Appointments: (919) 876-4327
Hearing & Balance
Pure tone audiometry is used to measure hearing for frequency specific tones and speech. The person is typically asked to raise their hand or press a button when they hear a sound. The softest sound an individual can hear is called the hearing threshold. Results from the test are plotted on a graph called an audiogram.
Assistive Listening Devices are designed to help you function better in day-to-day challenging communication environments. FM systems, loop systems, and other assistive listening devices are available depending on your lifestyle and hearing needs.
Auditory Brainstem Response (ABR) testing evaluates objective hearing sensitivity by measuring responses obtained from the auditory nerve in response to different stimuli. This test is similar to a hearing test, but allows the audiologist to evaluate the function of the auditory system by looking beyond the organ of hearing at the auditory pathway. Prior to testing, sticker electrodes will be placed behind the ears and on the forehead. Sounds are then administered using foam inserts. During this test, the patient is instructed to relax and naps are encouraged.
There are a variety of options designed for noise reduction, musician plugs, sleep plugs, and swimming. Our Audiologists can take impressions of your ears and make recommendations based on your needs.
Carolina Ear & Hearing Clinic, PC offers comprehensive hearing aid services. We offer consultation, fitting and programming of hearing aids, repairs, earmolds, batteries, and other hearing aid supplies. We work with ALL levels of technology, styles of hearing devices, and hearing aid manufacturers to ensure the best fit and sound quality for each individual patient.
The best hearing aid choice will depend on the type and degree of hearing loss, physical ear structures, lifestyle, and appearance preferences. The Doctor of Audiology will work with you to determine the hearing devices most appropriate for you. CEHC offers a thirty-day trial period from the date of purchase. Our Doctor’s of Audiology use both functional testing and verification measurements to ensure accurate hearing aid fitting. All hearing devices come with a three-year manufacturers repair and loss & damage warranty.
When hearing aids are not enough to provide adequate benefit for significant hearing loss, Cochlear Implants may be an option. This is true for patients with word understanding poorer than 50%. However, determination would require a medical evaluation with a neurotologist and cochlear implant evaluation with an audiologist.
A cochlear implant involves inserting an electrode array into the inner ear, essentially bypassing the damaged hair cells, to stimulate the auditory nerve directly. This device uses electrical impulses instead of acoustic stimulation to send the signal to the brain. A cochlear implant requires an external processor, which includes microphones to pick up the sound. A magnet is used to transmit the external sound to the internal processor. Success with a Cochlear Implant requires auditory rehabilitation exercises, and several follow up appointments. At Carolina
Ear & Hearing Clinic, we work with all Cochlear implant manufacturers. Each manufacturer will be discussed in depth at the evaluation.
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For patients with conductive or mixed hearing loss, or those that have chronic ear disease and or ear abnormalities/deformities where traditional amplification cannot be obtained, Osseointegrated Devices may be an option.
An OSSEOINTEGRATED DEVICE requires a titanium abutment or internal magnet with titanium screws to be inserted into the mastoid bone behind the ear. Over time, this abutment will become osseointegated with the bone. A processor which includes the microphones will pick up the sound and create a vibration that will stimulate the inner ear, bypassing the outer and middle ear.
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Our Doctor’s of Audiology are trained to monitor the facial nerve and auditory nerve during complex neurotologic surgeries. Using electromyography and sensory and motor evoked potentials to identify function changes in a patient’s peripheral and central nervous systems to reduce risk of injury during surgery and avoid significant postoperative impairment.
Speech testing evaluates an individual's ability to detect and understand speech signals. Speech testing can be carried out with word or sentence materials. Speech testing is necessary in order to determine the patients ability to understand speech in background noise and can also determine which level of hearing technology you need. This testing is also required for cochlear implant candidacy.
A test used to evaluate the stapedial reflex from the stapedius muscle (attached to the ossicular chain) in response to loud sounds.
Measures the mobility of the eardrum as air pressure is increased or decreased in the ear canal. Results are plotted on a graph called a tympanogram and can determine middle ear and eustachian tube function.
Dizziness and Balance
Carolina Ear and Hearing Clinic specializes in diagnosing and treating a wide range of dizziness and balance disorders. We are equipped with state-of-the-art equipment to determine the cause and severity of most disorders, including Meniere’s disease, cochlear hydrops, vestibular neuritis, Benign PAROXYSMAL Positional Vertigo, vestibular schwannomas, and acoustic neuromas, superior canal dehiscence, and age-related vestibular disorders.
Diagnostic Testing
Computerized Dynamic Posturography (CDP) is an objective method of differentiating sensory, motor, and central adaptive functional impairments of balance and is comprised of three test protocols. The Sensory Organization Test examines the patients use of vestibular, visual, and proprioceptive systems to control balance. The Motor Control Test evaluates the patients reflexive responses for restoring balance following sudden translations of the support surface. The Adaptation Test evaluates the patient’s ability to adapt to unexpected support surface irregularities.
Videonystagmography evaluates the causes of dizziness, vertigo, or balance dysfunction. VNG is designed to test the function of several of the systems involved in keeping us steady and balanced. Video goggles are used to measure and record eye movements for objective assessment of the oculomotor and vestibular system.
Vestibular Evoked Myogenic Potential (VEMP) evaluates portions of the vestibular system that the VNG cannot test. This test evaluates the vestibular system by looking at the contractions of neck muscles. During the testing the patient is asked to lift their head and turn away from a stimulus. This stimulates the muscles needed to measure the response. To measure the response small sticker electrodes are placed on the face and neck. These
electrodes do not administer any shock, they measure electrical activity from the muscle contraction.
Electrocochleography is an objective measure of the electrical potentials generated in the inner ear as a result of sound stimulation. ECOG is used to determine excessive inner ear fluid pressure which can cause symptoms such as fluctuating hearing loss, dizziness, aural fullness and pressure, and tinnitus.
Treatments
Canalith Repositioning Procedure (CRP)
The Canalith Repositioning Maneuver (CRM) or Epley Maneuver is the treatment for Benign Paroxysmal Positional Vertigo (BPPV). The treatment consists of head positions that will help move the otoconia back to the base of the semicircular canals so they can be absorbed into the body. The treatment can vary slightly depending on which canal that is affected.
Tinnitus Evaluations & Treatments
What is tinnitus?
Tinnitus is an umbrella term that defines any sound in the ears or head. This can include ringing, crickets, roaring, buzzing, whooshing, pulsing, etc. Anyone can experience tinnitus. It can be intermittent, temporary, or constant. Some people only notice their tinnitus while in silence and others struggle to go about their daily routine because of it. While there is no “cure” for tinnitus, there are tools and strategies that may provide relief!
What is tinnitus?
Tinnitus is commonly caused by hearing disorders/diseases of the ear. For example:
- Hearing loss of all types and degrees
- Prolonged/sudden exposure to loud sounds/noise
- Meniere’s disease
- Otosclerosis
- Ear infections
There are other health issues that can lead to tinnitus and/or hearing loss:
- Migraines
- Cardiovascular disease (Certain cardiovascular issues can lead to a pulsing tinnitus sound that corresponds with your heart beat)
- Diabetes
- Temporomandibular joint disorder (TMD)
- Thyroid disorders
- Psychiatric disorders
- Autoimmune disorders
- Medications (for example: salicylates, nonsteroidal anti-inflammatory, loop diuretics, and chemotherapy agents)
Research has concluded certain factors can contribute to/exacerbate the perception of tinnitus:
- Alcohol
- Caffeine intake
- Head injuries
- Muscle tension
- Sleep deprivation
- Sodium levels in food
- Stress
- Sugar substitutes
- TMD/grinding teeth/clenching jaw
- Tobacco
Treatment
It is vital to see a Doctor of Audiology for a comprehensive hearing evaluation and extensive patient history. The underlying cause will determine the most appropriate treatment route:
- Hearing Aids: stimulates the hearing nerve to reduce the presence of tinnitus
- Maskers/Assisted Listening Devices: specific sounds and devices to drown-out the internal sound… maskers can also be activated in some hearing aids
- Cognitive and Behavioral Therapy: desensitization process to reduce your emotional reaction to the internal sound
- Temporomandibular Joint Disorder (TMD) Treatment
- Tinnitus Retraining Therapy (TRT): habituation therapy to help patient’s reaction to the sound
Where do you start?
If you experience tinnitus, please call 919-876-4327 and schedule an appointment with one of our Doctors of Audiology today. We will start with a comprehensive hearing test and extensive interview regarding your symptoms. The appointment lasts about 60-90 minutes.
Resources and research
The American Tinnitus Association is “committed to a cure.” Their organization and website (www.ata.org) is a great reference to get involved and read about the latest treatment and current research.
FAQ's
Some parts of the vestibular evaluation elicit nystagmus (shaking eye movement) which can make patients feel dizzy. This feeling typically subsides a few minutes after the testing is completed.
We advise patients to find a ride home after testing due to the possibility of prolonged dizziness. If you cannot acquire a ride, be prepared to sit in the waiting room if you are feeling ill after testing is completed.
Please see our VNG handout under [documents] which lists all the medication and dietary restrictions prior to vestibular testing.
Depending on how many tests are ordered, testing can take between 1-3 hrs. Please plan accordingly.
Testing requires detailed review, report writing, and a follow-up appointment with Dr. McElveen. Once the testing is complete, a follow-up appointment will be made to see Dr. McElveen to go over the testing results.
There are instructions to follow prior to coming in for vestibular testing. It is advised to carefully review this prior so that results are not affected by other factors such as diet/medications. You can find these instructions under the [handout tab].
Our highly trained Audiologists and Doctoral Externs will complete the vestibular testing, review the results, and complete a comprehensive report interpretating the results. This report will then be reviewed by Dr. McElveen, whom you will see at a follow up appointment.
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