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العربية 
AUDIOLOGICAL SERVICES
• HEARING ASSESSMENT
TYMPANOMETRY for infants, children & adults
* Purpose: to measure the compliance (movement) of the ear drum. A small probe seals the entry of the ear canal; a change in air pressure is applied to the ‘sealed cavity’ resulting in movement of the ear drum. A different stimulus is used to counter the characteristic middle ear behavior identified in infants. As well, the test measures the middle ear pressure.
* Results: reported as a ‘type’ or ‘curve’ based on middle ear characteristics measured during the test. A Type ‘A’ curve is consistent with normal middle ear function.
*Indications: ear infection, middle ear effusion, Otosclerosis, perforated tympanic membrane, Eustachian tube dysfunction, wax impaction, ear canal occlusion.
SWIM MOULDS
* Purpose: to prevent water from entering the outer ear and middle ear cavity in case of ear drum perforation during showering, bathing or swimming.
* Indications: ear drum perforation, mastoid cavities, exostoses, Otitis Externa.
EUSTACHIAN TUBE FUNCTION
* Indications: difficulty equalising the middle ear during diving or flying, recurrent ear infection, Autophony (resonating of own voice), continual need to perform Valsalva, Tinnitus (head noises).
IPSILATERAL AND CONTRALATERAL ACOUSTIC REFLEX EVALUATION
* Purpose: An objective test of the Stapedius and Tensor Tympani reflex. By eliciting loud tones, we can activate the acoustic reflex pathway and measure tympanic membrane movement caused by the Stapedius’ muscle contraction to loud sounds. Movement of the ear drum indicates the presence of the reflex.
* Indications: Otosclerosis, suspected brainstem pathology, facial acoustic nerve abnormalities.
* Contraindications: middle ear pathology, effusion or Eustachian tube dysfunction, ear canal occlusion.
PURE TONE AUDIOMETRY (also see BOA, VROA, Play Audiometry for infant and young children)
* Purpose: An assessment to evaluate subjective hearing levels of simple tones and sounds. This test can be performed as a screening (air conduction with masking only) or as a complete test (air & bone conduction with masking).
* Indications: Any complaint relating to the ear, hearing and tinnitus.
SPEECH TESTING (also see Speech Reception Testing)
* Purpose: Evaluates a patient’s ability to understand and interpret complex sounds.
* Indications: Pure Tone Audiometry result indicates a hearing loss, suspected auditory nerve abnormality/ retrocochlear pathology.
AIDED HEARING TESTING
* Purpose: To identify the effectiveness of current hearing aid or implant fitting. Speech tests are performed with amplification switched ‘ON’.
* Indications: Poor performance with amplification, reported difficulties over and above what would be expected considering amplification and degree of hearing loss, recent decline in aided performance.
FULL AUDIOLOGICAL ASSESSMENT (Recommended)
* Purpose: A collection of test procedures (Otoscopy, Tympanometry, Acoustic Reflexes, Pure tone Audiometry, Speech Testing) to evaluate the overall ear health and hearing ability of the patient.
*Indications: patient reports difficulty hearing, ear-related symptoms such as tinnitus, loudness discomfort, ear health problems such as Otitis Externa/Media, Meniere’s disease and other diseases of the hearing and balance organs, brainstem pathologies.
EVALUATION FOR HEARING AID/ IMPLANT
* Purpose: A Full Audiological Assessment and Comprehensive Aided Hearing Testing to determine a patient’s candidacy for amplification.
* Indications: Hearing loss, poor performance with current amplification.
BEHAVIOURAL OBSERVATION AUDIOMETRY (children < 6 months)
* Purpose: To subjectively evaluate hearing levels and sound awareness in infants using common stimulus such as rattles, speech sounds, toys and observation of child’s behavior towards the sound source. This test is performed in a free field, only the best ear will respond.
* Indications: suspected hearing loss, children with the developmental delay such as those who cannot sit upright nor support their own head.
VISUAL REINFORCEMENT OBSERVATION AUDIOMETRY (children ~ 6 months to 3 years)
* Purpose: To subjectively evaluate hearing levels and sound awareness in young children using puppets, toys, tones, sounds ,voice and observation of eye movement towards sounds source. This test is performed in a free field, only the best ear will respond.
* Indications: suspected hearing loss, this test is for children with the developmental delay such as those who can sit upright, unassisted.
PLAY AUDIOMETRY (children ~ 3 to 5 years)
* Purpose: To subjectively evaluate hearing levels in children through game play. This test is desirable because information on individual ears can be obtained.
* Indications: suspected hearing loss, children should be able to concentrate for 15 to 30 minutes for good results
SPEECH RECEPTION TESTING (children ~ 3 to 5 years)
* Purpose: To evaluate a child’s ability to understand speech, complements and confirms results obtained during Play Audiometry.
* Indications: suspected hearing loss, hearing loss identified in Play Audiometry, children should be able to concentrate for 15 to 30 minutes.
Click & Tone Burst AUDITORY BRAINSTEM RESPONSE (ABR)
* Purpose: To evaluate the auditory nerve objectively using clicks or tone bursts and provides a more cost-effective alternative to MRI (though is less sensitive to small tumours). Tone bursts will allow greater threshold estimation than clicks.
* Indications: suspected Auditory Neuropathy, suspected Acoustic Neuroma (>1cm diameter), hearing loss in the disabled population and children.
OTOACOUSTIC EMISSIONS TESTING (OAE)
* Purpose: To objectively examine cochlear mechanics and more specifically, to evaluate outer hair cell function.
* Indications: commonly used as a hearing screening for infants, suspected auditory neuropathy or hearing loss.
AUDITORY STEADY STATE RESPONSE (ASSR)
* Purpose: To objectively estimate behavioural thresholds using high repetition rate stimuli and a sophisticated mathematical algorithm for detection and analysis. More specific than ABR.
* Indications: Failed ABR and considering amplification (hearing aid or cochlear implant).
• BALANCE ASSESSMENT
ENG/ VNG OCULOGRAPHY
* Purpose: Using a variety of visual targets, this collection of tests (gaze, saccades, pursuit/ tracking, optokinetic) challenges the oculomotor system and provides information about the integrity of the Vestibulo-Ocular Reflex. Can detect neurological abnormalities in some cases, but is generally used in conjunction with the Caloric Test to evaluate the balance system on the whole.
* Indications: acute and chronic dizziness or imbalance, balance disorders, central vestibular or neurological disorders.
CALORIC TEST OF LABYRINTH
* Purpose: To determine the responsiveness of the vestibular system, and how symmetrical the responses are between the left and right side. More specifically this test provides information about the horizontal semicircular canals’ reaction to cool and warm (water or air). The test generates a percentage value, which provides information about the ‘balance’ of the vestibular system.
* Indications: balance disorders or complaints of dizziness/ vertigo/ imbalance.
POSITIONAL TESTING
* Purpose: To subjectively examine and record positional test responses using video recordings rather than Frenzel lenses.
* Indications: Benign Paroxysmal Positional Vertigo (BPPV), Cervical Vertigo, Gaze Evoked Nystagmus. For patients with unique or notable positional nystagmus requiring video confirmation.
ROTARY CHAIR STUDY
* Purpose: To measure nystagmus during chair rotation and determine the state of the horizontal semicircular canal vestibulo-ocular reflex. To verify the result found during caloric test.
* Indications: bilateral hypofunction, to monitor ototoxicity, can be used in place of the caloric test for malformed or obstructed ears, inconclusive or inconsistent caloric test.
SUBJECTIVE VERTICAL TEST
* Purpose: To determine if an individual can perceive verticality using neurological inputs from the visual, vestibular and somatosensory systems. Can be abnormal if there is damage to the Otolithic organs.
* Indications: vestibular neuritis, acute vestibular injury, acute Meniere’s disease.
DYNAMIC VISUAL ACUITY TEST
* Purpose: A simple procedure using a classic eye chart, measuring visual acuity with the head in motion (the patient is asked to move their head from side to side and read the letters in the eye chart).
* Indications: bilateral vestibular loss.
POSTUROGRAPHY PLATFORM STUDY
* Purpose: a method of quantifying balance ability with test scenarios designed to challenge the visual, vestibular and somatosensory systems separately and all at once.
* Indications: monitoring disability, monitoring rehabilitation, medico-legal cases.
FULL VESTIBULAR ASSESSMENT (Recommended)
* Purpose: The ideal combination of vestibular tests to suit most patients. Includes Oculography and the Caloric Test.
* Indications: dizziness or imbalance, peripheral vestibular disorders and disease.
VESTIBULAR EVOKED MYOGENIC POTENTIAL (VEMP)
* Purpose: To determine if the Saccule, Inferior Vestibular Nerve and central pathways are intact and working normally, by stimulating the Saccule with loud, click stimuli and measuring the neuromuscular response from the Sternocleidomastoid (SCM) muscle of the neck.
* Indications: Superior Canal Dehiscence, Meniere’s, and Vestibular Neuritis
* Contraindications: hyper-recruitment, loudness sensitivity, and neck or shoulder injury.
EVOKED EYE MOVEMENTS
* Purpose: examines the Tullio Phenomenon (sound induced dizziness) to elicit eye movements using loud, impulse tones.
* Indications: most commonly found in Superior Canal Dehiscence Syndrome.
ELECTROCOCHLEOGRAPHY (ECOCHG)
*Purpose: An electrically evoked response to sound which demonstrates the action and summation potential of the cochlea to auditory stimulation.
* Indications: Meniere’s disease.
VESTIBULAR REHABILITATION THERAPY
* Purpose: To provide repetitive, controlled and individualized exercises. To allow patients to learn new limits after vestibular loss, re-establish neural connections and to develop new skills using other senses such as vision and proprioception.
* Indications: BPPV, unilateral or bilateral vestibular loss, fluctuating vestibular problems such as Meniere’s syndrome.
VIDEO HEAD IMPULSE TEST
* Purpose: To check for high frequency (speed), all 6 semicircular canal, VOR GAIN, Covert and Overt saccades..
* Indications: vertigo, dizziness, Imbalance, Visual Disturbance on head movement, high frequency balance loss.
