Piedmont Ear, Nose, and Throat Associates (PENTA) provide comprehensive audiological and hearing aid services at all three of our locations. Our audiologists are available to provide a full range of diagnostic testing and state-of-the art hearing aid services. PENTA’s licensed audiologists are dedicated to providing clinical excellence and unsurpassed customer service.

What is an audiologist?

An audiologist is a professional who has received a Master or Doctorate degree in Audiology from an accredited university graduate program. This means your services are being provided by a professional who has between six and eight years of college education, with at least two to four of those years spent exclusively focused in audiology.

What is audiology?

Audiology is the study of hearing disorders through identification and evaluation of hearing loss, and the rehabilitation of those with hearing loss, especially those which cannot be improved by medical or surgical means.

Hearing Science:

An audiological exam tests your ability to hear sounds and understand words. Sounds vary according to the intensity (volume or loudness) and the tone/frequency (the speed of sound wave vibrations).

Hearing occurs when sound waves move to the nerves of the inner ear and then the brain. Sound waves can travel to the inner ear by air conduction (through the ear canal, eardrum, and bones of the middle ear) or bone conduction (through the bones around and behind the ear).

INTENSITY of sound is measured in decibels (dB):

• A whisper is about 20 dB
• Loud music (some concerts) is around 80 to 120 dB
• A jet engine is about 140 to 180 dB

Usually, sounds greater than 85 dB can cause hearing loss in a few hours. Louder sounds can cause immediate pain, and hearing loss can develop in a very short time.

TONE/FREQUENCY of sound is measured in cycles per second (cps) or Hertz:

• Low bass tones range around 50 to 60 Hz
• Shrill, high-pitched tones range around 10,000 Hz or higher

The normal range of human hearing is from 20 Hz to 20,000 Hz, and some animals can hear up to 50,000 Hz.

PENTA provides a full range of diagnostic services

• Comprehensive audiogram – identifies the type and degree of hearing loss.
• Tympanogram – evaluates how well the ear drum is moving; often recommended in children with chronic ear infections or fluid behind the eardrum.
• Otoacoustic Emissions (OAEs) – is an objective test of the function of the outer hair cells in the cochlea (organ of hearing located in the inner ear)
• Auditory Brainstem Response (ABR) – determines the health of the hearing nerve (8^th nerve); often recommended if one ear has better hearing than the other; can also be used as an audiologic threshold seeking tool
• Videonystagmography (VNG) – assesses dizziness and balance disorders
• Electrocochleography (ECOG) – similar to the ABR but looks at a different part of the hearing nerve; used in the diagnosis of Meniere’s Disease.
• Intraoperative Monitoring – monitors the function of the cochlea and the 8^th nerve during certain surgical procedures through the use of ECOG and ABR

What to expect during a Comprehensive Audiogram:

Audiometry provides a more precise measurement of hearing. This is accomplished via headphones or inserts. The audiogram begins with testing your understanding of speech. First, you are asked to repeat two-syllable words that will gradually get softer in level. Then, a list of monosyllabic words will be presented at your most comfortable listening level, which you are asked to repeat. Once speech testing has been completed, pure tone thresholds(the softest level you can hear) are obtained. Pure tones of controlled intensity are delivered to one ear at a time. You are asked to raise a hand, press a button, or otherwise indicate when you hear a sound. The minimum intensity (volume) required to hear each tone is graphed. An attachment called a bone oscillator is placed against the bone behind each ear (mastoid bone) to test bone conduction.

By combining the results of all the different parts of an audiogram we are able to determine your amount of hearing as well as the type of hearing loss.


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.





What to expect during a Otoacoustic Emissions (OAEs):

You must remain silent and still during this test. It is very similar to the hearing test but you are not required to respond to the tones if you hear them. This test is completely objective. A small tip is inserted into the opening of the ear canal. You may hear a series of tones in your ear.



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 begins 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 two weeks 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.

What to expect during Electrocochleography (ECOG) testing: 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 ECOG Instruction Form)

This test begins with a tympanogram to verify the middle ear function. In preparation for the ECOG, the audiologist will scrub your forehead and ear canal before attaching electrodes. This will measure Wave I of the ABR in attempting to observe the cochlear status. It is very important to obtain excellent conductivity, therefore, it is asked that makeup not be worn. After the electrodes are in place, a tiptrode (electrode/insert) is placed in the ear canal. You will hear a loud series of clicks. These clicks will be presented at a slow rate. 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. After the test is complete the audiologist may be able to give some idea of the results, but needs to analyze and then send to the referring physician. It may take up to two weeks for you to receive the results from the physician.

Benign Paroxysmal Positional Vertigo (BPPV)

PENTA also provides treatment for Benign Paroxysmal Positional Vertigo (BPPV) called Canalith Repositioning Maneuver also referred to as an Epley.

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 extended over the end of the table 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 up to 3 times in one session. For several days following the maneuver please refrain from quick head movements.

Please call our office to schedule a repeat maneuver should the symptoms persist after one week.

Hearing Loss

Nearly 30 million Americans have impaired hearing - that's one in ten of the general population and one in three persons over the age of 60. Medical devices such as hearing aids and rehabilitation can substantially reduce hearing loss in the vast majority of patients.

Physicians classify hearing loss as either "conductive", "sensorineural", or "mixed."

A hearing loss is conductive when there is a problem with the ear canal, the eardrum and/or the middle ear including the three bones connected to the eardrum. Common reasons for this type of hearing loss are a plug of excess wax in the ear canal or fluid behind the eardrum. Medical treatment or surgery may be available for these and more complex forms of conductive hearing loss.

A hearing loss is sensorineural when it results from damage to the inner ear (cochlea) or auditory nerve, often as a result of the aging process and/or noise exposure. Sounds may be unclear and/or too soft. Sensitivity to loud sounds may occur. Medical or surgical intervention cannot correct most sensorineural hearing losses. However, hearing aids may help you reclaim some sounds that you are missing as a result of nerve deafness.

A mixed hearing loss is a combination of both conductive and sensorineural type hearing problems.

How do you know if you have a hearing loss?

Many people have a hard time believing or accepting that they have a hearing loss. Some people feel that hearing loss is associated with age and are hesitant to wear hearing aids. Due to machine noise, loud music, or other by-products of our noisy environment, a growing number of people are experiencing hearing loss at younger ages.

Hearing loss occurs gradually, and it is not always easy to determine if you’re experiencing it. Often, people discover their hearing loss from the reactions of others - usually family members.

The following questions may help you decide whether you should have your hearing checked:

1. Do you turn up the TV or radio is louder than other family members prefer?
   
2. Do you have difficulty understanding speech in a background of noise, for instance in restaurants?
   
3. Do you have more difficulty understanding children and women than men?
   
4. Do you experience difficulty hearing in meetings or any group situation?
   
5. Do you have problems hearing at public speaking events or church?
   
6. Do you have ringing in your ears?

A Simple Hearing Assessment

Most hearing losses occur gradually over the years, therefore, it is often difficult to recognize. Try this simple self-assessment of your hearing status. If you answer yes to one or more of the following statements, you should consider scheduling an appointment with an audiologist because you may have a problem with your hearing.

	yes	no
I use “huh” or “what” more than before.
I ask people to repeat themselves.
I need the radio or TV louder than other family members.
I avoid participating in groups because I don’t hear well.
I avoid speaking to strangers because I don’t hear well.
I watch TV less often because I can’t hear well.
I have difficulty understanding some people on the phone.
I try to avoid small talk at family gatherings.
I have trouble understanding people in noisy restaurants.
I find it necessary to watch people with whom I am speaking.
I am bothered by loud sounds.
I have arguments with family members because of my hearing.
I can hear but can’t understand what people are saying.
I have trouble with unexpected speech or rapid speech.
I complain that people do not talk clearly anymore.
I miss the punch line of jokes or key words in sentences.
I have trouble understanding the speaker in church or meetings.
I cannot easily locate the direction that sound is coming from.
I have ringing or other sounds in my ears.

If you suspect you have a hearing loss, please contact our office. We will schedule a comprehensive audiogram to determine the type and degree of hearing loss and advise you on your next step (whether you need to see a physician or can proceed to discuss your hearing options).

Winston-Salem Office: 336-768-0886 or 1-800-955-0532
Kernersville Office: 336-993-2366
Mount Airy Office: 336-786-7366

Hearing Aid Evaluation/Consultation

Once a hearing loss has been identified and all medical concerns have been addressed, you may be seen for a consultation to determine what, if any help is required. Each patient is singularly important, and the PENTA staff is committed to your long-term hearing health care. We strongly believe at PENTA that improved hearing enhances the quality of life at any age, whether it is at home, work, or in social situations such as family gatherings or church. Developing a personalized strategy between the patient and the audiologist is crucial. Educating patients on hearing problems and solutions, plus listening to each patient's needs and concerns, allows us to choose the best possible course of action.

Hearing instruments are changing radically and continuously. At Piedmont Ear, Nose & Throat Associates (PENTA), our audiologists view their role as being the patient advocate - helping you sort through the various technological and stylistic options currently available, to find the hearing solution best suited to your specific hearing loss and lifestyle needs. PENTA offers a wide variety of styles and brands of digital hearing aids from which to choose.

All hearing aids at PENTA are fitted on a 60-day trial basis - regardless of whether you are a first-time user or an experienced wearer upgrading to more advanced technology. We believe allowing you to experience hearing aids in your own home and personal environment helps you to determine what is best for you. If for any reason you choose not to keep the hearing instrument during the trial period, you may return the instrument(s) for a nominal restocking fee. Our professional team of audiologists continually works with you so you can receive maximum benefits from your hearing aids and are properly instructed on the correct use and care of your devices.

If you would like to schedule a hearing aid evaluation/consultation, please contact our office.

Winston-Salem Office: 336-768-0886 or 1-800-955-0532
Kernersville Office: 336-993-2366
Mount Airy Office: 336-786-7366