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Dizziness – part 2

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HeatherDizziness: Videonystagmography (part 2)
By Heather Meyer

At Midwest ENT Centre, we work with patients who may be experiencing dizziness, imbalance or vertigo episodes. Depending on the patient’s symptoms, the doctor may request further assessment of the inner ear balance system, called the Vestibular System.  One of the tests routinely performed by our audiologists here is Videonystagmography (VNG). What a mouthful!

What exactly is VNG testing all about?

VNG is composed of a series of tests used to determine the cause of a patient's dizziness or balance problems, and whether or not it is due to inner ear disease. It is one of the only tests available today that can decipher between a unilateral (one ear) and bilateral (both ears) vestibular problem. If dizziness is not caused by the vestibular portion of the inner ear, it might be caused by the brain, by medical disorders such as low blood pressure, or by psychological problems such as anxiety.

The test records nystagmus (quick eye jerks) using video imaging technology. There are neural connections between the balance mechanism in the inner ear and the muscles of the eye. A disorder of the balance system results in small eye jerks that are detected by a camera attached to a pair of infrared goggles the patient wears during a series of tasks. So you could say that the eyes are not only a “window into your soul” but also a “window into your vestibular system”!

Videonystagmography: what should I expect?

VNG testing is non-invasive, and only minor discomfort is felt by the patient as a result of wearing the goggles. A patient may also experience weakness, dizziness, or nausea during a VNG test, but this generally passes after a few minutes. If medically possible, patients are advised to abstain from food for four hours prior to the test, as a full stomach is more likely to cause discomfort or nausea. Some may feel as though they are going to fall down during testing, but we take special care to ensure this does not happen. The effects of the test are temporary and the level of discomfort depends on the underlying cause of the symptoms. In the event of prolonged dizziness, we recommend that patients arrange to have someone else drive them home.

There are 4 main parts to a VNG test:

The saccade test evaluates rapid eye movements.

The tracking test evaluates movement of the eyes as they follow a visual target.

The positional test measures dizziness associated with changes in position of the head or body.

The caloric test measures responses to warm and cold air circulated in the ear canals.

Because the hearing and balance functions of your inner ear are closely related, a hearing test will likely be administered as well. Appointments usually last about 60-90 minutes.

What if my symptoms have improved: should I still go ahead and take the VNG test?

Yes! The VNG test is designed to determine the underlying cause of your dizziness and other symptoms. Although these may have gotten better, the doctor still needs to find what the cause of your initial symptoms were and how the balance system is recovering. Importantly, the VNG results may be able to tell how likely you are to experience another episode in the future.


Source: The National Dizziness and Balance Center
Vestibular Function: Evaluation and Treatment (2004) Alan Desmond, AuD

Benefits of Using a Neck Loop

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Using the T-coil and Neck Loops With Your Hearing Aid

In the last blog, I talked about t-coils and how they can increase the functionality of your hearing aid or cochlear implant.  T-coils are like wireless antennas.  They pick up magnetic signals transmitted from a sound source and then deliver that sound directly to your hearing aid.  T-coils are easy to use – you activate them by pressing a button or switch on your hearing aid. 

Although t-coils were originally used to enhance the magnetic signal from a telephone handset, which allowed a hearing aid user to hear better on the telephone, there are a couple of other ways to use t-coils.  Today I’ll explain the benefits of using a neck loop with a t-coil. 

A neck loop is just a loop of wire worn (very loosely) around the neck and connected to a sound source.  The neck loop changes the incoming sound signal to a magnetic signal which is then transmitted through the wire loop.  The t-coil in the hearing aid picks up the magnetic signal from the neck loop and then processes the sound through the hearing aid.  A basic neck loop just takes the place of a “headset” for those who have t-coil equipped hearing aids.  A neck loop can be plugged into any device (sound source) that can be used with a headset such as an iPod or mp3 player, headphone connection at the gym, TV or stereo, personal amplifier, computer, cell phones, and land line telephones.  The sound from the connected device is relayed from the neck loop to the t-coil in the hearing aid, working just like a headset. 

Neck loops also come in amplified versions.  This type of neck loop includes a volume control and a microphone.  This allows for additional volume control adjustment independent from the volume control on the device.  The microphone on the loop replaces the mouthpiece of the telephone which enables hands free conversation.  So it’s very easy to have a two-way conversation – both speaking and listening – on the telephone using this type of neck loop.  Amplified neck loops still function like headsets and can be plugged into any device with a sound source.  

If you don’t like the idea of being hard-wired into your device, you can also get a Bluetooth version of a neck loop where the Bluetooth signal from the sound source is received by the neck loop and then transmitted to the t-coil equipped hearing aid.  The sound from a Bluetooth enabled device, like your cell phone or iPod, will be received by the neck loop and transmitted to the hearing aids via the t-coil without any wire connecting the neck loop to the sound source.

Why should you consider trying a neck loop?  There are many advantages to using neck loops with your t-coil equipped hearing aids.  First, sound from the neck loop is delivered directly into your hearing aid which has been programmed for your individual hearing loss – the sound has been shaped to match your hearing ability.  If you have the t-coil feature enabled in both of your hearing aids, then you will hear the delivered sound in both ears which can improve speech understanding.  Using neck loops can also significantly reduce the amount of background noise typically picked up in a listening environment.  Since neck loops stay with the user, they can be connected to various devices at any time or place.  Plus, neck loops are affordable.  The cost ranges from about $50.00 for a basic non-amplified model to about $350.00 for a Bluetooth model. 

Next blog, I’ll talk about using neck loops with the TV, personal listening systems, and FM systems.  Until then, talk to your audiologist about hearing better with a neck loop!

Realistic Expectations for Family Members With Hearing Loss

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“My mother still has a hard time hearing me even when she is wearing her hearing aids.” 

Many spouses and family members experience a lot of frustration when someone they love suffers from hearing loss.  Typically, they have dealt with this invisible disability for several years.  Once they finally convince that loved one to get hearing aids, they are so excited about the prospect of that loved one being able to hear again, they tend to be disappointed when their expectations are not met.  It is very easy to see someone wearing hearing aids and expect them to be able to hear.  Unfortunately, hearing aids do not restore our hearing nor are they beneficial in all situations. 

As discussed in previous blogs, hearing aids are an “aid” to our hearing.  They function best in smaller areas with distance of 3-6 ft. and in quiet situations.  Hearing aids do not necessarily know who the wearer wants to listen to nor can it ever eliminate background noise.  This is also in conjunction with the fact that the anatomy and physiology of an individual with hearing loss is abnormal as well as the natural progression of cognitive decline as we age. 

So what does this all mean?  Well, not only is it important for the hearing aid wearer to have realistic expectations of what a hearing aid can and cannot do, but also for the family members to understand that their loved one will NOT have normal hearing ever again, will always be an individual with hearing loss, and that there are communication strategies that everyone can use to optimize the ability to communicate with a loved one with hearing difficulties.  (See blog Communication Strategies for Family Members With Hearing Loss on 10/24/13)

Employee Spotlight – Darlene

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Darlene

About Darlene:

Nurse for Dr. Karen Boone for 15 years.

Happily married to Scott for 25 years and has two wonderful children, Nicole and Alex.

Darlene is an animal lover. She has 3 delightful dogs named Max, Mia and Frodo, who are very much a big part of the family!

Her hobbies and interests include baking (owner of Mia's Cupcakes), crafting, going to thrift shops, and watching baseball. Darlene is the #1 Fan of the St. Louis Cardinals!

Dizziness: Lightheadedness or Vertigo?

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Dizziness: Lightheadedness or Vertigo?  (part 1)

Your ears do more than just help you to hear. The Vestibular System is also useful for maintaining balance. Part of the inner ear contains three semi-circular canals. These are full of fluid that react whenever you move your head. As the fluid shifts within the canals, small cilia (or hair-like protuberances from a cell) are activated and send messages to the brain. These messages tell your brain which direction the body is moving.

You know that feeling of dizziness after you have been spinning around? Well, the fluid in your inner ears was also spinning. That made the cilia move in all different directions and briefly confused your brain. When a person has a vestibular disorder, disruptions somewhere within the inner ear structures or along the nerve or brain pathways may occur.

What is the difference?

Dizziness is often used to describe either lightheadedness or vertigo, so it is important to know the difference in symptoms to help narrow down the list of possible problems.

Vertigo is the illusion that you or your surroundings are moving (rotating, spinning, leaning, falling) without actual movement. Severe vertigo can cause nausea or even lead to vomiting.  You may physically lose your balance or even have trouble walking. Vertigo is not the same as motion sickness, though, as this feeling is not actually triggered by repeated motion.

Lightheadedness is the sensation of almost fainting or passing out, but without the feeling that your surroundings are moving. It often disappears when you lie down. When lightheadedness gets worse, it can feel like almost fainting and may sometimes cause nausea to the point of vomiting. It is not uncommon for people to get a bit lightheaded, and it usually is not caused by an inner ear problem (i.e. it could be a momentary drop in blood pressure caused by getting up too quickly).

At Midwest ENT Centre, we work with patients who may be experiencing dizziness, imbalance or vertigo episodes. Depending on the patient’s symptoms, the doctor may request further assessment of the Vestibular System.  I will go into more detail later about some of the tests we perform here.

Definition of a Copay

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A copay is a fixed amount you pay for a health care service such as a physician’s office, hospital, or  prescription.  This amount is set by the insurance company and not by the physician's office. A copay can vary by the type of service or specialty of the physician.
For example, a doctor’s office visit might have a copay of $30.00 and a specialist’s office visit might have a copay of $50. The copay for an emergency room visit will usually cost more.

The physicians at Midwest ENT Centre are considered specialists and copays are due and collected on the day of appointment.
 

Billing Questions:

If you have a billing question please call our office at 636-441-3100, or send a note through our secure Patient Portal (you will need to sign up and activate your portal account first to use this feature or to be able to pay your bill online).

Each physician has a dedicated Patient Account Specialist as follows:

Dr. J. Michael Conoyer  –  Joyce  (Ext. 269)
Dr. Karen Boone  –  Kat  (Ext. 270)
Dr. Robert MacDonald  –  Brenda  (Ext. 272)
Dr. Martin Willman  –  Tanya  (Ext. 267)
Dr. Matthew Conoyer  –  Donna  (Ext. 266)
Dr. Benjamen Conoyer   –  Joyce  (Ext. 269)

Airport Security and Hearing Aids

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Airport Security and Hearing Aids

Many people question if it is safe to go through the scanners at the security checkpoints with their hearing aids.   According to the TSA website, it is not necessary to remove your hearing aids, but you should inform the security officers that you have them.  It is actually better to leave the hearing aid(s) in your ear(s) so that you can better hear instructions and answer questions from the Security Officers.  If you still feel uncomfortable going through the scanners because of your instruments, you can ask for a full-body pat down.  If this is the case, the security officer may ask to inspect your device if needed.

Always ask (politely, of course) the security officers to look directly at you so that you can better understand what they are saying to you.  Simply explain you are hearing impaired and that it would be better if they could look directly at you.  You should then have no problem going through airport security.

Communicating With Hearing Impaired Family Members

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COMMUNICATION STRATEGIES FOR FAMILY MEMBERS

If you have a loved one who suffers from hearing loss, you understand the frustration that accompanies a conversation with them.  Even with hearing aids, that loved one is still hearing impaired and could use a little help on your part to optimize the listening situation.  Below are a few simple steps you can take to do just that:

1)      SAY THEIR NAME – Because it takes so much effort for a person with hearing loss to hear and comprehend, it is best to get their attention before speaking.  Say that person’s name and let them know you want to have a conversation. 

2)      “WALK BEFORE YOU TALK” (Remensnyder, Linda) – We all hear better when we can see who is speaking, read their lips, watch facial expressions and hand gestures; therefore, don’t expect someone with hearing loss to hear and understand you when they cannot see you. 

3)      TURN IT OFF – We all hear better when there is less noise around; therefore, make sure to turn off any competing sounds (e.g., TV, radio, dishwasher, etc.)

4)      SLOW DOWN – It is not necessary to shout at someone wearing a hearing aid if they are still struggling to hear you, simply enunciate your words; talk slowly and distinctly. 

5)      REPHRASE – If the hearing aid wearer says “what,” don’t repeat the exact same sentence; rephrase what you have said in order for them to use all of the information to fill in the blanks. 

6)      BE PATIENT – If you think it’s frustrating, just image what it is like on their end.  It can be very lonely and isolating when you cannot hear especially when you know that your better hearing loved ones are frustrated with you.  Communication is a two-way street.  Try to understand that your hearing impaired loved one has a disability and that you can help the conversation by implementing these simple communication strategies.

Recycling Hearing Aids

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Ever wonder what they do with old hearing aids? The ones that no one wants anymore because they are no longer working, or the technology is so outdated? What about grandpa’s hearing aids after he passed away? Can they be used again by someone else, or do they just get thrown away with the trash?

Audiologists get asked this question a lot. After spending so much time and money on hearing technology each year, what happens to the old, outdated, or unused amplification devices that are just collecting dust in drawers everywhere? Well, let me tell you that there is a better place for them to go than the trash can. Just like old computers and cell phones, hearing aids can be recycled, too. It’s better for the environment, and the used aids go towards a good cause.

Did you know that hearing loss affects 1 in 10 Americans, yet many cannot access the hearing devices that can help them? For several years now Mid-West ENT Centre has been working with a national organization to do something about this issue. Since 1973, the Starkey Hearing Foundation has been dedicated to helping the hearing-impaired. Each year, they donate thousands of free hearing aids to needy individuals and children around the world, improving many through their international outreach programs.

Mid-West ENT Centre is proud to be a participant in the Hear Now national program, which is committed to assisting U.S. residents with hearing loss who may not have sufficient resources to get hearing aids. The Starkey Hearing Foundation provides the aids and runs the program, but they count on the generosity of Hear Now providers and donors across the country.

How can you help? It’s really easy! You just drop off your hearing aids here at Mid-West ENT and we will send them in for you. Any make or model, regardless of age, can be donated. All donations are also tax deductible! Just fill out one of the donation forms and a letter of acknowledgment will be sent. If you want to remain anonymous, that’s fine too.

To learn more about the Starkey Hearing Foundation or the Hear Now program, just go online to http://www.starkeyhearingfoundation.org/programs/  or call (866) 354-3254

Does Your Hearing Aid Have A T-coil?

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Do you know if you have a t-coil in your hearing aid?  In the United States, 65% of all hearing aids dispensed have telecoils – or t-coils.  A telecoil can increase the functionality of your hearing aid or cochlear implant with little cost or effort on your part. 

A t-coil is a small copper wire wrapped around a metal rod which is built into most hearing aids and all cochlear implants.  T-coils receive magnetic signals transmitted from a sound source.  Those signals from the t-coil are then processed through the hearing aid which has been programmed to correct for the individual’s hearing loss.  So…a telecoil is like a wireless antenna coupled to a sound source that delivers a customized sound directly to the hearing aid user.

When do you use a t-coil?  T-coils were originally used to enhance the magnetic signal from a telephone handset so a hearing aid user could hear better on the telephone.  In fact, if you see a phone advertised as “hearing aid compatible”, it means the phone works with a t-coil equipped hearing aid.  T-coils can also be used with your TV at home, MP3 players, or computers.   It’s becoming more common to use t-coils with hearing assistive technology that may be found in churches, meeting rooms, theaters, airports, tour buses, and other places.  This kind of hearing assistive technology is called a hearing loop and it can make a huge difference in how well you understand speech from a distance, when background noise is present, or in a room with poor acoustics.  More to come on hearing loops in the next blog – it’s an important topic!

T-coils are standard in most behind-the-ear hearing aids and don’t add anything to the cost of the aid.  If space allows, t-coils can be added to many in-the-ear type hearing aids.  T-coils are activated by pressing a button or switch on your hearing aid – very simple!  Whether you currently wear hearing aids or are just now considering your first set of aids, be sure to have your audiologist explain the benefits of t-coils.

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