What to expect during testing

What to expect during a Tympanogram:

A small tip is pressed against the opening of the ear canal. You may hear a slight hum and feel a little pressure (as if you are going up a mountain). This will only last about 10 seconds per ear. This evaluates the mobility of the tympanic membrane (eardrum) to help with diagnosis of middle ear problems.

What to expect during an Auditory Brainstem Response (ABR):

After being scheduled for this test, you will receive a set of instructions informing you about the test and your preparation for this test. (click to view the ABR Instruction Form)

This test may begin with a tympanogram to verify the middle ear function. Then otoacoustic emissions are performed to provide unique information on auditory status and help detect cochlear dysfunction. In preparation for the ABR, the audiologist will scrub your forehead and earlobes before attaching electrodes that will measure the function of the auditory (8^th ) nerve. It is very important to obtain excellent conductivity, therefore, it is asked that makeup not be worn. After the electrodes are in place, inserts are placed in the ear canals. You will hear a loud series of clicks. These clicks will be presented at different rates. It is very important to stay as relaxed and still as possible. It is also asked that you keep your eyes closed through the entire test. Movement can cause interference, therefore, affecting the reliability of the test. This test lasts about one hour to one and a half hour. After the test is complete, the audiologist may be able to give some idea of the results, but needs to analyze and then send a report to the referring physician. It may take up to one week for you to receive the results from the physician.

If attempting to obtain thresholds, the clicks will be at varing frequencies and decrease in volume until there is no longer a response. This allows us to estimate a patient’s thresholds, but is not exact.

What to expect during a Videonystagmography (VNG) test:

After being scheduled for this test, you will receive a set of instructions informing you about the test and your preparation for this test. (click to view the VNG Instruction Form) It is critical that you read and follow these instructions to the best of your abilities. Do not wear makeup, especially eyeliner or mascara.

Results for this test will not be available on the day of the test due to the large amount of information collected. Once the audiologist has interpreted the findings of this test, he/she will send a report to the referring physician. The physician will contact you with the results and based on this test as well as case history or any other clinical testing will make his/her recommendations for treatment.

A VNG is a battery of tests in which the patient’s eye movements are recorded using video equiped goggles. This test lasts approximately two hours. The test is divided into three different sections which include oculomotor testing, positional testing, and caloric testing. Your eye movements are recorded in order to determine if any of the tests provoke nystagmus, which is a back and forth movement of your eyes. These eye movements are a window into the vestibular system.

Some patients experience a slight increase in symptoms immediately after testing. It is recommended that you have someone available to call if you do not feel comfortable driving home.

Sections of the VNG Test

• During the oculomotor testing, you are required to follow a small object moving in various ways, using only your eyes.
• During the positional testing, you are moved into different positions to attempt to evoke nystagmus.
• During the caloric testing, air pressure is directed into each ear to stimulate the vestibular system of that ear, for a minimum of 4 times (typically, once for each ear with cool air and once for each ear with warm air); however, this process may be repeated, at maximum, two more times to verify responses. Recordings for each ear are compared to ensure both sides of the vestibular system are responding the same.
• The air is placed in the ear for about one minute and then following removal of the air, you are asked to answer questions. This test may make you feel as if the room or your own body is spinning. It is very important that you do your best to focus on answering the questions and not on the way you feel. The answer to these questions are not important; the main focus is to keep your brain busy so that it does not suppress the response we are trying to see.

Please refer to the information above referencing the ABR and ECOG

BPPV is a disorder of one of the balance centers in the inner ear, usually the posterior semicircular canal. It is one of several types of positional vertigo and by far the most common. BPPV is benign because it is not life threatening; paroxysmal because the dizziness comes on suddenly and without warning; it is positional because the dizziness either starts or is made worse with head or body movement; and it is vertigo because the dizziness is a whirling type of sensation. It is believed that BPPV occurs when small particles break free from the walls of the semicircular canals located in the inner ear and float in fluid contained in these canals. These floating particles can gather to form tiny clots that may act like a tiny plunger that pushes and pulls the fluid that fills these canals. This is important as the semicircular canals control our sense of balance. The changes in fluid movement can cause false messages to be generated which lead to vertigo. BPPV is thought to be caused by a previous head injury that could have happened years before the dizziness started. The main symptoms of BPPV are vertigo, imbalance and nausea that last for a short time, only to return with a change in body or head position. Some people report a feeling of imbalance that lasts throughout the day. BPPV is a very common problem and accounts for almost half of the balance problems seen by our group. Performing special balance exercises or using a canalith repositioning maneuver usually relieves BPPV. This is moving the free floating particles to an area into the vestibular system where they will not stimulate fluid movements and cause false messages. The canalith repositioning maneuver, or Epley maneuver, is a physical therapy we perform in our office that effectively eliminates the dizziness associated with BPPV in 90% of people.

What to expect during a Canalith Repositioning Maneuver, or Epley Maneuver:

After being scheduled for this test, you will receive a set of instructions informing you about the test and your preparation for this test. (click to view the Epley Instruction Form)

The canalith repositioning or Epley maneuver consists of 4 head movements designed to move the free floating particles out of the semicircular canals. First, you will be moved from a sitting to reclining position where your head is placed at a 45 degree angle for approximately 1 1/2 minutes. Next, you are asked to turn your head to the other side slowly and keeping your head at a 45 degree angle for approximately 1 1/2 minutes. Then, you roll onto your side with your head slightly angled while looking down at the floor for approximately 1 1/2 minutes. Finally, you return carefully to a sitting position while keeping your chin tucked. This maneuver may be repeated several times in one session. For several days following the maneuver please refrain from quick head movements.