Audiology

The ear is a complex organ that is divided into three different sections.  It not only allows you to hear but helps with balance. At CHI Health Clinic Audiology, we help diagnose and treat hearing and balance disorders as well as other conditions affecting the ear.

Below is a list of some of the ear conditions we evaluate:

• Hearing Loss
• Balance Disorders/Vertigo
• Tinnitus
• Sudden Hearing Loss
• Ototoxic Monitoring
• Fluid/Recurrent Infections
• Eustachian Tube Dysfunction
• Ear Drum Perforations
• Disorders of Hearing Bones
• Congenital Deformities
• Cholesteatomas, Cysts and Tumors
• Ear Wax (Cerumen)
• Foreign Bodies
• Otitis Externa (swimmer’s ear)

Our Audiologists perform comprehensive hearing evaluations for both pediatric and adult patients. Hearing tests are often ordered during a patient’s visit with an ENT physician, or they may be scheduled directly with an Audiologist. 

Adult Hearing Evaluations

What to expect during your evaluation?

When you arrive for your audiology appointment, you will be asked to describe what areas of concern you have regarding your ears and hearing. We will also review your history to help determine if there is anything in your family, medical, and personal history that could impact your hearing ability.  They will discuss the types of testing used to evaluate and diagnose the problem, which may be done that day or scheduled for a later appointment. At the time of the testing, the audiologist will review your test results, as well as any recommended follow up care needed.

What is a hearing test?

Hearing tests are painless and non-invasive and occur in a quiet, sound-treated room known as a hearing booth. You will be asked to wear headphones or soft earplugs with wires connected to an instrument called an audiometer that is used to conduct the test. 

During this test, you will be asked to listen to tones at different pitches and volumes.  The test measures the very softest sounds you can hear at each frequency tested.

The speech portion of the exam evaluates the softest speech sounds (threshold) you can hear and understand. You will then be asked to repeat back words that are presented at a level well above threshold to see how well you can understand them accurately.

What is immittance testing (tympanometry)?

If necessary, the audiologist may perform tympanometry and a test of your acoustic reflexes. For these tests, a soft plug that creates pressure changes and generates sounds will be placed in the ear. This will determine how well your eardrum is moving and will measure the reflexive responses of the middle ear muscles.

Pediatric Hearing Evaluations

What to expect during your evaluation?

When you bring your child in for their audiology appointment, you will be asked to describe what areas of concern you have regarding the child’s hearing, speech and language or balance. We will also review your child’s medical and developmental history.  They will discuss the types of testing used to evaluate and diagnose the problem, which may be done that day or scheduled for a later appointment. At the time of the testing, the audiologist will review your child’s testing results, as well as any recommended follow up care needed. 

Newborn Hearing Screening

What happens if my baby doesn’t pass the hospital hearing screening? Not all babies pass the hearing screening the first time. Your baby will be screened again before leaving the hospital. If your baby does not pass the hospital hearing screenings, you will be referred to an audiologist for further evaluation.  Typically, babies who fail the newborn hearing screen are evaluated in our office at two weeks gestational age.

Infant/Child Testing

Age appropriate testing, including Visual Reinforcement Audiometry, Condition Play Audiometry, and Computer-Based Condition Play Audiometry are all utilized at CHI Audiology to fully assess your child’s hearing ability.  Otoacoustic Emission Testing and Auditory Brainstem Response Testing are also utilized when appropriate.

Evaluations for all ages

• Comprehensive diagnostic hearing evaluations for adults.
• Pediatric hearing evaluations ranging from Visual Reinforcement Audiometry, Conditioned Play Audiometry, or Computerized Play Audiometry.

Vestibular Testing

BPPV assessment and treatment

BPPV is an acronym for a vestibular disorder called benign paroxysmal positional vertigo. BPPV is a common disorder, affecting up to 30% of patients that report a spinning sensation called vertigo. BPPV may affect people of all ages, but is most likely to develop in adults over the age of 50. BPPV diagnosis and treatment falls under the scope of practice of both Audiologists and Physical Therapists.

BPPV occurs when tiny crystal-like structures within the inner ear called otoconia detach from their normal position and migrate into one of the ear’s semicircular canals. If the “crystals” are present in one of the semicircular canals, then a person’s ear may send a signal of motion to the brain, the person becomes dizzy for a brief period. The dizziness is typically associated with head movements, such as rolling over in bend, laying down, bending over, or tilting the head up.

BPPV is diagnosed by having a patient lay down on a table with their head in different positions and observing the eyes for a repetitive beating motion called nystagmus. Once BPPV is diagnosed, it may be treated in the office using repositioning maneuvers that allow the “crystals” to escape the semicircular canal and be reabsorbed into their place of origin. The treatments are effective in relieving symptoms for 85-95% of patients.

VNG testing

A VNG is a battery of tests that measures the function of the vestibular, or balance, system by recording the movements of the eyes using goggles containing a high-tech camera. Eye movements give clues on the function of the balance system. The VNG assesses both central vestibular pathways within the brain and also peripheral function of the inner ear’s balance system. VNG tests are typically ordered by ENT physicians and performed by Audiologists.

The VNG is composed of three major parts: eye tracking, positional testing, and a water task. During the eye tracking tests, the patient is instructed to hold their gaze in different directions and track moving lights on a screen. During positional testing, the eyes are observed as the patient sits and/or lays with their head in a variety of positions.  During the water task, warm and cool water are ran in each ear canal for a brief time. The temperature of the water acts as a stimulus the inner ear—just as sound acts a stimulus to the ear during a hearing test—and the ear’s responses are reflected through eye movements.

Specialized Testing

• ABR (Auditory Brainstem Response)
  This test measures the response as stimulus is presented to the ear and as it travels to the brainstem. This test gives doctors information about the integrity of the auditory system threshold and neurodiagnostics.
  
• ENG (Electronystagmography)
  Electronystagmography is a test that records the interaction between your balance system in the inner ear and your eye. This helps determine whether the vestibular system is the cause of dizziness.
  
• DIX-HALLPIKE
  This test is used to determine if the type of dizziness present is Benign Paroxysnal Positional Vertigo (BPPV).
  
• OAE (Otoacoustic Emission)
  Otoacoustic Emission measures an acoustic response from the inner ear (cochlea) that is generated in response to a series of sounds that is presented through a tiny headphone. This helps determine whether or not the outer hair cells in the cochlea are functioning properly.
  
• Inner ear conditions
  Our experienced Audiologists are specially trained to assist patients with concerns related to the inner ear; including hearing loss, balance and dizziness.

Hearing Aids

CHI Health Audiologists provide a full range of hearing aid services for adults and children. Our recommendations for hearing aids are always made with the patient’s best interest in mind, and are made by considering many factors including the type and degree of hearing loss, the person’s lifestyle, and the person’s communication needs and goals. Hearing aid technology has come a long way over the last several years and the companies are constantly coming out with improved features. Some developments of the last few years include rechargeable batteries and bluetooth hearing aids that can stream a phone call or music from your cell phone.

The experience with hearing aids is unique for each person, so what one person does not like may work well for another person. Our Audiologist are here to help you navigate the process and find the solutions that work best for you. We offer a 30-day trial period on all hearing devices, which is designed to protect you in case you are not satisfied with the investment. Our prices include all services that you may need for the whole life of the hearing aid, including all appointments to clean, adjust, or troubleshoot the hearing aids. Remember that you are paying for more than just the device itself, but also the professional expertise and compassionate care from an Audiologist you can trust.

Digital Hearing Aids

The digital hearing aids do four basic things:

1.  Sound Processing: This is the basic function of a hearing aid. The sound is modified and amplified to make speech clearer to the damaged ear. One critical element in sound processing is harmonic distortion. Any time we process sound electronically, we introduce some level of distortion of sound. Today’s best hearing aids produce about a half a percent, down from 3-5 percent only abut five years ago.
2. Noise Suppression: The processors in the best hearing aids can identify steady-state background noise, like fans, machinery, road noise and the hubbub of a crowd. The noise is then turned down without affecting speech. The purpose isn’t to control noise, but rather to enhance speech intelligibility.
3. Directional Microphones: This technology uses two microphones to cut out sounds that come from the back and sides, which is very useful in restaurants, movies, church or any other situation when you only care to hear what is in front of you.
4. Feedback Control: Feedback is that nasty whistling sound hearing aids can make. Feedback makes hearing more difficult and is annoying to everyone. It’s usually caused by too much amplification of a high-pitched sound. New computer algorithms can reduce or even eliminate this common problem.

Batteries

Virtually all hearing aid batteries sold today are Zinc-Air. This means that they contain zinc and "burn" air to produce a current. Zinc-Air batteries should always be stored at room temperature. Never put hearing aid batteries in the refrigerator, as this will ruin them. From the date of the manufacturer, most batteries will store well for up to four years.

Batteries come in four standard sizes that are numbered and color-coded. Size 10 batteries are coded yellow, size 312 are coded brown, size 13 are coded orange, and size 675 are coded blue.

Custom Ear Plugs

Audiologists play an important role in educating patients on the risks of noise exposure and providing guidance on hearing protection. We offer a range of custom-fit earplugs for a variety of needs. Examples include swim plugs for keeping water out of the ears, hearing protection for musicians or frequent concert attendees, and hearing protection for hunters. If you are interested in discussing or ordering custom ear plugs, please call to schedule an appointment with one of our Audiologists. We will provide recommendations on the best options for you and take impressions of your ears.

Bone-Anchored Hearing Aids

A small percentage of people with hearing loss are potential candidates for a type hearing device called a BAHA, or a bone-anchored hearing aid. Part of the BAHA (the abutment) is surgically placed into the skull; the surgery is an outpatient procedure that is an hour or less in duration. The other part of the BAHA (the sound processor) is worn externally on the head. The sound processor is activated up to 12 weeks following the surgery.

Candidacy for a BAHA is based on the type of hearing loss. Some BAHA candidates have a conductive or mixed hearing loss. Patients with mixed or conductive hearing losses do not hear very well when sound is presented through their ear canal because structural problem(s) within their outer or middle ears significantly reduces the sound energy that reaches the inner ear. The BAHA works by directing sound directly to the inner ear, where persons with a conductive or mixed hearing loss have better hearing sensitivity. Other candidates for a BAHA have single-sided deafness, which is defined as normal hearing in one ear and a severe to profound hearing loss in the other ear. For these patients, the BAHA can detect sound on the side of the “bad ear” and redirect it toward the “good ear.”

BAHA candidates will meet with an Audiologist for comprehensive hearing testing and also an ENT Surgeon to discuss medical and surgical factors. Part of the evaluation includes a CT scan of the head. 

Vestibular Disorders and Testing

You use your vestibular system to keep your balance, maintain posture and keep your head and body stable while moving. Your vestibular system in your inner ear provides your brain with information about motion, head position and your body’s position in relation to surrounding space.

Vestibular Disorder Symptoms 

• Dizziness 
• Spinning sensation 
• Loss of equilibrium 
• Headaches 
• Fullness of the ears and head 
• Deconditioning 
• Muscle tension

Vestibular Testing

These tests help determine the type and extent of vestibular disorder you are experiencing. One or more of the following tests may be recommended:

• Electronystagmography/Videonystagmography (ENG/VNG) - This test evaluates how the vestibular system affects balance by tracking eye movements with infrared goggles as you follow a moving light with your eyes. During the test, you will sit and lie in specific positions.
• Rotary Chair Test - This 30-minute test involves sitting in a computer-driven chair in a dark booth. The chair’s gentle rotations stimulate your inner balance system and cause eye movements which are recorded with electrodes and infrared goggles.
• Positional Testing - This test records the amount of eye motion that occurs when you move your head and your whole body as opposed to just your eyes. For example, you may be instructed to turn your head quickly to one side, or you may be asked to sit up quickly after you have been lying down.
• Caloric Testing - During this test, your ear canals are irrigated with warm and cool water to cause a temperature change which creates measurable eye movements.
• Warm Air/Cool Air Caloric Test - This test involves introducing warm or cool air into the ear canal. If no problem exists, your eyes will move involuntarily to this stimulus.
• Dix-Hallpike Test - You will be safely lowered so that your neck is extended 30 degrees below horizontal and you are face up. A side-lying test may be used if the Dix-Hallpike cannot be easily performed.

Vestibular Disorder Treatment

These test results are used to develop a customized and individualized treatment plan that will help resolve the vestibular symptoms you’re experiencing.

Hearing Aids

CHI Health Audiologists provide a full range of hearing aid services for adults and children. Patients may need one or more of the types of assistance below.

A Hearing Aid Consultation:

• Discussion of your daily listening needs
• Complete overview of hearing aid technology and accessories
• Overview of our policies and procedures

Hearing Aid Fitting:

• Daily use and routine
• Changing the batteries
• Charging the batteries
• Cleaning/care of the hearing aids
• Insertion removal of the hearing aid
• Accessory operation (if applicable)

Follow Up Care:

• Adjusting the hearing aid
• Clean and check the hearing aid
• Real Ear Verification Measurements
• Any additional counseling that is needed

Hearing Protection:

Exposure to noise is one of the most common causes of sensorineural hearing loss. Noise damages the hair cells in the cochlea, and once damaged, the cells critical to hearing cannot be restored. The result is permanent hearing loss. CHI Audiology Clinic provides a wide array of both OTC and custom hearing protection including, but not limited to, solutions for hunters, musicians, woodworkers and others exposed to noise at work or play.