinic. An appointment can be made with the ENT specialists upon referral by your family physician. Our team works in collaboration with each other to provide the best services for hearing and balance disorders.

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This is a special clinic. Typically a patient will be referred by the family physician to ENT specialists. After examination the ENT specialist may ask for some special testing to find out the cause of dizziness. Apart from medical treatment by our ENT specialist we also perform repositioning Maneuvers for the treatment of Benign Paroxysmal Positional vertigo (BPPV).

VRT can be described as systematic repetitive exercises and protocols which extinguish or ameliorate patient’s motion provoked symptoms as well as enhancing postural stability and equilibrium.

  • The underlying physiological bases For VRT is “Plasticity of the CNS”.
  • VRT does not work by regeneration or treatment of the damaged vestibular end organs.
  • It works by allowing the CNS to acclimate or adapt to asymmetrical/conflicting input from the vestibular mechanism.
  • Normally the CNS compensates within 90 days following dysfunction or loss of the vestibular system.

But certain vestibular lesions, particularly those that occur with rapid onset, do not benefit from compensation phenomenon. The reasons for failure of compensation:

  • Reluctance of the patients to do any activities involving active head movements which produce symptoms of dizziness.
  • “The brain cannot fix what the brain cannot see”.
  • Drugs like Meclizine, Valium and Stugron which either suppress CNS or peripheral vestibular function also hamper central compensation.
  • VRT works best for the patients who are not in acute phase of the disease. (Symptoms no longer have the acute labyrinthine storm with debilitating vertigo accompanied by nausea, vomiting and diaphoresis).
  • Patients with End stage Meniere’s disease who do not have any active diseases, but have signs and symptoms of vestibulopathy and patients with Labyrinthitis, Vestibular neuritis, vertibrobasilar and labyrinthine ischemia.
  • Symptoms are provoked by head movement
  • Particular frequency of motion and in particular direction.
  • There may be significant visual provocation.
  • Sense of motion sickness while looking at certain patterns of floor tiles or wallpapers.
  • Difficulty in walking down the aisle of a grocery store while turning their head side to side and up and down while shopping.

balance testing

The Dynamic Visual Acuity Test assesses impairments in a patient’s ability to perceive objects accurately while actively moving the head. In normal individuals, losses in visual acuity are minimized during head movements by the vestibular ocular reflex (VOR) system that maintains the direction of gaze on an external target by driving the eyes in the opposite direction of the head movement. When the VOR system is impaired, visual acuity degrades during head movements. This test can be administered using a traditional Snellen Chart or by new computerized diagnostic methods. The patient is required to move his head side to side and up and down to a computer generated sinusoidal signal. The results are compared with the normative data and analyzed for any abnormality in vestibular system.

VHIT_Performed2

Vestibular Evoked Myogenic Potentials: Assesses two important organs in the inner ear that assist with balance; the saccule and the utricle . The vestibulo-collic reflex and the vestibulo-ocular reflex helps pin point the functionality of the vestibular nerve in dizzy patients.

cVEMP Cervical Vestibular Evoked Myogenic Potentials:
– Checks for Saccule and Inferior Vestibular nerve (also compliments ABR, tinnitus and retrocochlear pathology).
-The only test which can check the Inferior Vestibular nerve function.

OVEMP Ocular Vestibular Evoked Myogenic Potentials :
-Checks for Utricle and Superior Vestibular nerve (also compliments ABR for retrocochlear pathology)

VEMPS

Videonystagmography (VNG) is a technology for testing inner ear and central motor functions, a process known as vestibular assessment. It involves the use of video goggles to trace eye movements during visual stimulation and positional changes. VNG can determine whether dizziness is caused by inner ear disease, particularly Benign Paroxysmal Positional Vertigo (BPPV), as opposed to some other cause such as low blood pressure or anxiety.

videostagnamytesting

Electronystagmography (ENG) is a diagnostic test to record involuntary movements of the eye caused by a condition known as nystagmus. It can also be used to diagnose the cause of vertigo, dizziness or balance dysfunction by testing the vestibular system.

Technique and Results

The test is performed by attaching electrodes around the eyes or recording eye movements by video camera attached to the goggles and measuring the movements of the eye in relation to the ground electrode. The vestibular system monitors the position and movements of the head to stabilize retinal images. This information is integrated with the visual system and spinal afferents in the brain stem to produce the vestibulo-ocular reflex (VOR). ENG/VNG. It is series of test which include testing for occulomotor function, Positional testing, Optokinetic testing and caloric tests. The caloric test is generally performed by using water (warm and cool) but in cases of perforated eardrums it can be performed by air to irrigate the ears.

The standard ENG test battery consists of:

  • Saccades testing
  • Tracking test
  • Gaze testing (horizontal and vertical)
  • Optokinetic test
  • Positioning testing
  • Positionational testing
  • Active head rotation test
  • Caloric stimulation of the vestibular system

This is still considered as gold standard test for vestibular testing. While VNG/ENG is the most widely used clinical laboratory test to assess vestibular function, normal ENG test results do not necessarily mean that a patient has normal vestibular function. ENG abnormalities can be useful in the diagnosis and localization of site of lesion; however, many abnormalities are non localizing; therefore, the clinical history and otologic examination of the patient are vital in formulating a diagnosis and treatment plan for a patient presenting with dizziness or vertigo.

The purpose of Rotational Chair Testing is to identify if the vestibular or the neurological system is the cause of a balance disorder. A Rotational Chair Test is performed by securing the patient to a rotary chair which rotates at various speeds and directions while eye movements are being recorded.

rotatry chair

This is the test in which the patient rotates his head back and forth while the body remains stationary. It enables us to expand our ability to evaluate the vestibulo-ocular reflex in its physiological range of function above I HZ. Rotational tests and other ENG test (Caloric) measure the response of the lateral SSC only but with this test we can measure VOR in response to vertical SSC as well. So combined with ENG we are able to provide our patients with a comprehensive diagnostic services.

VAT

The head impulse test (vHIT) is a test of chronic peripheral vestibular loss. The head thrust test is performed by turning the patient’s head to either side in the angular-horizontal plane to reveal the high-frequency properties of the peripheral vestibular system. This test correlates well with significant excitability reduction indicated via caloric testing.

vhitOTO

It is described as brief attacks of vertigo and concomitant positioning rotatory linear nystagmus, precipitated by rapid head extension as well as by lateral head tilt towards the affected side. This is the most common cause of vertigo in elderly and is caused by either Cupulolithiasis or Canalilithiasis. These patients with persistent symptoms can be treated most of the time by different repositioning or liberatory maneuvers, depending upon the diagnoses (Canalilithiasis or Cupulolithiasis), canal involved and the ear involved. Once the diagnoses is made it becomes easier for physicians to treat the problem by simple repositioning maneuvers.

BPPV


Where Our Tests Work

This diagram shows you the which part of the ear each of tests and treatments can address.