Vertigo & Deafness Clinic

Vertigo & Deafness Clinic

Jain ENT Hospital has an advanced vertigo clinic with facilities to diagnose all causes of vertigo. We have a dedicated staff in the clinic which is headed by Dr. Anita Bhandari. She has undergone special training in Otology and Neurotology from Singapore. She has presented many lectures and articles on the subject. All kinds of deafness can be assessed and treated in the hospital. Investigations like pure-tone audiometry, tympanometry, BERA, hearing aid trials, Craniocorpography (CCG) and electronystagmography (ENG), otoacoustic emission [OAE] are done routinely. We have treated over 3000 patients of vertigo.

Special testing is available here for the assessment and treatment of TINNITUS-a problem of ringing sounds in the ears. Tinnitus is a common but extremely troublesome problem. Tinnitus retraining therapy is conducted for suitable patients.

Neurotological Tests
BERA Test – Brain Stem Evoked Response Audiometry is an objective test that gives us the approximate hearing threshold level of the subject. It is a very reliable test to objectively evaluate the hearing threshold of an adult or child across all frequencies except for the low frequencies. It is usually done using a click sound by which the subject’s average hearing threshold across all frequencies can be automatically assessed without the subject having to respond. This test can be used to assess hearing thresholds even in newborn babies.

Pure Tone Audiometry – This is a subjective test in which the result is dependent on the patient’s response. It is considered to be the most informative test in the audiological test battery and is a very reliable test if done by a reliable person. It gives an idea of the hearing threshold in the different frequencies . If there is deafness it tells us whether the deafness is due to defect in the middle ear or in the inner ear or in the nerve of hearing. Localizing tests like TDT, SISI, ABLB and glycerol tests which help in diagnosing the nature and site of lesion are also done here.

High Frequency Audiometry – This special testing is done for patients of tinnitus, sudden hearing loss, hearing loss due to exposure to loud noise, industrial workers etc. We test frequencies from 250 – 16,000 Hz.

Impedance Audiometry – Also called tympanometry, this test tells us about the functioning of the middle ear and also that of the cochlea (i.e. inner ear). This is an objective test (i.e. the results are not dependent upon the subject’s response) and it helps the clinician to identify the nature of pathology in middle ear disorders, like whether it is a case of Otosclerosis, Otitis Media with Effusion, adhesive otitis media etc.

OAE – Otoacoustic Emission Test (OAE) is a very quick objective test to know whether the subject (i.e. the adult / child on whom the test is being conducted) has normal hearing or not. Like the other audiological tests it is a painless test. The test is very commonly used for testing newborn infants to check whether they have any hearing defect. If any deafness is detected then the degree of deafness has to be ascertained by other tests like- BERA / ASSR etc. as OAE cannot evaluate the hearing threshold and it can only tell us whether any deafness is at all present or if the hearing is normal. The OAE test is now mandatory in all newborns in most developed countries and is a must in all infants born of high risk pregnancies.

ENG – Electronystagmography is the basic test for evaluating the functioning of the balance system. It is the primary test of balance function and is mandatory in all patients suffering from vertigo and imbalance, i.e. giddiness and instability. ENG test evaluates the functional and structural integrity of the vestibular labyrinths and that of the vestibulo-ocular reflex system.

CCG – Craniocorpography is a test to evaluate the vestibulospinal system which helps in maintenance of balance. It is very simple, objective test which hardly takes 5-7 minutes time and informs the clinician about the net vestibular status of the patient, i.e. whether the vestibular lesion has compensated or not. This is the most important information obtained from the CCG test and this information is of immense value to the clinician for formulating the treatment protocol in a balance disorder patient. CCG evaluates the functional and structural integrity of the vestibulo-spinal reflex system.

VEMP – vestibular evoked myogenic potentials – This is a test to evaluate the otolith organs, inferior vestibular nerve and vestibulospinal system.

Hearing Aid Fitting – Fitting and Programming of high tech digital hearing aids is another facility that we have at the Vertigo and Deafness Clinic at Jain ENT Hospital. Very sophisticated modern digital hearing aids are dispensed.

FAQ’s
Have you experienced a sensation of spinning, giddiness or dizziness? Do you feel unsteady while walking? If yes, then you could be suffering from Vertigo, which is a false sensation of movement of the surroundings when you are actually at rest. The National Institute of Health has estimated that around 42% of the population experiences some balance problem at least once in their lifetime. Thus vertigo is a fairly common problem. But unfortunately, it is often misunderstood and misdiagnosed.

How is the body balance maintained?
The body is dependent on three systems to give signals about the position of the body- the eyes, the ears and the muscle and joint receptors. These three systems send information to the brain about the present position of the body and the brain then ensures maintenance of equilibrium.

Whom should you consult?
This is the dilemma that a patient faces- who should he/she go to- a general practioner, physician, ENT specialist, ophthalmologist, neurosurgeon? As the causes of vertigo are diverse, so the patients and often the treating doctor wonder who would be the best person to treat the patient. In a large percentage of patients, the vertigo is due to an ear problem. Hence an ENT specialist would be the best person for a preliminary consultation.

How to evaluate a patient?
The doctor will critically evaluate history regarding when the vertigo began, how long the spells last, any associated features like hearing loss, any triggers which bring on the attacks and any associated medical illness. After a detailed history, a complete ENT checkup is done. This is followed by a computerized evaluation of the balance system called electronysatgomography or ENG. A Craniocorpography test is conducted to the balance system in different situations. Unfortunately very few centers in Jaipur have these facilities for evaluation of vertigo.

Treatment
The key to the treatment of vertigo is diagnosing the root cause of the problem and then proceeding to treat it. Specific treatment according to the cause will help the patient improve rapidly. ‘One size fits all’ type of therapy in which a cocktail of drugs is given to suppress vertigo is not recommended.

Common causes of vertigo
BPPV – This condition manifests as sudden onset of vertigo when the patient goes to a particular position like turning to one side in bed. The vertigo lasts for less than a minute. It is a due to calcium carbonate crystals collecting to form larger particles which stimulate the nerve of balance. It can be easily treated by physical therapy in the form of Epley’s manoeuvre.

Meniere’s Diseases
This is a condition in which episodes of vertigo occur along with hearing loss and ringing in the ears. It is due to the increased fluid pressure within the inner ear. This condition can be controlled by medicines

Ototoxocity
This is caused by medicines like Streptomycin, amiakacin, frusemide, etc. which cause weakness of the nerves of balance. These patients can be helped by physical therapy.

It is important for vertigo patients to understand the cause and how treatment will help them.

NEWBORN HEARING SCREENING PROGRAMME

Why does my baby need to have a hearing screening?
One in 1000 babies have significant hearing impairments at birth. They are at a risk for delay in speech, language social development. Early detection followed by appropriate intervention will minimize the harmful effects on the child’s development. Without scanning, this impairment may not be detected till much later.

When & how will my baby’s hearing be screened?
The screening test is performed within the first few days after birth. It is performed by trained staff. It takes 15-30 minutes. The screening is safe and will not hurt your baby in anyway. Screening is done by an instrument called Otoacoustic emission (OAE). For the OAE, a small probe is placed at the opening of your baby’s ears. The instrument makes clicking sounds and the probe listens is the responses (echoes) from the babies ears.

What does it mean if my baby passes the screening test?
This means that your baby’s hearing function is normal at the time of testing. However in some babies, hearing impairment may develop gradually as a result of recurrent ear infection, generic factors or chronic illness. So you must continue to monitor the behavioral response of your child’s hearing. If at any time you suspect your child is not hearing properly, you should consult your doctor.

What if my baby fails the test?
It does not necessarily mean that your baby has a hearing impairment but further investigation will be required.

High risk factors for hearing impairment.
Brain infections
Face and skull deformities
Family history of Hearing loss.
Frequent middle ear infections
Jaundice
Low birth weight
Premature babies
Maternal infections like rubella, herpes, CMV etc.
Milestones of Hearing??At birth: Statrle reflex?3 months: Looking towards source of sound?5-6 months: Turning head towards source of sound?9-10 months: babbling-meaningless words eg Dada, lala?14 months: meaningful words-mummy, papa?18 months: 2 word sentences?24 months: fluent language.??NOISE INDUCED HEARING LOSS??What is noise induced hearing loss & How does it occur???When excessive sound energy strikes the inner ear, it damages the hair cells of the cochlea. If it is brief and not very loud, the noise may cause a temporary reversible damage called temporary threshold shift. This is seen in the initial stages off factory exposure, music concerts, loud i-POD music etc. If the noise is loud and for long duration or sudden and very loud, it may cause a permanent (irreversible) threshold shift.??How can you tell if a noisy situation is dangerous to your hearing???Noise is probably damaging to hearing if the noise

Makes it necessary to shout to be heard over the background noise
Causes ear pain
Makes the ear ring
Causes a loss of hearing for several hours after exposure to noise.

How loud can a sound get before it affects hearing?
Continual exposure of more than 85 dB may be dangerous
Whisper – 30 dB
Normal Conversation – 60 dB
Drill – 90 dB
Firecracker :- 100 dB

Regulations for ‘on the job’ noise exposure
Occupational Safety and health Administration
(OSHA) has advised that habitual exposure above 85dB will cause gradual hearing loss.
The allowed exposure time decreases by one half for each 5 dB increase

Noise level Permitted exposure/day
90 dB 8 hrs
95 dB 4 hrs
100 dB 2 hrs
115 dB 15 min
>140 dB Not permitted
How effective are hearing protection devices?

Hearing protection devices (ear plugs and ear muffs ) decrease the intensity of sound reaching the ear drum by 15-30 dB

ACHIEVEMENTS – DR.ANITA BHANDARI
1. Contributed chapter in book Common Vestibulocochlear Diseases-published by Elsivier in 2012
2. Speaker at International ENT update, Kolkata Oct.2012-Topic-Medical Management of vertigo
3. Speaker at vertigo update,Goa Sept.2012 organized by sathi Foundation. Topic-New Innovations in the field of vertigo
4. Coundected Instructional Cource on BPPV at AIIMS, New Delhi at NES conference. June,2012
5. Elected Executive member of Governing Body, NES India
6. Member of Vertigo Board India
7. Attended Workshop on Tinnitus and Tinnitus Retraining therapy by Prof. Jasterboff ,2012
8. Speaker and Panelist at National AOI conference, Chennai
9. Participated in Vertigo Academy, Italy held by Prof. Georgio Guerdetti in 2011,2010
10. Fellowship in otology and Neurotology from Singapore
11. Conducts regular training programs for physicians and GPs on vertigo