Hearing and Balance Center – Otology and Neurotology
Services & Treatments
- Tinnitus Management
- Hearing Aids
- Balance Testing Protocol
- Hearing testing
- Inner ear perfusion
Excellence in Hearing and Balance
ENT Physicians provide state of the art diagnostic hearing and balance testing for all ages, newborn through geriatrics, including immittance testing, otoacoustic emission testing, auditory brainstem response testing, visual reinforced and comprehensive audiometry, and electronystagmography.
How do we hear?
Sound waves reach our outer ear and are funneled into our ear canals vibrating the eardrum. The sound is magnified as it is moves along the middle ear bones to the inner ear. The cochlea is a fluid filled portion of the inner ear containing small hair cells that are activated as sound energy continues along this auditory pathway. These hair cells are connected to our auditory nerve which then sends the signal along a complex pathway to reach the auditory cortex in the brain. Only then is the sound truly “heard”. A disturbance along any portion of this pathway can result in hearing loss. Hearing loss can be classified as conductive, sensorineural, or mixed.
Conductive hearing loss occurs when there is a problem with the outer or middle ear, such as ear canal occlusion of wax or an ear infection. Most conductive hearing losses can be treated medically or surgically to improve the hearing loss.
Sensorineural hearing loss combines two sub-categories: sensory hearing loss arising from problems with the inner ear and neural hearing loss associated with abnormalities in the auditory neural pathway. In most cases sensorineural hearing loss is permanent and we must compensate for the loss through devices such as hearing aids.
A mixed hearing loss is a combination of both conductive and sensorineural elements.
Diagnostic Testing: Hearing
Immittance testing, most commonly a tympanogram, reflects eardrum mobility. This test is often ordered to confirm or rule out fluid in the middle ear.
Otoacoustic emission testing reveals outer hair cell activity. It is commonly used as a screening test on children under three years of age. Present emissions convey a normal pathway from the ear canal to the outer hair cells of the cochlea in the inner ear.
Auditory brainstem response testing in infants tests auditory nerve sensitivity. This test is typically ordered when an infant is referred from a newborn hearing screening. For adults this test can be used to evaluate auditory nerve function.
Visual reinforced audiometry uses lighted animated characters to positively reinforce awareness of speech and tonal stimuli in the soundfield of a sound booth. This testing is mostly used with small children.
Comprehensive audiometry is the most common hearing test ordered for older children and adults. It encompasses both speech testing as well as testing for threshold responses at different pitches.
Balance disturbances can manifest themselves in many ways, including but not limited to, a feeling of lightheadedness, a spinning sensation, or general unsteadiness. Our balance is maintained by a complex neurologic system between the inner ear, sensory receptors in our joints and muscles, visual input, and our central nervous system. Treatment options may vary based on cause of dizziness. It is important to describe your symptoms to the physician, including how long the symptoms last, movements that make the symptoms better or worse, along with a complete list of medications. Some causes may resolve on their own or additional testing may be required.
Diagnostic Testing: Balance
Electronystagmography is used to evaluate the vestibular system. It is a combination of positional and caloric tests. It uses cameras in goggles that are worn over the eyes to record eye movements based on the balance system’s response during these tests.