What We Do
A hearing aid is a small electronic device that you wear in or behind your ear. It allows the person with a hearing loss to communicate, and participate more fully in daily activities.
We test your hearing to determine if you have hearing loss, the cause and type of hearing loss and which ear the loss is in. We can then determine the most suitable treatment options.
Otoacoustic Emission Testing
Otoacoustic Emission Testing
Otoacoustic emissions (OAE)’s are low-level sounds generated by the outer hair cells of the cochlea (inner ear) in response to auditory stimuli. OAEs are present in nearly all normal-hearing ears. Absent OAEs indicate hearing loss and/or middle ear pathology.
When are OAE tests used?
OAE tests are used to assess the following:
- Infants from newborn to children up to 4 years of age
- Children and adults who are or who are unable to cooperate with other methods of testing
- Hearing testing (e.g. individuals with autism or stroke)
- Children with developmental or delayed speech or language disorders
- Individuals with tinnitus, acoustic trauma, noise induced hearing loss, or sudden hearing loss
- Individuals with abnormal auditory perception
- Individuals with sensorineural hearing loss
- Individuals with abnormal auditory function studies or failed hearing exam
- Potentially malingering individuals who may be feigning a hearing loss
- Monitoring of ototoxicity in patients before, during, and after administration of agents known to be ototoxic (e.g., aminoglycosides, chemotherapy agents)
Types of OAE’s
- Distortion Product Otoacoustic Emissions (DPOAEs)
DPOAEs are generated by simultaneous stimulation of the outer hair cells by presenting two pure tones of different frequency through the OAE probe.
- Transient Evoked Otoacoustic Emissions (TEOAEs).
TEOAEs are generated when the ear is stimulated by clicks or tonebursts.
DPOAEs and TEOAEs are equally reliable in the 1.5 kHz to 4 kHz range. TEOAEs are more reliable for frequencies below 1.5 kHz while DPOAEs are more reliable for frequencies above 4 kHz.
What will happen during the test?
An OAE probe with eartip is inserted into the ear canal to obtain a seal. The acoustic signal is presented from the probe. The signal travels through the ear canal, the middle ear, and finally reaches the cochlea where the outer hair cells are excited and the emission is generated. The emission travels back through the middle and outer ears and is detected by a highly sensitive microphone in the OAE probe. Other than the annoyance of having a soft plug in your ear canal, the patient will not experience any discomfort. Newborns will often sleep during the entire procedure.
Industrial Hearing Testing
What is Industrial Hearing Loss?
Industrial hearing loss or occupational hearing is a condition that results in the loss of hearing (often over a prolonged period of time) as a consequence of a person’s working environment.
There are a range of different types of hearing loss that can be caused from noise in the workplace, from temporary to permanent loss of hearing and conditions such as tinnitus or acoustic shock syndrome.
The Occupational Health and Safety Agency (OSHA) has in place regulations to protect workers from having to suffer from high levels of noise in the workplace. Employers that have a noisy work environment should be following the instructions as dictated in those policies. Regardless, of the specific profession, if there are consistent levels or noise above 80 dB an employer should be looking into lowering noise levels and/or providing ear protection equipment to staff.
Noise, or unwanted sound, is a pervasive occupational health problem. Exposure to high levels of noise can cause hearing loss. The extent of damage depends primarily on the intensity of the noise and the duration of the exposure.
Noise-induced hearing loss can be temporary or permanent. Temporary hearing loss results from short-term exposure to noise, with normal hearing returning after period of rest. Generally, prolonged exposure to high noise levels over a period of time can gradually cause permanent damage.
Our hearing conservation program is designed to protect workers with significant occupational noise exposures from hearing impairment even if they are subject to such noise exposures over their entire working lifetimes.
Our center provides DOT employees with the following: provides the following:
- Hearing evaluations for DOT physicals
- Employee baseline testing
- Annual hearing evaluations
- Monitoring of threshold shifts in accordance with OSHA regulations
Auditory Brainstem Response Testing
Auditory Brainstem Response Test
If you or someone in your family has been referred for an Auditory Brainstem Response (ABR) test, here’s what you will need to know. Auditory nerve-brain stem evoked responses (ABR) have been used for many years to evaluate auditory and neurological disorders.
An Auditory Brainstem Response (ABR) test or as it is sometimes called a Brainstem Auditory Evoked Potential (BAER) test is generally considered to be one of the most significant advances in the history of Audiology. ABR tests measure the latency and amplitude of electrical potentials that are generated by specific sounds as they progress from the auditory nerve to the brain.
How Do We Do an ABR Test?
The ABR procedure is non-invasive and painless. You do not need to prepare for the test in advance. The patient is required to do very little other than remain relatively still during testing. Electrodes are placed on the forehead and one on each earlobe. Headphones or earplugs are used to deliver the clicking sounds that are used for this procedure. You do not need to do anything in response to the sounds. The electrodes placed on your scalp and earlobes will record how your brain reacts to the noises you hear.
The electrical response of the auditory nerve and brainstem pathways to thousands of acoustic click stimuli is measured and averaged by a computer, which generates a series of waves. These waves represent electrical potentials that grossly correspond to anatomical sites in the brainstem.
By comparing latencies, amplitudes and waveforms to those obtained from normal subjects, abnormalities in the auditory system can be defined. Results characteristic of disorders of the cochlea, auditory nerve or brainstem can be categorized to aid in medical diagnosis. ABR waveforms are extremely reliable and can be duplicated with a high degree of consistency. This enhances their clinical use and reliability.
What Can an ABR Test Help to Evaluate?
Approximation of Hearing Sensitivity in Challenging Patients
- Small Children
- Comatose Patients
- Special Needs Patients
One of the greatest challenges in hearing assessment is an accurate evaluation of the very young and/or difficult-to-test population. Though frequency-specific information is still difficult to obtain, ABR testing allows the best available approximation of hearing sensitivity.
Site of Lesion
Many studies point to ABR as a sensitive test differentiating cochlear, VIIIth nerve, and brainstem pathology in cases of unknown etiology or when there is a concern of retrocochlear involvement
The test takes one to two hours. Your audiologist will share your results with you after the test.
What is videonystagmography (VNG)?
Videonystagmography (VNG) is a test that measures a type of involuntary eye movement called nystagmus. These movements can be slow or fast, steady or jerky. Nystagmus causes your eyes to move from side to side or up and down, or both. It happens when the brain gets conflicting messages from your eyes and the balance system in the inner ear. These conflicting messages can cause dizziness.
You can briefly get nystagmus when you move your head a certain way or look at some types of patterns. But if you get it when you don't move your head or if it lasts a long time, it may mean you have a disorder of the vestibular system.
Your vestibular system includes organs, nerves, and structures that are in your inner ear. It is your body's main center of balance. The vestibular system works together with your eyes, sense of touch, and brain. Your brain communicates with the different systems in your body to control your balance.
Other names: VNG
What is it used for?
VNG is used to find out if you have a disorder of the vestibular system (the balance structures in your inner ear) or in the part of the brain that controls balance.
Why do I need a VNG?
You may need a VNG if you have symptoms of a vestibular disorder. The main symptom is dizziness, a general term for different symptoms of imbalance. These include vertigo, a feeling that you or your surroundings are spinning, staggering while walking, and lightheadedness, a feeling like you are going to faint.
Other symptoms of a vestibular disorder include:
- Nystagmus (involuntary eye movements that go side to side or up and down)
- Ringing in the ears (tinnitus)
- Feeling of fullness or pressure in the ear
What happens during a VNG?
A VNG may be done by a primary health care provider or one of the following types of specialists:
- An audiologist, a health care provider who specializes in diagnosing, treating, and managing hearing loss
- An otolaryngologist (ENT), a doctor specializing in treating diseases and conditions of the ears, nose, and throat
- A neurologist, a doctor specializing in diagnosing and treating disorders of the brain and nervous system
During a VNG test, you will sit in a dark room and wear special goggles. The goggles have a camera that records eye movements. There are three main parts to a VNG:
- Ocular testing. During this part of the VNG, you will watch and follow moving and nonmoving dots on a light bar.
- Positional testing. During this part, your provider will move your head and body in different positions. Your provider will check if this movement causes nystagmus.
- Caloric testing. During this part, warm and cool water or air will be put in each ear. When cold water or air enters the inner ear, it should cause nystagmus. The eyes should then move away from the cold water in that ear and slowly back. When warm water or air is put in the ear, the eyes should move slowly toward that ear and slowly back. If the eyes don't respond in these ways, it may mean there is damage to the nerves of the inner ear. Your provider will also check to see if one ear responds differently from the other. If one ear is damaged, the response will be weaker than the other, or there may be no response at all.
Will I need to do anything to prepare for a VNG?
You may need to make changes in your diet or avoid certain medicines for a day or two before your test. Your health care provider will let you know if there are any special instructions to follow.
Are there any risks to a VNG?
The test may make you feel dizzy for a few minutes. You may want to make arrangements for someone to drive you home, in case the dizziness lasts for a longer period of time.
What do the results mean?
If the results were not normal, it may mean you have a disorder of the inner ear. These include:
- Meniere's disease, a disorder that causes dizziness, bouts of hearing loss, and tinnitus (ringing in the ears). It usually affects only one ear. Although there is no cure for Meniere's disease, the disorder may be managed with medicine and/or changes in your diet.
- Labyrinthitis, a disorder that causes vertigo and imbalance. It is caused when part of the inner ear becomes infected or swollen. The disorder sometimes goes away on its own, but you may be prescribed antibiotics if you are diagnosed with an infection.
An abnormal result may also mean you have a condition that affects the parts of the brain that helps control your balance.
If you have questions about your results, talk to your health care provider.
Is there anything else I need to know about a VNG?
Another test called electronystagmography (ENG) measures the same type of eye movements as a VNG. It also uses ocular, positional, and caloric testing. But instead of using a camera to record eye movements, an ENG measures eye movements with electrodes placed on the skin around the eyes.
While ENG testing is still being used, VNG testing is now more common. Unlike an ENG, a VNG can measure and record eye movements in real-time. VNGs can also provide clearer pictures of eye movements.
Complete article can be found at the US National Library of Medicine
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We strive to provide our patients with exceptional customer service and patient-centered care on their path towards better hearing. We desire to improve the quality of life for our patients by providing exceptional audiology services in a caring and compassionate setting. Our goal is to improve the quality of life of our patients by providing superior products and services designed to improve your ability to communicate more effectively.
“Your state of the art Bluetooth technology has been a tremendous help with my business and my personal life. Dr. Ruppert was very knowledgeable, thorough and compassionate. I can even connect through my hearing aids to television and land line telephone. I highly recommend the doctors and staff at ASC. “
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