NASHVILLE ENT AUDIOLOGY
Audiometric Evaluations: Adults & Pediatric
Audiometric Evaluations: Adults The audiometric evaluation (audio) consists of testing with both speech and pure tones. Testing with pure tones is done to determine the amount of hearing loss for volume. Speech discrimination scores are obtained to estimate the loss of hearing pertaining to the fine-tunig ability of the ear. Audiometric Evaluations: Pediatrics Depending on the age of the child, different play techniques are employed to determine the amount of hearing loss in each ear using pure tones and speech stimuli. For the youngest children, information specific to each ear may not be obtainable, but overall information is possible.
Tympanometry is an examination used to test the condition of the middle ear and mobility of the eardrum (tympanic membrane) and the conduction bones, by creating variations of air pressure in the ear canal.
Understanding Your Hearing Test
Frequency (or pitch) is depicted on the horizontal axis, from low frequencies on the left (250 Hz) to high frequencies on the right (8000 Hz). The amount of hearing loss is shown on the vertical axis with the higher numbers indicating a greater degree of hearing loss. A symbol on this axis (circle, open or closed) is a measure of the person’s hearing threshold at this frequency, i.e., the loudness (intensity) point where sound is just audible. Thresholds from zero to 20 dB are considered to be within the normal hearing range. After that point, people will usually begin to display some communication difficulties because of the elevated hearing thresholds. The higher the number, the greater the impact of the hearing loss. The 100 dB point should not be confused with a 100% hearing loss, which is a total lack of hearing. Hearing sensations do continue past this point, with some audiometers extending this vertical range to 120 dB. In short, the audiogram is a chart of a person’s hearing loss, frequency by frequency. Now note the shaded area extending across the audiogram (the so-called “speech banana”). This is a general representation of the acoustical speech energy across frequency. Vowels are predominantly in the lower pitches and consonants are predominantly in the higher pitches. Only the shaded area of the speech banana above the threshold curve is audible. Looking at the audiogram again, and relating it to the speech banana, it is apparent that a person with this hearing loss will hear more of the lower frequency speech sounds than the higher ones. Indeed, some of the higher frequency sounds, such as the /s/ sound (the most frequently used phoneme in the English language) will barely be heard at all. Will this person be able to understand normal speech without a hearing aid? Yes, but only with some difficulty and then only if the talker is close by and raises his or her voice slightly. There are, unfortunately, many people with audiograms similar to this who do not, for one reason or another, wear hearing aids. One often sees this type of audiogram in older people whose hearing loss just “crept up” on them and who are still not fully aware of the difficulty they are causing themselves, their family and friends,
Hearing Aid: Sales & Services
Hearing Aids – We offer a wide selection of hearing aids, including digital processing and digitally programmable, from a variety of manufacturers. We will work with you to find the best solution for your hearing healthcare needs within your budget. Repair All Makes – We can get your hearing aid repaired quickly at a reasonable cost and give you a loaner hearing aid to use until yours comes back.
We keep a supply of batteries for you to purchase in our office. Stop in routinely for fresh batteries. Make sure to check the batteries in your hearing devices often and make sure there is no dirt, wax or debris interfering with the batteries performance. Batteries that are properly charged will make a noise (a squeal) when cupped in your hand or after it has been inserted in your ear, when you cup your hand over the hearing aid it will also make a noise. Size 10 (yellow) Size 312 (brown) Size 13 (orange) Size 675 (blue)
VNG Balance Evaluations
Videonystagmography evaluates the function of the vestibular portion of the inner ear for patients who are experiencing symptoms of vertigo, unsteadiness, dizziness, and other balance disorders. Hearing evaluation tests are frequently combined with vestibular studies for the identification of inner ear disorders.
Computerized Electronystagmography (ENG) or Videonystagmography (VNG)
During the ENG and VNG, eye movements are recorded, as there is an interaction between eye movement and function of the inner ear balance (vestibular) system. Electrodes are placed on your face near you eyes (ENG) or goggles are placed over the eyes (VNG). For the first part of the test, the patient will be instructed to watch a light moving on a bar. Next, eye movements will be recorded as the patient lies in different positions (seated, lying down with head turned right or left, etc.) Lastly, warm and cool water will be placed in the ear canal. Some portions of this test, particularly the last part, may make you dizzy. Dizziness is a normal response and usually resolves in two to three minutes. Because medications can influence the results of this test, the patient is asked to avoid the use of certain drugs. These are listed under Medications to Avoid Prior to Testing. ENG and VNG testing takes about 1-1 hours. IT IS VERY IMPORTANT TO AVOID WEARING MAKE UP FOR THIS TEST AS IT CAN INTERFERE WITH THE RECORDING.
Vestibular Autorotational Test (VAT)
The VAT is used to test the Vestibulo-Ocular Reflex (VOR). The primary purpose of the VOR is to allow clear vision during walking and other faster movements. Much like the ENG, electrodes are placed on your face near your eyes. A lightweight helmet is worn to connect with the electrodes. The patient is then instructed to keep their eyes on one spot directly in front of them. They will hear tones coming from a speaker. Patients are instructed to keep their eyes on the spot target on the wall and to move their head in time to the computer-generated tone while keeping their body still. The tones will start out slow and will get progressively faster. VAT testing takes 15 minutes.
The Gans SOP Test has a calculated sensitivity of 90%+ for non-compensated vestibular deficits when correlated with caloric test weakness. Comprised of Romberg, CTSIB and Fukuda, the Gans SOP Test is an important evaluation tool for all clinicians working with patients with vestibular disorders. It also may be administered post-therapy to demonstrate treatment outcomes.
Computerized Dynamic Posturography (CDP)
During this test, you will stand on a specialized platform to determine how steady you are under varying conditions. Posturography assesses how the inner ear, visual and muscular systems are used to maintain balance. Testing occurs in bare feet and a safety harness is worn. Due to the harness, slacks should be worn for testing. CDP testing takes about 30 minutes and is done at the Rehabilitation Department.
The test is similar to the ABR in that it uses clicks and the same electrode arrangement. The ECochG is used to determine if there is too much fluid or pressure within the inner ear mechanism, as is frequently seen with Menieres Disease or cochlear hydrops. Testing usually requires 30 to 45 minutes. An EcochG is indicated for a patient who complains of unilateral hearing loss, buzzing or fullness sensation in the ear, balance difficulties, or when there is a suspician of acoustic neuroma.
Vestibular Evoked Myogenic Potentials (VEMP)
A series of clicking sounds are presented to the ears to measure a reflex that comes from the balance nerve. Electrodes are placed on either side of your neck and between your collarbones. The patient is in a seated position and is instructed to turn their head as far as they can to the right or to the left (depending on which ear is being tested) to tighten the sternocleidomastoid muscle. The head is kept in this position while the patient is hearing clicking sounds through the earphones which can last anywhere from 30 to 60 seconds. This is repeated several times on each side. There will be an opportunity for the patient to rest between each test run. VEMP testing usually requires 20 minutes.
Auditory Brainstem Response (ABR)
A series of clicking sounds are presented to the ears to determine how sound is transmitted through the inner ear and along the nerve of hearing. Testing is completed in a reclined position and you are encouraged to sleep or relax. The test is very sensitive to body and facial movement, so the more still the patient is, the faster the testing will be completed. Electrodes are worn on the forehead and at each ear. Testing requires approximately 15 to 30 minutes.
Counseling and rehabilitation for patients with hearing loss and their families
Digital, programmable, and conventional hearing aid prescription and fitting
Live Speech Mapping
Live Speech Mapping is a fitting process that uses probe microphones and live real-time speech to allow the patient and their family members to immediately see and understand the benefits of hearing aids and fitting adjustments.
Tinnitus is described as a ringing in the ear, and can range in severity. A tinnitus evaluation can help you identify how much tinnitus interferes with your daily life and if there are treatment options that can benefit you.
Assistive Listening Devices (ALDs)
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