Hearing and Balance Tests and Treatments
If you suffer from hearing loss or other hearing and balance related conditions, you may benefit from an audiologic evaluation. These comprehensive diagnostic exams can determine the cause, severity and best treatment option for these conditions in infants, children and adults.
Newborn hearing screening is a noninvasive exam used to detect hearing loss in infants. Three out of every 1,000 newborns are born with permanent hearing loss, and many of them have no risk factors for the condition. Newborn hearing loss can greatly affect the development of speech and language, as these skills are acquired during the first two years of life by listening to the familiar sounds and voices of their home and family. By identifying hearing loss early, special care can be provided to help your child develop normal language skills during the critical first two years of life.
There are two types of screening tests typically performed to assess newborn hearing, both of which are conducted while your baby is quiet and sleeping. These tests may be performed separately or together, and will not harm your baby in any way. These tests screen for mild or greater hearing loss, but cannot diagnose the cause of hearing loss. Most hearing screenings are performed before babies leave the hospital or within the next few weeks.
Hearing Evaluation Tests
The hearing evaluation tests commonly used for newborns may include:
Otoacoustic Emissions Testing
Otoacoustic emissions testing, also known as OAE tests, are very soft acoustic responses to stimuli from the outer hair cells in the cochlea. The test is performed by inserting a microphone and two speakers into the ear to emit a sound and then record the response signal. Absent or very soft response signals may be the result of hearing loss, fluid behind the ears or damage to the cochlea.
Brainstem Auditory Evoked Response Test
Also known as the auditory brainstem response test or ABR, the brainstem auditory evoked response test examines brain waves that are stimulated by a clicking sound to evaluate the auditory pathways in the brain. Electrodes are placed on the scalp and earlobes and the patient listens to a clicking noise through headphones. The electrodes record the brain's reaction.
If the results of a hearing screening are abnormal, additional testing may be performed. The abnormal results can also be caused by a middle ear infection or blocked ear canal, so it is important to determine the true cause through an audiologic evaluation or other testing procedures. If hearing loss is diagnosed, hearing aids and therapy may be prescribed to help your baby develop normal communication, listening and speaking skills.
Common audiologic tests for older children and adults may include:
An audiogram uses sounds of specific frequencies and intensity levels to determine what a person can hear in each ear. The sounds are heard through headphones and the patient is asked to identify each time they hear a sound and in which ear. The sounds will become lower and lower to determine the level at which a patient can barely hear. An audiogram may also include speech in the form of two-syllable words to determine how well a patient can comprehend what is being heard. Normal results allow for a patient to hear a normal speaking voice, whisper and ticking of a watch.
Play audiometry is a modified version of the diagnostic audiogram, sometimes chosen instead when working with preschool and school age children. The sounds are heard through headphones, but rather than raising a hand to indicate hearing a sound, the child places a toy in a container.
Tympanometry examines and diagnoses the middle ear by varying air pressure in the ear canal to see how the ear responds. A probe is inserted into the ear to change the air pressure, produce a tone and then measure the responses. The patient may not speak, move or swallow during the test because these actions can affect the ear pressure. Tympanometry measures the functionality of the ear drum or tympanic membrane. Abnormal results may be the result of fluid in the middle ear, perforated ear drum or impacted ear wax.
Hearing Aids and Cochlear Implants
A hearing aid is a small electronic device that is worn in or behind your ear and amplifies sounds so they can better be heard. Digital hearing aids convert the sound waves into numerical codes and amplify them. They can be programmed to amplify some frequencies more than others and to focus on sounds coming from a certain direction.
Cochlear implants are small, electronic devices used to correct hearing loss in those who are completely deaf or severely hard-of-hearing. The device is implanted into the inner ear, bypassing the damaged parts of the ear to directly reach the auditory nerve and send sound signals to the brain. Cochlear implants can benefit adults and children over 12 months old. The success of cochlear implants varies depending on how long a person has been deaf, how many nerve fibers remain and their motivation to hear.
Bone Anchored Hearing Aid
A bone anchored hearing aid, or BAHA is an implantable device used to improve hearing by stimulating the inner ear through the bone. BAHAs can improve hearing in patients with less severe cases of conductive or mixed hearing impairment. It is ideal for patients who are not candidates for regular hearing aids because of a physical deformity, frequent ear infections or narrow ear canals.
A bone anchored hearing aid placement procedure takes less than an hour to perform on an outpatient basis, using local anesthesia for adults and general anesthesia for children. Patients can return home the same day. During the initial procedure, only the titanium screw and abutment are placed, while the hearing aid is implanted during a second procedure three to six months later. This ensures that the titanium becomes integrated into the bone for long-lasting correction.
Aural rehabilitation for those with cochlear implants or bone anchored hearing aids generally includes learning strategies to communicate more effectively in conversation as well as how to handle distracting background noise.
Ear Wax and Foreign Body Removal
Ear wax is a natural substance produced to protect the ear from damage and infections and cleaning generally is needed. However, if an extreme amount of wax builds up, it may need to be cleaned, or lavaged, by your doctor. Ear drops may also be prescribed to soften the wax and allow it to be cleared out.
When a foreign body has lodged in the ear canal, it is essential to see a medical professional. Your doctor will most likely remove it using either tweezers or by flushing the canal with saline.
Tympanostomy Tube Placement and Eardrum Perforation Repair
Those who suffer from repeat ear infections or fluid in the ear may benefit from ear tubes. Ear tubes are plastic inserts that are surgically placed in the eardrum to help air enter the middle ear, allow fluid drainage, prevent future buildup of fluid and restore hearing. Most patients experience a significant reduction in the number of ear infections from this treatment, as well as relief from hearing loss and associated symptoms.
Ear tube surgery, known as a tympanostomy, involves a tiny incision in the eardrum. Any fluid in the ear is removed and the tube is inserted. The surgery is performed as an outpatient procedure and only takes 10-15 minutes. Most patients can resume normal activities the next day.
Eardrum Perforation Repair
The tympanic membrane, or ear drum, can be easily damaged by injury or infection. Tympanoplasty is reconstructive surgery for perforated tympanic membranes that can help restore hearing. The surgery can be performed through the ear canal or behind the ear. Tympanic membrane grafting may be required, in which skin tissue around the ear is used to reconstruct the eardrum.
Custom Swim Mold Creation
Custom swim molds are silicone ear plugs created from an impression of an individual's ear. They provide a water-tight seal to keep ear canals dry, which is important for people who have undergone ear surgery or have certain chronic conditions. Used for swimming and bathing, swim molds repel the moisture that can exacerbate symptoms or delay healing.
Assistive Listening Devices
Assistive listening devices are technological instruments that can improve your listening comfort level in everyday situations. Some examples of assistive listening devices are television listening devices, corded or cordless amplified telephones, personal amplifiers and Captel captioned telephones that can display the words of a call as they are spoken.
Tinnitus Management with the Zen Program
The Zen Program is an option offered in certain hearing aids for tinnitus management. Tinnitus sufferers experience a ringing or other noise in their ears that can be very stressful, especially if it is loud or constant. The Zen feature plays harmonic tones through your hearing aid, making tinnitus less noticeable to many patients and promoting relaxation.
Balance Disorder Services
Diagnosing a balance disorder can be a complicated procedure. Since dizziness and vertigo are symptoms of many conditions, it is hard to pinpoint the exact cause. Your doctor may perform a series of audiologic, vestibular and movement tests depending on your symptoms. Identifying the underlying cause and the type of balance disorder are both important in successful treatment.
Treatment for a balance disorder depends on its cause. Treating the underlying cause can eliminate balance problems for many people. For others, balance training exercises and life changes can help relieve symptoms. Surgery may be recommended for patients whose symptoms cannot be controlled by more conservative methods. Managing these complex conditions requires interdisciplinary care.
Benign Positional Paroxysmal Vertigo
Benign Paroxysmal Positional Vertigo, or BPPV, is a common form of vertigo, is a balance disorder caused by inner ear issues. Patients with BPPV experience a sensation of tilting or spinning when neither is actually occurring. To diagnose BPPV, a physical exam is done, along with a test of the nervous system to detect communication issues between the nerves and the brain. While BPPV often goes away on its own, recurrence is possible. To prevent BPPV, certain exercises can be done to train the brain against vertigo-inducing signals.
Two of the most effective treatments for BPPV are types of head exercises: the Epley maneuver and canalith repositioning. During each, the patient is seated and the physician repositions the head several times. This creates movement of the matter within the canal that typically causes this kind of vertigo.
Diagnostic Testing for Balance Disorders
The following tests may be performed when diagnosing balance disorders:
Videonystagmography, or VNG is used to determine whether inner ear functions are the cause of balance disorders. VNG is a series of tests that examine the involuntary movement of the eyes known as nystagmus. The movements are recorded through infrared cameras in the form of goggles placed over the eyes. VNG is one of the only tests that can determine if the problem is unilateral, or one ear or bilateral which is both ears.
Dynamic Platform Posturography
Dynamic Platform Posturography, or DPP is a test performed to evaluate balance. The patient stands on a platform attempting to remain completely motionless. Over the course of the test, the platform will be moving in a number of different directions. The patient will keep his or her eyes open for portions of the test and closed for other portions.
Auditory Evoked Potentials
Auditory evoked potentials, also known as auditory brainstem response, or ABR, is a diagnostic test performed to evaluate neurological functioning and identify problems with hearing and the nervous system. This test may also be performed on patients suffering from brain injury or various speech disorders. Auditory evoked potentials is safe for all patients, with no associated risks.
The patient will remain in a reclined position during the test. The technician places electrodes on the scalp and earlobes. The patient will hear a series of clicks and tones during auditory evoked potentials and the brain's response to each noise is recorded onto the electrodes.
Electrocochleagraphy, or ECoG is a diagnostic procedure that measures electrical potentials within the inner ear by stimulating sounds. This procedure may be performed to determine if there is an excessive amount of fluid pressure on the inner ear, and is also effective in diagnosing Meniere's disease. During the ECoG procedure, several electrodes will be placed on the head, while a microphone and earphone will be placed inside the ear. A series of clicking noises will begin as the electrodes measure the body's natural response. This procedure can be performed in your doctor's office and takes about 40 minutes.