Hearing, Dizziness and Balance
We are proud to offer the following audiologic services:
- Newborn hearing evaluations
- Pediatric and adult comprehensive hearing evaluations
- Balance and dizziness testing*
- Dispensing and fitting of hearing aids for all ages
- Bone anchored hearing aid services (including trial, surgery & programming)
- Central Auditory Processing Disorder (CAPD) evaluations*
- Cochlear implant programming
- Tinnitus (ringing or buzzing in the ear) evaluations and management
- Concussion evaluations and management*
- Dispensing and fitting of assistive listening devices and hearing aid accessories
- Custom hearing protection for noise management, including hunter’s earplugs
- Custom swimmer’s earplugs for water precaution
Please see below for information on hearing loss and balance disorders.
Hearing loss is the partial or total loss of hearing in one or both ears. Loss of hearing can be temporary or permanent. Several disorders can affect the hearing in adults as well as children. If left untreated, hearing loss can have a significant impact on your employment, education, relationships and general well-being. Please click here for a hearing loss check list to help determine if you may need a hearing evaluation by an audiologist.
The 3 common types of hearing loss include:
- Conductive hearing loss: This is the condition where the sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones of the middle ear (ossicles).
- Sensorineural hearing loss: This is the most common type of permanent hearing loss, resulting from damage to the tiny hair cells or to the nerve endings from the inner ear to the brain.
- Mixed hearing loss: This type of hearing loss occurs in people who have both conductive and sensorineural types of hearing loss.
Hearing loss can be congenital (present at birth) or acquired (may appear later). Common causes of conductive hearing loss include, ear infections, middle ear fluid, allergies, perforated eardrum, ear canal infection, benign tumors, impacted earwax, and anatomic abnormalities.
Some of the possible causes of sensorineural hearing loss include, illness, aging, head trauma, prolonged exposure to loud noises, certain drugs, and inner ear malformation.
Hearing loss may be gradual or sudden, can range from mild to profound, and may involve one or both ears. Symptoms may include, dull hearing, difficulty understanding speech, ear pain, ringing or buzzing in the ear, itching, drainage, and vertigo (dizziness). Other symptoms include need for high volume when listening to the radio or television, avoiding social situations, and depression. Tinnitus (ringing or buzzing in the ear) maybe present with or without significant hearing loss and occur in one or both ears. Please click here for more information on tinnitus.
Your doctor will diagnose hearing loss by asking about your symptoms and with a detailed physical examination of the ears using an instrument called otoscope. Your doctor may also recommend hearing evaluation that may comprises of:
- Pure tone audiometry: This test determines how well a person can hear sound travelling through the ear canal and through the skull.
- Speech reception and word recognition tests: To check your ability to hear and understand speech.
- Acoustic immittance tests (tympanometry): This test evaluates the eardrum’s and middle ear’s ability to receive sound energy.
- Otoacoustic emissions (OAE) testing: This test measures the sounds given off by the inner ear.
- Auditory brain stem response (ABR) testing: This objective test may be administered to test the auditory nerve pathways in the brain.
- Tuning fork test: This test helps to differentiate conductive hearing loss from sensorineural hearing loss with the help of tuning fork.
When an injury or tumor is suspected other imaging techniques such as CT or MRI scan of the head may be done.
Treatment for temporary or conductive hearing loss depends on its cause and is often treated successfully. An ear infection is treated with the antibiotics, and blocked ear with earwax is treated by removing the wax using special instruments. Corticosteroids may be used in the case of sudden sensorineural hearing loss. If medical and/or surgical treatment is unsuccessful in correcting a temporary or conductive type hearing loss, then hearing devices (such as traditional or bone anchored hearing aids) may be a treatment option.
In the case of permanent hearing loss, hearing devices (such as traditional hearing aids) or hearing implants (such as bone anchored hearing aids or cochlear implants) may be used to restore your hearing and to help you communicate more easily. If a hearing loss presents as severe-to-profound or worsens to a severe-to-profound hearing loss, then a cochlear implant may be an option; however, further testing is needed prior to pursuing such options.
A cochlear implant is a small complex electronic device that is surgically placed within the inner ear to help transmit sound via an electrical signal. It consists of external components (a microphone, a speech processor, and a transmitter) and an implanted component (a receiver/stimulator, and an electrode array). The microphone picks up sound from the environment and sends the signal to a speech processor which selects analyses and digitizes the sound signals before they are sent to a transmitter. This in turn transmits these digitized sound signals via radio waves to the internal implant where the fibers of the auditory nerve are electrically stimulated and sound sensations are perceived. Please click here for more information on cochlear implants.
Dizziness & balance problems
Dizziness means feeling light-headed or the feeling of imbalance or unsteadiness, and is a nonspecific term. Lightheadedness is a feeling of fainting and may be due to low blood pressure, illness, or other factors. Vertigo is a feeling of spinning sensation with loss of balance and may be due to a balance disorder within the inner ear.
Dizziness is often caused by decreased blood supply to the brain and the impaired blood supply may be because of low blood pressure or dehydration which may be caused by diarrhea, fever, and vomiting. Elderly people may experience lightheadedness when they get up quickly from a lying or seated position. Lightheadedness may also be associated with flu, low blood sugar, sweating, and common cold. Vertigo is often associated with inner ear problems or disorders. Other conditions that lead to dizziness include heart problems and stroke and in these cases patients may also develop symptoms like chest pain, loss of speech, and change in vision.
The most common causes of vertigo may include:
- Benign paroxysmal positional vertigo (BPPV) – The crystals in the inner ear become dislodged and move to one of the semicircular canals and cause irritation. It is caused because of sudden positioning of the head and most commonly occurs in older people.
- Labyrinthitis – Is an ear disorder that involves inflammation of the balance organ in the inner ear which commonly occurs after a viral infection.
- Meniere’s disease – Is an inner ear disorder that causes severe hearing loss, ringing in the ears and dizziness. The disease can affect one or both ears.
- Acoustic neuroma – Is a benign tumor of the ear causing ringing in the ears, hearing loss and dizziness and balance problems.
- Trauma to the inner ear
- Barotrauma causes damage to the inner ear and vertigo due to pressure changes between the middle and inner ear.
You may feel spinning sensation associated with loss of balance and unsteadiness. Other symptoms include decreased hearing and ringing in the ear (tinnitus). Nausea and vomiting may be also associated with vertigo causing dehydration and weakness.
Your doctor will perform a thorough physical examination and may ask you about the associated symptoms and past medical history. Hearing tests may be recommended to make sure that that the middle ear, the cochlea, and the auditory nerve are functioning accurately. Additional specialized diagnostic testing may be ordered to help determine the source or cause of the vertigo.
Dizziness is a symptom and not a disease and if it is not treated at the right time, it may lead to serious health problems.
Treatment includes treating underlying disease conditions, for example:
- Dehydration – Drink more amounts of liquids or fluids and in cases where you are unable to drink water then intravenous administration may be preferred
- Fever or infection – Medications for fever or antibiotics to treat infections may be prescribed
- If dizziness is due to heart conditions or anxiety related disorders necessary treatment may be initiated
- Vertigo from BPPV or labyrinthitis is often treated with vestibular rehabilitation exercises, also referred to as Epley manoeuvres. It involves positioning and manipulating the patients head to remove the crystals from the semicircular canals and thus reducing the inflammation.
- Medications such as stemetil may be prescribed to reduce the vertigo symptoms inflammation within the vestibular system
- Corticosteroids and antiviral medications such as acyclovir or valacyclovir may be prescribed for viral infections causing the labyrinthitis
- Surgery may be needed in patients with acoustic neuroma or other anatomical disorders of the ear.