What is an Audiologist? An audiologist is a healthcare professional who has earned a Doctoral degree in the diagnosis and management of persons with hearing and balance problems. Audiologists are also licensed by the state in which they practice to select, fit and dispense hearing aids. The audiologist’s scope of practice may also include the evaluation of patients with balance problems or those bothered by head noises known as tinnitus. Audiologists have earned doctoral degrees and therefore have earned the right to be called Doctor; however, it is important that you recognize that an audiologist is not a medical doctor (physician). Audiologists are experts in the understanding and management of persons with hearing and balance problems, but they do not use medicines and surgery to treat hearing and balance disorders.
Can I make an appointment with the audiologist to have my hearing tested? YES you can. However, many insurance companies require that the hearing test be recommended by a medical doctor. We have a Ear, Nose and Throat Physician that would be happy to evaluate your ears for any medical conditions prior to sending you to one of our audiologists. Otherwise, you can speak with your family doctor about your concerns. S/He can then recommend that you have a hearing evaluation if necessary.
HEARING AIDS:
Do you sell hearing aids? YES. Our audiology staff is very knowledgeable about a wide range of hearing aid technology and we provide expert counseling to help you choose the technology that will meet your needs. Our focus is not on selling you a hearing aid, but on helping you to choose assistive technology that will improve your communication abilities.
How much do hearing aids cost? Hearing aids in this office range from $1000 to $3500 per hearing aid. The cost is dependent largely on by the type of technology and much less on the size and style of the hearing aid.
Does insurance cover the cost of hearing aids? Most major insurance companies do NOT provide hearing aid benefits; however, there are increasingly more managed care operations that have negotiated hearing aid benefits from certain providers. Those insurance programs that have a hearing aid benefit are typically union-negotiated contracts for employees who may be at risk for hearing loss from occupational noise. Our office would be happy to get your insurance particulars and contact your insurance company to determine what, if any, benefits you have.
What is the process for getting a hearing aid? Prior to being fitted with hearing aids it is very important that you be examined by an audiologist or doctor and to determine the extent and type of hearing problem. Following that, the audiologist will explain the test findings in detail and determine if you are a candidate for hearing aids. If so, you and the audiologist will determine together the appropriate amplification for your hearing loss and lifestyle. Once you feel comfortable with the decision you have made about the style and technology, the audiologist will make impressions of your ears and order your hearing aids.
How long does this process take? Usually after the hearing aids are ordered you are scheduled for a hearing aid fitting in two weeks. Once the hearing aid is fit we require a follow up appointment at two weeks and then as often as needed until initial adjustments are made. Once the initial adjustments have been made we recommend follow up every 6 months. We always recommend a one to two month period during which you will be able to access our office during the initial fitting.
Do I pay for my visit when I come for check ups? NO. These visits are typically complementary for 2-3 years.
What if I don’t like my hearing aid? The law in the state of Georgia does not require a trial period, however, we offer a 45-day trial period. If within these 45 days you decide your hearing aids do not meet your satisfaction you can return them. You will get all your money back with the exception of the down payment typically $225-$325.
Do you repair hearing aids? Yes. Our audiologist can check your hearing aid to determine if the problem is something they can repair in our office or whether it requires factory service. If your device is out of warranty and needs to be sent to the factory the cost will be approximately $250 if the hearing aid is less than 3 years old. If the hearing aid is greater than 3 years old the cost may be approximately $250 and if the hearing aid is more than 5 years old, and can still be repaired by the manufacturer, the cost is generally $250 or more.
IS THERE SALES TAX ON HEARING AIDS? NO. Hearing aids are considered a medical device and do not incur a sales tax.
Do hearing aids use batteries? YES. All hearing aids use batteries. There are several sizes of batteries available and different hearing aids use different size batteries. The vast majority of hearing aids use Zinc Air batteries.
Do you sell batteries? YES. Our batteries are sold in packs of 4 to 8 and cost between $4.75 and $8.00
Do I need any other supplies for my hearing aid? For the most part when you receive your hearing aids you will receive all the supplies you need to care for them. However, we recommend all our patients invest in a dehumidifier. Here in South Georgia and North Florida moisture can become a problem for any electrical device. Corrosion sets in readily. Maintaining a routine of dehumidifying your hearing aids is proven to prolong use.
ALD’s:
Is a hearing aid the only way to help me hear? NO. While hearing aids are the most common and most versatile way to help you hear, many other devices are also available. We call these devices Assistive Listening Devices (ALDs). These devices include:
Communication ALDs: These devices are intended to enhance communication between the hearing impaired person and the speaker. With these devices the effects of background noise and distance on the loudness and clarity of speech is eliminated. With these systems a microphone (transmitter) is worn by the speaker and a headset is worn by the hearing impaired person. When the speaker talks into the microphone the hearing impaired person hears directly through the headset.
Telecommunication ALDs: People with hearing impairment often have difficulty communicating using the telephone. Amplifiers for telephones are available in a variety of styles. These devices allow the telephone user to increase and decrease the volume dependent on their needs.
Media ALDs: Media ALDs are devices that allow for easier listening of television and music. With these devices a transmitter is connected to the television or stereo through the audio jack. A headset is worn by the listener. Because these devices do not interfere with the sound exiting the speaker on the TV or stereo, other family members in the home may listen to the television or stereo at loudnesses that are comfortable for them.
Alterting ALDs: Alerting ALDs are used to inform a hearing impaired person that sound is present. These devices may flash or vibrate to alert a person to the telephone, doorbell, emergency signal, or a crying baby. Alarm clocks are also available that will flash a light or vibrate a pillow.
ABR:
What does ABR stand for? The letters ABR stand for Auditory Brainstem Response. Some doctors use the letters BAER, which stands for Brainstem Auditory Evoked Response.
What is an ABR? An ABR is a specialized test that helps to evaluate how sound travels from the ear through the hearing nerve (8th nerve) into the brainstem.
Why did the doctor want me to have this test? The doctor generally requests this test if the hearing test (audiogram) shows a difference in hearing between the two ears. Normally the hearing in both ears is the same (symmetrical). Sometimes there is a difference in the hearing between the two ears (asymmetrical).
Who will perform the test? The test will always be performed by a board certified doctor of Audiology, we do not use technicians.
Is the test going to be painful? NO. The test is painless.
Do I have to do anything special for the test like stop eating or drinking or stop taking my medications? NO. You can eat, drink and take your medications as you would do normally. If you have other tests scheduled on the same day as your ABR, as is often the case, make sure you follow the recommended procedures for those tests. Please do drink alcohol for 24 hours prior to the test
What is going to happen during the test? The audiologists will clean your forehead and either your ear lobes or your ear canals. Then they will attach electrodes to the cleaned areas and put foam ear plugs in your ears (like those used during the hearing test). You will lie down on a table and the lights will be turned off. The audiologist will instruct you to close your eyes and to remain relaxed and still. Too much movement or body activity can cause interference with the test results. You will hear a rapid clicking sound in one ear and eventually it will be switched over to the other ear.
How long does the test take? The test will take approximately 30-60 minutes.
Will I get the results immediately? NO. The audiologist will have to interpret the test results and write a report. The report is given to your doctor and he will follow-up with you.
ENG:
What is an ENG? An ENG is a test of the balance (vestibular) system. The balance system is very complex. While the primary portion of the balance system is found in the inner ear, it is also connected to many other parts of our body including our eyes and our sense of touch. All these things work together so that we can turn and move in our environment without falling. The ENG will evaluate the vestibular system to determine if it may be responsible for your balance problems.
What does ENG stand for? ENG stands for Electronystagmography. Basically a recording and analysis of predictable eye movements caused by stimulating the vestibular system.
Why did the doctor do a hearing test first? I complained I was dizzy. I hear fine. The balance (vestibular) system shares a common nerve with the Cochlea (the organ of hearing). Often, when someone is dizzy they also have some abnormalities in the hearing system. The results of the hearing test in conjunction with the ENG results help your doctor and audiologist to more clearly understand why you are dizzy. Once a diagnosis is made, then a plan for treatment can begin.
Who will perform the test? The test will always be performed by a board certified audiologist, we do not use technicians.
Is the test going to be painful? NO. The test is quite simple and painless. The audiologist will begin by asking you specific questions about your dizziness. To prepare for recording the audiologist place special goggles over your eyes containing tiny video cameras. This is how your eye movements can be recoded and measured.
First, the audiologist will ask you to follow a light on a bar as it moves in different patterns. Next, you will be placed in different positions, both sitting and lying to determine if these movements or positions cause your symptoms. Finally, you will lie down with your head slightly raised. The audiologist will look into your ears and then run warm and cool air into your ears. Once this test is completed the entire ENG is finished.
How long will the test take? The test will take between 60 and 90 minutes.
Do I need to do anything special for the test? YES! It is very important that you read the instructions sent to you by our office. There is a detailed list of medications that will interfere with the performance of the test. READ THIS LIST CAREFULLY. If you have ANY questions, please call our office and one of our audiologists will help you to know if you need to discontinue a medicine prior to the test.
Why should I not eat before the ENG? Actually, eating will not disrupt the test. Sometimes, though, during the test you may feel woozy or a sensation of movement. This feeling will not last a long time, but we find patients feel better if they do not have a full stomach.
Why do I need someone to drive me? Sometimes during or after this test you may feel woozy or a sense of motion. If this happens we want you to be safe on your way home. Having someone drive you assures you can relax on a safe drive home after completing the test.
BPPV / CRT:
What is BPPV? BPPV stands for Benign Paroxysmal Positional Vertigo.
So, What is it? BPPV is a common balance problem and fortunately, one of the easiest balance problems to treat. In the inner ear there are three round tubes called semicircular canals and two sacs called the utricle and the saccule. Crystal-like substances are found inside the sacs. They are called otoconia. These crystals are embedded in a jelly-like substance. When the head moves the crystals and the jelly move together. This is how the body knows when you are moving and when you are at rest. Sometimes (and in the case of BPPV) these crystals become dislodged and begin to float within the fluid of the inner ear. If the otoconia move into the semicircular canals the body begins to experience a rotational movement called vertigo. It is this conflict of reality (the body is stopped) combined with the signals the loose otoconia are giving (your body thinks you are moving) that cause the sensation of spinning.
What is vertigo? Vertigo is a sensation of spinning. Vertigo is a symptom, NOT a disease or diagnosis.
How did I get BPPV? The original cause of BPPV is frequently unknown. Sometimes it is caused by degeneration of the vestibular system due to the normal aging process, head injury, viral infection, poor blood flow or even prolonged bed rest. BPPV is most common in the elderly, but is sometimes seen in people of all ages including children.
What can I do about it? As noted before, BPPV is one of the easiest balance disorders to treat. The audiologists can perform a canalith repositioning treatment or CRT.
What is CRP? CRT is a therapy that attempts to move the loose crystals into another compartment in your inner ear where they won’t continue to make you think you are moving.
Is CRT effective? YES. When the diagnosis of BPPV is made accurately , over 90% of patients are relieved of their symptoms.
What if CRT doesn’t work? There are several different forms of CRT treatment and sometimes the same treatment needs to be repeated. If none of these methods work we will recommend you participate in a vestibular rehabilitation program conducted by a physical therapist who can give you more comprehensive treatment for your balance problem.
Once it’s gone will it come back? Recurrence of the vertigo associated with BPPV is not unusual. However, you will be given a series of exercises to perform daily to prevent BPPV from recurring. If it does recur the treatment can be repeated.
Does insurance pay for this treatment? Medicare will pay for this treatment; however, it is our experience that some other insurance companies may not
GENERAL AUDIOMETRIC TESTING:
Audiogram Comprehensive: This is a standard hearing test and will include air conduction hearing thresholds as well as bone conduction hearing thresholds. This test will also include Speech Recognition Thresholds and Word Recognition Scores, as well as any appropriate masking that may be needed. This test will take approximately 20 minutes and will always be performed by a Board Certified Audiologist
Tympanometry: This is a pressure test used to determine if sound can easily move through the eardrum and middle ear system. This test can detect if there may be fluid behind the eardrum.
These two tests are commonly performed together in one appointment.
Otoacoustic Emissions (OAEs): OAEs are very soft sounds that healthy hearing systems (hair cells in the cochlea) produce when stimulated with different tones. When our equipment sends specific sounds into the ear the healthy cochlea responds by making another sound. Our equipment is sensitive enough to measure these sounds. By documenting these sounds, we predict whether or not your child has a hearing loss. We know that unhealthy hearing systems do not make these sounds at all. This test is performed on all children when possible.
HEARING SCREENING: This is a quick test that determines only air conduction thresholds, it is often required for many government jobs and people who work in loud settings. (SELF PAY $ 30)
PEDIATRICS:
What methods are used to test children? At our office we have a variety of ways to test a child’s hearing. Depending on the particular problem your child is having the physician may order one or more of the following tests:
Tympanometry: This is a pressure test used to determine if sound can easily move through the eardrum and middle ear system. This test can detect if a child may have fluid behind his/her eardrum.
Otoacoustic Emissions (OAEs): OAEs are very soft sounds that healthy hearing systems (hair cells in the cochlea) produce when stimulated with different tones. When our equipment sends specific sounds into the ear the healthy cochlea responds by making another sound. Our equipment is sensitive enough to measure these sounds. By documenting these sounds, we predict whether or not your child has a hearing loss. We know that unhealthy hearing systems do not make these sounds at all.
Visual Reinforcement Audiometry (VRA): If your child is too young to accurately tell us what sounds they can here, we use VRA. The child learns that if s/he turns his/her head in response to a sound, s/he will be rewarded by seeing a toy with flashing lights. At our office this test will take up to one hour.
Conditioned Play Audiometry (CPA): CPA is used for children who are old enough to learn a listening task. The child learns that if s/he hears a sound, s/he may complete a task or play a game. Often we ask the children to listen and when they hear the sounds they place a block in a bucket or put a peg in a hole. This test is will take up to one hour.
I was told my child may need tubes. What are “tubes”? The word “tube” is actually short for pressure equalization tube. As many parents know, ear infections and fluid behind the eardrum are a common problem for their children. This problem is caused when the Eustachian tube (a small tube that is located between the middle ear and the back of the nose/throat) doesn’t work right. This poor functioning frequently causes fluid build up and possible infection within the middle ear. When medicine has failed to clear up this problem your physician may recommend s/he insert tubes. In a short surgery the physician will lance the eardrum and remove all the infection and fluid from the middle ear space. S/He then will place a small tube that looks like a spool into the eardrum. In a short time the eardrum will heal around the tube. This tube will prevent pressure from building in the middle ear space and infection and fluid from collecting.
So, does the tube stay in there forever? NO. Most tubes will come out (extrude) within 6 months to a year. The hope is that when the tube finally comes out the Eustachian tube can now do it’s job on its own.
How will they find out my child needs tubes? When a physician looks into a child’s ear s/he can see if fluid or infection is present behind the eardrum. Most of the time, though, s/he will want to confirm this with some of the tests we mentioned before. Most commonly a hearing test and/or tympanometry will be performed before tubes are placed.
At what age should my child be tested? The NIH (National Institute of Health) recommends that all babies be tested for hearing loss at birth. In Florida, ALL babies are REQUIRED to be tested prior to leaving the hospital when they are born. However if, at any time, you have concern about your child’s hearing then s/he should be tested. We have the ability to accurately determine or predict a child’s hearing levels at any age.
How will my infant be tested? Infants under the age of six months have not developed the proper muscles to turn their head to sound, therefore, OAEs will be used to test their hearing. VRA will be attempted with infants over the age of 6 months.
How will my toddler be tested? All children are different. Even the brightest children may be intimidated by a sound booth and fail to participate in age-appropriate testing. However, most toddlers are able to respond to sounds using VRA or CPA.
How will my 3 - 5 year old be tested? Most children ages 3-5 can complete audiometric testing using CPA or even conventional methods.
How will my school age child be tested? Most children over the age of 5 can complete audiometric testing in the same fashion as an adult, by listening to sounds and pressing a button to let the audiologist know that s/he hears the sounds.
I expect that my child will not be able to perform at age level. Will s/he be able to be tested? With children who are difficult to test, the audiologist(s) will speak to the parents or guardians and determine which course of action should be taken to obtain the most reliable results. Remember, it is most important that we determine how much your child can hear. The method we use to achieve that goal is not at all important.
What if my child does not complete the test? It is not uncommon that a child cannot complete an entire hearing test. The attention span of most children is short. The audiologists will attempt to complete the test; however, if the child is not able
to finish the test additional visits may be required.
Who should accompany my child to the office? In order for testing to be completed, at least one parent or legal guardian must accompany the child to the office and stay for the duration of the appointment. Other adult family members or caregivers are also welcome to attend.
May I bring my other children with me to the office? If possible, it is preferable that the child’s siblings stay at home. Siblings can be distracting for a child during a hearing evaluation.
What is the best time during the day for my child to have a hearing test? It is best that the child is awake and alert for the hearing evaluation. A full belly and a good night’s sleep always make for a more positive experience! The parent may decide what time of day his/her child is most cooperative. If your child is only visiting our office for OAEs, it is preferable that you bring the child in sleeping.
Will I learn the test results at the time of the appointment? YES, either the audiologist or the physician will discuss the test results with you at the end of the appointment.
My child passed the hearing screening at the hospital/ at school. Does s/he still need a hearing test? If you, your child’s teachers, your audiologist, or physician suspect hearing loss, even following a hearing screening, then the child should complete a diagnostic hearing evaluation.
OUR AUDIOLOGY STAFF:
Nathan A Rhodes Au.D. CCC-A, FAAA
Doctor of Audiology
Board Certified in Audiology
Director of Audiology
Dr. Rhodes is originally from Russell PA. He attended the Pennsylvania State University at University Park where he graduated with a Bachelor of Science degree in Communication Disorders with a minor in Human Development and Family Studies with an emphasis on childhood development, geriatrics and human biology.
After graduation Dr. Rhodes went to Australia where he studied speech therapy and anatomy at Curtain University of Technology in Perth, Western Australia. Upon returning to the United States he continued his education at Western Michigan University in Kalamazoo where he earned a Master of Arts in Audiology, and then on to the University of Florida where he earned his Doctor of Audiology degree.
Dr. Rhodes Holds a Certificate of Clinical Competence in audiology issued by the American Speech-Language Hearing Association as well as Board certification by the American Board of Audiology.
He is a fellow in the American Academy of Audiology and holds license to practice audiology in Georgia and Florida.
Dr. Rhodes serves on the ASHA Audiology Advisory Council for the state of Florida.
AUDIOLOGY ACRONYMS:
ABR- Auditory Brainstem Response
ALD- Assistive Listening Device
AuD- Doctor of Audiology
BTE– Behind the Ear (hearing aid)
BPPV– Benign Paroxysmal Positional Vertigo
CCC-A— Certificate of Clinical Competence in Audiology
CIC– Completely in the Canal (hearing aid)
CPA– Conditioned Play Audiometry
CRP– Canalith Repositioning Treatment
EAA- Electroacoustic Analysis
ENG– Electronystagmography
ENT– Ear, Nose and Throat Specialist
FAAA– Fellow of the American Academy of Audiology
ITC– In the Canal (hearing aid)
ITE- In the Ear (hearing aid)
HE– Hearing Aid Evaluation
HF– Hearing Aid Fitting
HFSNHL- High Frequency Sensorineural Hearing Loss
MA– Master of Arts
MS– Master of Science
MSEd– Master of Science in Education
OAEs– Otoacoustic Emissions
SNHL– Sensorineural Hearing Loss
TDD– Telecommunications Device for the Deaf
TT- Text Telephone
VRA– Visually Reinforced Audiometry
Can I make an appointment with the audiologist to have my hearing tested? YES you can. However, many insurance companies require that the hearing test be recommended by a medical doctor. We have a Ear, Nose and Throat Physician that would be happy to evaluate your ears for any medical conditions prior to sending you to one of our audiologists. Otherwise, you can speak with your family doctor about your concerns. S/He can then recommend that you have a hearing evaluation if necessary.
HEARING AIDS:
Do you sell hearing aids? YES. Our audiology staff is very knowledgeable about a wide range of hearing aid technology and we provide expert counseling to help you choose the technology that will meet your needs. Our focus is not on selling you a hearing aid, but on helping you to choose assistive technology that will improve your communication abilities.
How much do hearing aids cost? Hearing aids in this office range from $1000 to $3500 per hearing aid. The cost is dependent largely on by the type of technology and much less on the size and style of the hearing aid.
Does insurance cover the cost of hearing aids? Most major insurance companies do NOT provide hearing aid benefits; however, there are increasingly more managed care operations that have negotiated hearing aid benefits from certain providers. Those insurance programs that have a hearing aid benefit are typically union-negotiated contracts for employees who may be at risk for hearing loss from occupational noise. Our office would be happy to get your insurance particulars and contact your insurance company to determine what, if any, benefits you have.
What is the process for getting a hearing aid? Prior to being fitted with hearing aids it is very important that you be examined by an audiologist or doctor and to determine the extent and type of hearing problem. Following that, the audiologist will explain the test findings in detail and determine if you are a candidate for hearing aids. If so, you and the audiologist will determine together the appropriate amplification for your hearing loss and lifestyle. Once you feel comfortable with the decision you have made about the style and technology, the audiologist will make impressions of your ears and order your hearing aids.
How long does this process take? Usually after the hearing aids are ordered you are scheduled for a hearing aid fitting in two weeks. Once the hearing aid is fit we require a follow up appointment at two weeks and then as often as needed until initial adjustments are made. Once the initial adjustments have been made we recommend follow up every 6 months. We always recommend a one to two month period during which you will be able to access our office during the initial fitting.
Do I pay for my visit when I come for check ups? NO. These visits are typically complementary for 2-3 years.
What if I don’t like my hearing aid? The law in the state of Georgia does not require a trial period, however, we offer a 45-day trial period. If within these 45 days you decide your hearing aids do not meet your satisfaction you can return them. You will get all your money back with the exception of the down payment typically $225-$325.
Do you repair hearing aids? Yes. Our audiologist can check your hearing aid to determine if the problem is something they can repair in our office or whether it requires factory service. If your device is out of warranty and needs to be sent to the factory the cost will be approximately $250 if the hearing aid is less than 3 years old. If the hearing aid is greater than 3 years old the cost may be approximately $250 and if the hearing aid is more than 5 years old, and can still be repaired by the manufacturer, the cost is generally $250 or more.
IS THERE SALES TAX ON HEARING AIDS? NO. Hearing aids are considered a medical device and do not incur a sales tax.
Do hearing aids use batteries? YES. All hearing aids use batteries. There are several sizes of batteries available and different hearing aids use different size batteries. The vast majority of hearing aids use Zinc Air batteries.
Do you sell batteries? YES. Our batteries are sold in packs of 4 to 8 and cost between $4.75 and $8.00
Do I need any other supplies for my hearing aid? For the most part when you receive your hearing aids you will receive all the supplies you need to care for them. However, we recommend all our patients invest in a dehumidifier. Here in South Georgia and North Florida moisture can become a problem for any electrical device. Corrosion sets in readily. Maintaining a routine of dehumidifying your hearing aids is proven to prolong use.
ALD’s:
Is a hearing aid the only way to help me hear? NO. While hearing aids are the most common and most versatile way to help you hear, many other devices are also available. We call these devices Assistive Listening Devices (ALDs). These devices include:
Communication ALDs: These devices are intended to enhance communication between the hearing impaired person and the speaker. With these devices the effects of background noise and distance on the loudness and clarity of speech is eliminated. With these systems a microphone (transmitter) is worn by the speaker and a headset is worn by the hearing impaired person. When the speaker talks into the microphone the hearing impaired person hears directly through the headset.
Telecommunication ALDs: People with hearing impairment often have difficulty communicating using the telephone. Amplifiers for telephones are available in a variety of styles. These devices allow the telephone user to increase and decrease the volume dependent on their needs.
Media ALDs: Media ALDs are devices that allow for easier listening of television and music. With these devices a transmitter is connected to the television or stereo through the audio jack. A headset is worn by the listener. Because these devices do not interfere with the sound exiting the speaker on the TV or stereo, other family members in the home may listen to the television or stereo at loudnesses that are comfortable for them.
Alterting ALDs: Alerting ALDs are used to inform a hearing impaired person that sound is present. These devices may flash or vibrate to alert a person to the telephone, doorbell, emergency signal, or a crying baby. Alarm clocks are also available that will flash a light or vibrate a pillow.
ABR:
What does ABR stand for? The letters ABR stand for Auditory Brainstem Response. Some doctors use the letters BAER, which stands for Brainstem Auditory Evoked Response.
What is an ABR? An ABR is a specialized test that helps to evaluate how sound travels from the ear through the hearing nerve (8th nerve) into the brainstem.
Why did the doctor want me to have this test? The doctor generally requests this test if the hearing test (audiogram) shows a difference in hearing between the two ears. Normally the hearing in both ears is the same (symmetrical). Sometimes there is a difference in the hearing between the two ears (asymmetrical).
Who will perform the test? The test will always be performed by a board certified doctor of Audiology, we do not use technicians.
Is the test going to be painful? NO. The test is painless.
Do I have to do anything special for the test like stop eating or drinking or stop taking my medications? NO. You can eat, drink and take your medications as you would do normally. If you have other tests scheduled on the same day as your ABR, as is often the case, make sure you follow the recommended procedures for those tests. Please do drink alcohol for 24 hours prior to the test
What is going to happen during the test? The audiologists will clean your forehead and either your ear lobes or your ear canals. Then they will attach electrodes to the cleaned areas and put foam ear plugs in your ears (like those used during the hearing test). You will lie down on a table and the lights will be turned off. The audiologist will instruct you to close your eyes and to remain relaxed and still. Too much movement or body activity can cause interference with the test results. You will hear a rapid clicking sound in one ear and eventually it will be switched over to the other ear.
How long does the test take? The test will take approximately 30-60 minutes.
Will I get the results immediately? NO. The audiologist will have to interpret the test results and write a report. The report is given to your doctor and he will follow-up with you.
ENG:
What is an ENG? An ENG is a test of the balance (vestibular) system. The balance system is very complex. While the primary portion of the balance system is found in the inner ear, it is also connected to many other parts of our body including our eyes and our sense of touch. All these things work together so that we can turn and move in our environment without falling. The ENG will evaluate the vestibular system to determine if it may be responsible for your balance problems.
What does ENG stand for? ENG stands for Electronystagmography. Basically a recording and analysis of predictable eye movements caused by stimulating the vestibular system.
Why did the doctor do a hearing test first? I complained I was dizzy. I hear fine. The balance (vestibular) system shares a common nerve with the Cochlea (the organ of hearing). Often, when someone is dizzy they also have some abnormalities in the hearing system. The results of the hearing test in conjunction with the ENG results help your doctor and audiologist to more clearly understand why you are dizzy. Once a diagnosis is made, then a plan for treatment can begin.
Who will perform the test? The test will always be performed by a board certified audiologist, we do not use technicians.
Is the test going to be painful? NO. The test is quite simple and painless. The audiologist will begin by asking you specific questions about your dizziness. To prepare for recording the audiologist place special goggles over your eyes containing tiny video cameras. This is how your eye movements can be recoded and measured.
First, the audiologist will ask you to follow a light on a bar as it moves in different patterns. Next, you will be placed in different positions, both sitting and lying to determine if these movements or positions cause your symptoms. Finally, you will lie down with your head slightly raised. The audiologist will look into your ears and then run warm and cool air into your ears. Once this test is completed the entire ENG is finished.
How long will the test take? The test will take between 60 and 90 minutes.
Do I need to do anything special for the test? YES! It is very important that you read the instructions sent to you by our office. There is a detailed list of medications that will interfere with the performance of the test. READ THIS LIST CAREFULLY. If you have ANY questions, please call our office and one of our audiologists will help you to know if you need to discontinue a medicine prior to the test.
Why should I not eat before the ENG? Actually, eating will not disrupt the test. Sometimes, though, during the test you may feel woozy or a sensation of movement. This feeling will not last a long time, but we find patients feel better if they do not have a full stomach.
Why do I need someone to drive me? Sometimes during or after this test you may feel woozy or a sense of motion. If this happens we want you to be safe on your way home. Having someone drive you assures you can relax on a safe drive home after completing the test.
BPPV / CRT:
What is BPPV? BPPV stands for Benign Paroxysmal Positional Vertigo.
So, What is it? BPPV is a common balance problem and fortunately, one of the easiest balance problems to treat. In the inner ear there are three round tubes called semicircular canals and two sacs called the utricle and the saccule. Crystal-like substances are found inside the sacs. They are called otoconia. These crystals are embedded in a jelly-like substance. When the head moves the crystals and the jelly move together. This is how the body knows when you are moving and when you are at rest. Sometimes (and in the case of BPPV) these crystals become dislodged and begin to float within the fluid of the inner ear. If the otoconia move into the semicircular canals the body begins to experience a rotational movement called vertigo. It is this conflict of reality (the body is stopped) combined with the signals the loose otoconia are giving (your body thinks you are moving) that cause the sensation of spinning.
What is vertigo? Vertigo is a sensation of spinning. Vertigo is a symptom, NOT a disease or diagnosis.
How did I get BPPV? The original cause of BPPV is frequently unknown. Sometimes it is caused by degeneration of the vestibular system due to the normal aging process, head injury, viral infection, poor blood flow or even prolonged bed rest. BPPV is most common in the elderly, but is sometimes seen in people of all ages including children.
What can I do about it? As noted before, BPPV is one of the easiest balance disorders to treat. The audiologists can perform a canalith repositioning treatment or CRT.
What is CRP? CRT is a therapy that attempts to move the loose crystals into another compartment in your inner ear where they won’t continue to make you think you are moving.
Is CRT effective? YES. When the diagnosis of BPPV is made accurately , over 90% of patients are relieved of their symptoms.
What if CRT doesn’t work? There are several different forms of CRT treatment and sometimes the same treatment needs to be repeated. If none of these methods work we will recommend you participate in a vestibular rehabilitation program conducted by a physical therapist who can give you more comprehensive treatment for your balance problem.
Once it’s gone will it come back? Recurrence of the vertigo associated with BPPV is not unusual. However, you will be given a series of exercises to perform daily to prevent BPPV from recurring. If it does recur the treatment can be repeated.
Does insurance pay for this treatment? Medicare will pay for this treatment; however, it is our experience that some other insurance companies may not
GENERAL AUDIOMETRIC TESTING:
Audiogram Comprehensive: This is a standard hearing test and will include air conduction hearing thresholds as well as bone conduction hearing thresholds. This test will also include Speech Recognition Thresholds and Word Recognition Scores, as well as any appropriate masking that may be needed. This test will take approximately 20 minutes and will always be performed by a Board Certified Audiologist
Tympanometry: This is a pressure test used to determine if sound can easily move through the eardrum and middle ear system. This test can detect if there may be fluid behind the eardrum.
These two tests are commonly performed together in one appointment.
Otoacoustic Emissions (OAEs): OAEs are very soft sounds that healthy hearing systems (hair cells in the cochlea) produce when stimulated with different tones. When our equipment sends specific sounds into the ear the healthy cochlea responds by making another sound. Our equipment is sensitive enough to measure these sounds. By documenting these sounds, we predict whether or not your child has a hearing loss. We know that unhealthy hearing systems do not make these sounds at all. This test is performed on all children when possible.
HEARING SCREENING: This is a quick test that determines only air conduction thresholds, it is often required for many government jobs and people who work in loud settings. (SELF PAY $ 30)
PEDIATRICS:
What methods are used to test children? At our office we have a variety of ways to test a child’s hearing. Depending on the particular problem your child is having the physician may order one or more of the following tests:
Tympanometry: This is a pressure test used to determine if sound can easily move through the eardrum and middle ear system. This test can detect if a child may have fluid behind his/her eardrum.
Otoacoustic Emissions (OAEs): OAEs are very soft sounds that healthy hearing systems (hair cells in the cochlea) produce when stimulated with different tones. When our equipment sends specific sounds into the ear the healthy cochlea responds by making another sound. Our equipment is sensitive enough to measure these sounds. By documenting these sounds, we predict whether or not your child has a hearing loss. We know that unhealthy hearing systems do not make these sounds at all.
Visual Reinforcement Audiometry (VRA): If your child is too young to accurately tell us what sounds they can here, we use VRA. The child learns that if s/he turns his/her head in response to a sound, s/he will be rewarded by seeing a toy with flashing lights. At our office this test will take up to one hour.
Conditioned Play Audiometry (CPA): CPA is used for children who are old enough to learn a listening task. The child learns that if s/he hears a sound, s/he may complete a task or play a game. Often we ask the children to listen and when they hear the sounds they place a block in a bucket or put a peg in a hole. This test is will take up to one hour.
I was told my child may need tubes. What are “tubes”? The word “tube” is actually short for pressure equalization tube. As many parents know, ear infections and fluid behind the eardrum are a common problem for their children. This problem is caused when the Eustachian tube (a small tube that is located between the middle ear and the back of the nose/throat) doesn’t work right. This poor functioning frequently causes fluid build up and possible infection within the middle ear. When medicine has failed to clear up this problem your physician may recommend s/he insert tubes. In a short surgery the physician will lance the eardrum and remove all the infection and fluid from the middle ear space. S/He then will place a small tube that looks like a spool into the eardrum. In a short time the eardrum will heal around the tube. This tube will prevent pressure from building in the middle ear space and infection and fluid from collecting.
So, does the tube stay in there forever? NO. Most tubes will come out (extrude) within 6 months to a year. The hope is that when the tube finally comes out the Eustachian tube can now do it’s job on its own.
How will they find out my child needs tubes? When a physician looks into a child’s ear s/he can see if fluid or infection is present behind the eardrum. Most of the time, though, s/he will want to confirm this with some of the tests we mentioned before. Most commonly a hearing test and/or tympanometry will be performed before tubes are placed.
At what age should my child be tested? The NIH (National Institute of Health) recommends that all babies be tested for hearing loss at birth. In Florida, ALL babies are REQUIRED to be tested prior to leaving the hospital when they are born. However if, at any time, you have concern about your child’s hearing then s/he should be tested. We have the ability to accurately determine or predict a child’s hearing levels at any age.
How will my infant be tested? Infants under the age of six months have not developed the proper muscles to turn their head to sound, therefore, OAEs will be used to test their hearing. VRA will be attempted with infants over the age of 6 months.
How will my toddler be tested? All children are different. Even the brightest children may be intimidated by a sound booth and fail to participate in age-appropriate testing. However, most toddlers are able to respond to sounds using VRA or CPA.
How will my 3 - 5 year old be tested? Most children ages 3-5 can complete audiometric testing using CPA or even conventional methods.
How will my school age child be tested? Most children over the age of 5 can complete audiometric testing in the same fashion as an adult, by listening to sounds and pressing a button to let the audiologist know that s/he hears the sounds.
I expect that my child will not be able to perform at age level. Will s/he be able to be tested? With children who are difficult to test, the audiologist(s) will speak to the parents or guardians and determine which course of action should be taken to obtain the most reliable results. Remember, it is most important that we determine how much your child can hear. The method we use to achieve that goal is not at all important.
What if my child does not complete the test? It is not uncommon that a child cannot complete an entire hearing test. The attention span of most children is short. The audiologists will attempt to complete the test; however, if the child is not able
to finish the test additional visits may be required.
Who should accompany my child to the office? In order for testing to be completed, at least one parent or legal guardian must accompany the child to the office and stay for the duration of the appointment. Other adult family members or caregivers are also welcome to attend.
May I bring my other children with me to the office? If possible, it is preferable that the child’s siblings stay at home. Siblings can be distracting for a child during a hearing evaluation.
What is the best time during the day for my child to have a hearing test? It is best that the child is awake and alert for the hearing evaluation. A full belly and a good night’s sleep always make for a more positive experience! The parent may decide what time of day his/her child is most cooperative. If your child is only visiting our office for OAEs, it is preferable that you bring the child in sleeping.
Will I learn the test results at the time of the appointment? YES, either the audiologist or the physician will discuss the test results with you at the end of the appointment.
My child passed the hearing screening at the hospital/ at school. Does s/he still need a hearing test? If you, your child’s teachers, your audiologist, or physician suspect hearing loss, even following a hearing screening, then the child should complete a diagnostic hearing evaluation.
OUR AUDIOLOGY STAFF:
Nathan A Rhodes Au.D. CCC-A, FAAA
Doctor of Audiology
Board Certified in Audiology
Director of Audiology
Dr. Rhodes is originally from Russell PA. He attended the Pennsylvania State University at University Park where he graduated with a Bachelor of Science degree in Communication Disorders with a minor in Human Development and Family Studies with an emphasis on childhood development, geriatrics and human biology.
After graduation Dr. Rhodes went to Australia where he studied speech therapy and anatomy at Curtain University of Technology in Perth, Western Australia. Upon returning to the United States he continued his education at Western Michigan University in Kalamazoo where he earned a Master of Arts in Audiology, and then on to the University of Florida where he earned his Doctor of Audiology degree.
Dr. Rhodes Holds a Certificate of Clinical Competence in audiology issued by the American Speech-Language Hearing Association as well as Board certification by the American Board of Audiology.
He is a fellow in the American Academy of Audiology and holds license to practice audiology in Georgia and Florida.
Dr. Rhodes serves on the ASHA Audiology Advisory Council for the state of Florida.
AUDIOLOGY ACRONYMS:
ABR- Auditory Brainstem Response
ALD- Assistive Listening Device
AuD- Doctor of Audiology
BTE– Behind the Ear (hearing aid)
BPPV– Benign Paroxysmal Positional Vertigo
CCC-A— Certificate of Clinical Competence in Audiology
CIC– Completely in the Canal (hearing aid)
CPA– Conditioned Play Audiometry
CRP– Canalith Repositioning Treatment
EAA- Electroacoustic Analysis
ENG– Electronystagmography
ENT– Ear, Nose and Throat Specialist
FAAA– Fellow of the American Academy of Audiology
ITC– In the Canal (hearing aid)
ITE- In the Ear (hearing aid)
HE– Hearing Aid Evaluation
HF– Hearing Aid Fitting
HFSNHL- High Frequency Sensorineural Hearing Loss
MA– Master of Arts
MS– Master of Science
MSEd– Master of Science in Education
OAEs– Otoacoustic Emissions
SNHL– Sensorineural Hearing Loss
TDD– Telecommunications Device for the Deaf
TT- Text Telephone
VRA– Visually Reinforced Audiometry