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Audiology Update

Hearing Tests (Audiological Test) and Vestibular Tests Details

A. (Standard) Pure Tone Audiometry:

Description:

It assesses the Frequency Specific Hearing Sensitivity Level (upto 8 kHz) subjectively.

Preparation:

No preparation required.

Eligibility Criteria:

  • Intact/Normal intellectual Functioning level.
  • Age range is around > 6 years.
  • Validation of Report:

    Around 3 months (depends on advancing age & Pathological conditions).

    B. (Extended) High Frequency Pure Tone Audiometry

    Description:

    It assesses the Frequency Specific Hearing Sensitivity Level (beyond 8 kHz & upto 16 or 20 kHz) subjectively.

    Preparation:

    No preparation required.

    Eligibility Criteria:

  • Intact/Normal intellectual Functioning level.
  • Age range is around > 5 years.
  • Patient having tinnitus, monitoring the effects of ototoxic medications, Noise exposure & hearing loss resulting from surgery are reliable candidates for this test.
  • Validation of Report:

    Around 3 months (depends on advancing age & Pathological conditions).

    C. Free Field/Sound Field Audiometry

    Description:

    It is used for Non-Formal Screening of Hearing Sensitivity Level.

    Preparation:

    Sedated & Natural Sleep is not allowed during testing.

    Eligibility Criteria:

  • Age range is generally below 6 years.
  • Patients who is not a reliable candidate for Pure Tone Audiometry/Play Audiometry.
  • Validation of Report:

    Around 3 months (depends on advancing age & Pathological conditions).

    D.Immittance Audiometry (Low Frequency Tympanometry & Acoustic Reflexometry)

    Description:

    It is objectively assesses mobility of the Tympano-Ossicular system as well as to rule out any Middle Ear Pathology (Tympanometry) & assesses the Acoustic Reflex Pathways (Ipsi & Contra) (Acoustic Reflexometry).

    Preparation:

    Chewing, Swallowing, & Head or body movements are not allowed during testing as well as during sedated deep sleep, positive pressure may build up in the Middle Ears, which can compromise the results; although positive Middle Ear Pressure does not have any significant diagnostic values.

    Eligibility Criteria:

  • Patient having Active Otorrhea, Severe Otalgia, H/O recently operated Ear(s), Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), Perilymphatic Fistulas are generally not a reliable candidate for tympanometry & Tullio Phenomenon and Hyperacusis suffering patients for Acoustic Reflexometry .
  • Validation of Report: Around 3 months (depends on advancing age & Pathological conditions).

    E.High/Multi Frequency Tympanometry

    Description:

    Objectively assesses the Mass related Pathology of the Middle Ear.

    Preparation:

    Chewing, Swallowing, Head or body movements are not allowed during testing as well as during sedated deep sleep, positive pressure may build up in the Middle Ears, which can compromise the results; although positive Middle Ear Pressure does not have any significant diagnostic values.

    Eligibility Criteria:

  • Patients having Active Otorrhea, Severe Otalgia, H/O recently operated Ear(s), Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), Perilymphatic Fistulas are generally not a reliable candidate.
  • Patients having the Mass related Pathology/Characteristics (Ossicular Discontinuity) of the Middle Ear, particularly of the Eardrum & Ossicles are a reliable candidate.
  • Validation of Report:

    Around 3 months (depends on advancing age & Pathological conditions).

    F.Eustachian Tube (E. Tube) Function Test (William's Test for Intact T.M. & Toynbee Maneuver for Perforated T.M.)

    Description:

    It is used to identify objectively (with subject's co-operation) the abnormal E. Tube function, to differentiate functional obstruction from mechanical obstruction, to differentiate obstruction from abnormal patency, & to monitor E. Tube functioning following Cleft Lip & Palate repair, Adenoidectomy, and elimination of nasal & nasopharyngeal inflammation.

    Preparation:

    Chewing, & Head or body movements are not allowed during testing.

    (a) William's Test:

  • Toynbee: After establishing resting position Middle Ear Pressure through tympanogram, the patient is told to close his/her mouth and nose and to swallow (dry).
  • Valsalva: After Toynbee Maneuver, the patient is told to close his/ her mouth and nose & force air into the middle ear from the nasopharynx as if he/she were blowing his/her nose until the ears feel full.
  • (b) Toynbee Maneuver: After establishing resting position Middle Ear Pressure through tympanogram, the patient is told to close his/her mouth and nose and to swallow (dry).

    Eligibility Criteria:

  • Patient having Active Otorrhea, Severe Otalgia, H/O recently operated Ear(s), Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), Perilymphatic Fistulas are generally not a reliable candidate.
  • Validation of Report:

    Around 3 months (depends on advancing age & Pathological conditions).

    G.Special Tests (TDT, SISI, STAT, ABLB, MLB etc.)

    Description:

    These tests are used to rule out Cochlear from Retrocochlear Pathology subjectively

    .

    Preparation:

    No preparation required.

    Eligibility Criteria:

  • Intact/Normal intellectual Functioning level.
  • Age range (generally > 8 years) is depends on Intellectual Functioning Level of the Patient.
  • Typical Sensory/Neural Hearing Loss is required otherwise outcome will be Insignificant.
  • For Alternate Binaural Loudness Balance Test & Supra Threshold Adaptation Test, Unilateral or Asymmetrical Sensory/Neural Hearing Loss (>40 dB or more) is required.
  • Validation of Report:

    Around 3 months (depends on advancing age & Pathological conditions).

    H.Speech Audiometry (SRT, SDS/WRS, SAT, MCL, UCL, DR, Rollover Ratio or PI-PB Function etc.)

    Description:

    Speech Audiometry is subjectively assesses the speech perception ability of the patient & Rollover Ratio is used to rule out Cochlear from Retrocochlear Pathology.

    Preparation:

    No preparation required.

    Eligibility Criteria:

  • Intact/Normal intellectual Functioning level.
  • Age range is around > 8 years.
  • Typical Sensory/Neural Hearing Loss is required otherwise outcome will be Insignificant for Rollover Ratio.
  • Validation of Report:

    Around 3 months (depends on advancing age & Pathological conditions).

    I.Auditory Brainstem Response (ABR)/ Brainstem Evoked Response Audiometry (BERA) [Diagnostic]

    Description:

  • Air Conduction ABR: It is used for Site of Lesion (differentiate Cochlear from Retrocochlear Pathology) testing & for threshold estimation (average degree of Hearing Level) objectively; in difficult to test population.
  • Bone Conduction ABR: It is used to detect Average Bone Conduction Hearing Level as well as Type of Hearing Loss, objectively (only in combination with Air Conduction ABR) & in presence of Anatomical Deformities like Aural Atresia/Stenosis etc.
  • Preparation:

    Sedation or Natural sleep is generally required for elimination of Muscle Artifacts.

    Eligibility Criteria:

  • Age range is generally > 2 months.
  • Patient having Active Otorrhea, Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), are generally not a candidate for this test.
  • Validation of Report:

    Around 3 months (depends on advancing age & Pathological

    Conditions).

    J.Auditory Steady State Response/ASSR Or Amplitude Modulation Following Response/AMFR or The Envelop Following Response/EFR or Steady State Evoked Response/SSER or Steady State Evoked Potential/SSEP [Diagnostic]

    Description:

    It assesses Frequency Specific (500 Hz to 4 kHz) average Hearing Sensitivity Level (degree of Hearing) objectively in difficult to test population.

    Preparation: Sedation or Natural sleep is generally required for elimination of Muscle Artifacts.

    Eligibility Criteria:

  • Age range is generally > 2 months.
  • Patient having Active Otorrhea, Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), are generally not a candidate for this test.
  • Validation of Report:

    Around 3 months (depends on advancing age & Pathological Conditions).

    K.Oto Acoustic Emissions/OAEs (Distortion Product & Transient Evoked) [Diagnostic]

    Description:

    It assesses the Outer Hair Cells Functioning upto Periphery Level & to rule out Auditory Neuropathy Spectrum Disorders, objectively (only in Combination with Air Conduction ABR).

    Preparation:

    Sedation or Natural sleep is generally preferred but in awake condition with quiet state, this test is done successfully.

    Eligibility Criteria:

  • Age range is generally > 48 hours after birth.
  • Patient having Active Otorrhea, Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), are generally not a candidate for this test.
  • Validation of Report:

    Around 3 months (depends on advancing age & Pathological Conditions).

    L.Digital Electronystagmography/ENG [Caloric & Non-Caloric or Air Caloric (by �Vario air instrument)]

    Description:

    It assesses the functioning of the Vestibulo-Ocular Reflex System & records electrical charges between Cornea & Retina.

    Preparation:

  • Patient is instructed to avoid any form of alcohol & certain drugs (sedatives, hypnotics, anitihistaminics, anti-vertigo medications etc.) minimum 72 hours (if not possible then minimum 48 hours) before the test.
  • To avoid tea, coffee, or any stimulating drinks, chocolate & any form of smoking, tobacco etc. at least 2 hours prior to the test.
  • Patient is instructed to take only a light meal/not eats for several hours before the test.
  • Eligibility Criteria:

  • Intact/Normal intellectual Functioning level.
  • Age range is generally adult population.
  • Patient having Active Otorrhea, Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), & any significant Outer and Middle Ear diseases is generally not a candidate for this test.
  • Caloric ENG is not recommended in case of Perforated Tympanic Membrane or any significant Middle Ear diseases where Non-Caloric or Air-Caloric ENG is the best option.
  • Validation of Report:

    Around 6 months (depends on advancing age & Pathological Conditions).

    M.Vestibular Evoked Myogenic Potentials/VEMPs (Cervical & Ocular)

    Description:

    It assesses the functioning of the Vestibulo-Collic Reflex System as well as the function of Otolith Organs (mainly Saccule) of the Inner Ear.

    Preparation:

  • Patient is instructed to avoid any form of alcohol & certain drugs (sedatives, hypnotics, anitihistaminics, anti-vertigo medications etc.) minimum 72 hours (if not possible then minimum 48 hours) before the test.
  • To avoid tea, coffee, or any stimulating drinks, chocolate & any form of smoking, tobacco etc. at least 2 hours prior to the test.
  • Eligibility Criteria:

  • Intact/Normal intellectual Functioning level.
  • Age range is generally adult population.
  • Patient having Active Otorrhea, Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), & any significant Middle Ear diseases is generally not a reliable candidate for this test.
  • Validation of Report:

    Around 6 months (depends on advancing age & Pathological Conditions).

    N.Electrocochleography (ECochG/ECoG)

    Description:

    It is used to rule out Endolymphatic Hydrops (Menieres Disease), ascertaining of average hearing thresholds & helping the interpretation of ABR where the Peak -I of ABR is not identifiable.

    Preparation:

  • Patient is instructed to avoid any form of alcohol & certain drugs (sedatives, hypnotics, anitihistaminics, anti-vertigo medications etc.) minimum 72 hours (if not possible then minimum 48 hours) before the test.
  • To avoid tea, coffee, or any stimulating drinks, chocolate & any form of smoking, tobacco etc. at least 2 hours prior to the test.
  • Eligibility Criteria:

  • Age range is generally adult population.
  • Patient having Active Otorrhea, Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), & any significant Outer & Middle Ear diseases is generally not a reliable candidate for this test.
  • Patient should have Sensory/Neural Hearing Loss (not more than 50-60 dB, at mid to high frequency region) in Pure Tone Audiometry, otherwise the outcome will be contradictory/insignificant especially to evaluate Endolymphatic Hydrops.
  • Validation of Report:

    Around 6 months (depends on advancing age & Pathological Conditions).

    O.Glycerol Test

    Description: It is used to rule out Endolymphatic Hydrops (Meniere's Disease). Preparation: 1. Patient is instructed to avoid any form of alcohol & certain drugs (sedatives, hypnotics, anitihistaminics, anti-vertigo medications etc.) minimum 72 hours (if not possible then minimum 48 hours) before the test. 2. To avoid tea, coffee, or any stimulating drinks, chocolate & any form of smoking, tobacco etc. at least 2 hours prior to the test. 3. Patient is instructed to stay in fasting condition (most preferable) before the test. Eligibility Criteria: 1. Intact/Normal intellectual Functioning level. 2. Age range is generally adult population. 3. Patient having Active Otorrhea, Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), & any significant Outer & Middle Ear diseases is generally not a reliable candidate for this test. 4. Patient should have Sensory/Neural Hearing Loss or Normal Hearing Sensitivity. Validation of Report: Around 3 months (depends on advancing age & Pathological Conditions).

    P.Video Electronystagmography/VNG [Caloric]

    Description: It directly records eye movements (Rotational Nystagmus) by a Video Camera only in Eyes open position as well as to observe, measurement & analysis of Vestibulo-Ocular Reflex (VOR) & evaluates Oculomotor System.

    Preparation: 1. Patient is instructed to avoid any form of alcohol & certain drugs (sedatives, hypnotics, anitihistaminics, anti-vertigo medications etc.) minimum 72 hours (if not possible then minimum 48 hours) before the test. 2. To avoid tea, coffee, or any stimulating drinks, chocolate & any form of smoking, tobacco etc. at least 2 hours prior to the test. 3. Patient is instructed to take only a light meal/not eats for several hours before the test. Eligibility Criteria: 1. Intact/Normal intellectual Functioning level. 2. Age range is generally adult population. 3. Patient should stay in Eyes Open position during testing. 4. Patient having Active Otorrhea, Impacted Cerumen/Debris in EAC, Anatomical Deformities (Aural Atresia/Stenosis), & any significant Outer and Middle Ear diseases is generally not a candidate for this test. 5. Caloric VNG is not recommended in case of Perforated Tympanic Membrane or any significant Middle Ear diseases. Validation of Report: Around 3 months (depends on advancing age & Pathological Conditions).

    Q.Subjective Visual Vertical/SVV

    Description: It assesses the ability of a person to perceive verticality & to detect abnormal subjective tilt & evaluates the function of Otolith Organs (mainly Utricle) of the Inner Ear. Preparation: 1. Patient is instructed to avoid any form of alcohol & certain drugs (sedatives, hypnotics, anitihistaminics, anti-vertigo medications etc.) minimum 72 hours (if not possible then minimum 48 hours) before the test. 2. To avoid tea, coffee, or any stimulating drinks, chocolate & any form of smoking, tobacco etc. at least 2 hours prior to the test. Eligibility Criteria: 1. Intact/Normal intellectual Functioning level. 2. Age range is generally adult population. 3. Patient should have Vertigo. Validation of Report: Around 3 months (depends on advancing age & Pathological Conditions).

    R.Video Head Impulse Test/VHIT or Video Thrust Test/VTT

    Description: It provides diagnostic and functional information about the vestibular system, specifically the Vestibular Ocular Reflex (VOR) & objectively evaluates the Superior & Anterior Semicircular Canals as well as tests the Vestibular System at higher frequencies. Preparation: 1. No need to discontinue any medications before the test if it is done uniquely. 2. To avoid tea, coffee, or any stimulating drinks, chocolate & any form of smoking, tobacco etc. at least 2 hours prior to the test. Eligibility Criteria: 1. Intact/Normal intellectual Functioning level. 2. Age range is generally adult population. 3. Patient should stay in Eyes Open position during testing. Validation of Report: Around 3 months (depends on advancing age & Pathological Conditions).

    S.Tinnitus Matching & Masking

    Description: It is used for (audiological) assessment & management of tinnitus subjectively. Preparation: Pure Tone Audiometry is mandatory before this. Eligibility Criteria: 1. Intact/Normal intellectual Functioning level. 2. Age range is generally adult population. Validation of Report: Around 1 month (depends on advancing age Pathological conditions).

    T.Speech-Language Therapy

    Description: It is a scientific procedure for Speech-Language disordered Populations. Preparation: No preparation required, but it should be more effective if it continues with Occupational/Physio Therapy & Special Education. Note: Voice Therapy & Adult Speech Therapy is done here only by prior appoinment. Child Speech-Language Therapy & Adult Language Therapy may be an option of us in future. Progress: Totally depends on the disorders & it generally a time consuming/long term procedures. For more contact : (033) 25300175 SANTO DUTTA, Sr. Audiologist & Speech Language Pathologist - Mentor BASLP (WBUHS), MASLP (WBUHS) Reg. No. A18493 (RCI)