Re-Positioning Maneuver (Epley)

The Epley maneuver is a series of head movements that restores equilibrium of the vestibular system and relieves symptoms of benign positional vertigo (BPV). BPV is caused by disturbances of the vestibular system in the inner ear when crystals of calcium carbonate clog the semicircular canals and sensory receptors send mixed signals to the brain about the body’s position. There are four major steps that make up the Epley maneuver.
For the first step, you will sit on an exam table with your legs extended. The doctor will turn your head 45 degrees in the direction of the ear that is causing BPV. Keeping your head in place, the doctor will tell you to lie back until your shoulders are resting on the table. Your head, however, will hang over the edge with the affected ear facing the floor. You will remain in this position for 30 seconds or until symptoms of BPV cease.

Second, without changing your elevation, the doctor will turn your head to a 45-degree angle in the opposite direction so that your affected ear faces the ceiling. On this side, the doctor will hold your head for 30 seconds or until BPV symptoms stop.

Third, the doctor will hold your head still and you will roll your body so that you are lying on your side, in the same direction your head is facing. At this point, the affected ear that is causing your BPV is still facing upward. Again, you will remain in this position for 30 seconds or until BPV stops.

Finally, you will slowly sit up and hang your legs off the table, in the same direction you were facing when lying down.

The whole session takes about ten to fifteen minutes. If it is successful, the crystals will become dislodged from the semicircular canals and you will no longer experience BPV symptoms.

Vestibular Neuronitis

Vestibular neuronitis is a disorder of the vestibulocochlear nerve of the inner ear. The purpose of the nerve is to send balance and head position information from the inner ear to the brain. When the nerve is infected or inflamed, it disrupts the flow of information.
Symptoms of vestibular neuronitis include vertigo, dizziness, nausea, vomiting, trouble concentrating and problems with balance. In general, severe symptoms last just a few days; however, these symptoms make everyday tasks very difficult. Full recovery often takes several weeks, but could take months.

This disorder is diagnosed by a specialist such as an otologist, also known as an ear doctor. The doctor may test your hearing and/or balance. One test, called the head thrust test, determines if you can maintain focus on an object during rapid head movement; the doctor will look for uncontrolled rapid eye movement, which is a sign of vestibular neuronitis.

If the underlying cause of vestibular neuritis can be determined, the doctor will first treat that. If a virus is causing symptoms, such as herpes, antiviral medicine is prescribed. (Vestibular neuritis is not caused by bacteria so antibiotics are never used.)

The doctor will also help you manage your symptoms. You may take a combination of anti-nausea medications, anti-dizziness medications (vestibular suppressants) and steroids. If symptoms still present, your doctor may recommend a balance rehabilitation program – the purpose of which is to retrain the brain to adapt to changes in the balance system.

Ninety-five percent of patients only experience vestibular neuritis once in their life, and most patients fully recover.


The inner ear has a mechanism called the vestibular system that controls balance. Inside the system are semicircular canals with ducts, tiny hairs cells (stereocilia) and a thick gel structure called the cupula. When you turn your head, stand up or sit down, the gel moves against the stereocilia and receptors tell the brain that your body has changed orientation.
When the inner ear becomes infected, grows a tumor or encounters trauma, these structures may malfunction. When this happens, you can experience vertigo and other balance related symptoms. For some people, balance and inner ear disorders are hereditary and lifelong.

Symptoms of vertigo go beyond simply dizziness; they include feeling disoriented, nauseous and weak as well as producing erratic eye movements. Vertigo is sometimes associated with an illusion of movement – feeling like you are swaying or falling even if you are perfectly still. Since vertigo is connected with inner ear problems, someone experiencing vertigo may also have hearing loss and ringing or discomfort in the ears.

The most common tests for inner ear-related vertigo or balance issues include electronystagmogram (ENG) or videonystagmogram (VNG) procedures wherein warm or cool air is softly blown into the ear canal and then eye movements are measured. The purpose of this is to test the strength of the inner ear as well as eye movement coordination.

Treatment for vertigo takes many forms depending on the cause. Your physician will try to target the underlying condition in order to reduce or eliminate the symptoms. Options include medications (antihistamines, sedatives, antibiotics, steroids), physical or occupational therapy, surgery, repositioning exercises, vestibular retraining programs and lifestyle modifications such as dietary changes and elimination of alcohol and nicotine.


The most common form of vertigo is benign positional vertigo (BPV). BPV is a sensation similar to spinning and can be triggered by tilting your head up or down, turning over, lying down or getting up. BPV is caused by disturbances of the vestibular system in the inner ear. BPV occurs when crystals of calcium carbonate clog the semicircular canals, because the vestibular system then sends mixed messages to the brain about the body’s position. Although the most common symptom of BPV is dizziness or a “spinning” sensation, other symptoms include vomiting, blurred vision, nausea, lightheadedness and loss of balance. BPV is diagnosed by a test called the Dix-Hallpike maneuver wherein a doctor holds your head in a certain position while you lie down quickly. The doctor then monitors eye movements and asks you to describe your symptoms.

Speech Evaluations

Speech disorders occur when a patient (typically a child) has trouble producing certain sounds. They can be broken down into different categories depending on the nature of the problem. Speech disorders include:
  • Articulation disorders. The patient has trouble with certain syllables, or pronounces words incorrectly to such an extent that it is extremely difficult to understand what is being said.
  • Fluency disorders. These are characterized by interruptions in the normal flow of speech. Stuttering – an abnormal repetition or prolonging of sounds, syllables or words – is the most common fluency disorder.
  • Voice disorders. These involve problems with pitch, volume or voice quality.
  • Dysphagia. Swallowing disorders can also cause trouble with speech.

Speech-language pathologists (SLPs), commonly referred to as speech therapists, can evaluate a patient’s speech, language, cognitive, communication and swallowing skills in order to diagnose a speech disorder.

The SLP will gather a history of the child’s health, family, development and school performance before the evaluation. Depending on the age and attention span of the child, the evaluation may be completed in just one session, or it could span over several sessions. The length of the session depends on the SLP’s plan and the child’s cooperation.

The SLP will likely evaluate the following categories:

  • Understanding and use of different words
  • Correct use of words in correctly formed sentences
  • Use of language for different purposes
  • Pronunciation of speech sounds
  • Physical ability to produce speech
  • Voice quality
  • Fluency or smooth flow of speech
  • Fine motor skills.

Pediatric Services

Pediatric audiology is the study and treatment of hearing loss in infants, toddlers and children. Our experts evaluate and treat children of all developmental stages. Our goal is to detect and treat hearing loss in children as early as possible. Since our audiologists work closely with our ENTs, we can care for your child’s whole hearing health.

Hearing is essential for babies’ and young children’s social and cognitive development. It is especially important to treat deafness in children so that they can cultivate essential speech and communication skills during their early developmental years. This is why we focus on early detection and treatment of hearing loss.

We offer many of the same diagnostic services for children as we do adults. However, we recognize that children respond differently to testing and may have a lesser ability than adults to focus or respond to stimuli. We therefore incorporate a more fun and caring approach with children.

For children old enough to follow instructions and respond to sounds, we use testing methods made to feel like games, such as conditioned play audiometry and speech audiometry (word recognition). Physiological tests are used for infants who cannot respond to behavioral tests. These include otoacoustic emissions, acoustic reflex testing, auditory evoked potential testing and auditory steady state response. Our audiologists are able to recommend facilities that can provide these advanced diagnostic tests.

Balance Disorders

A balance disorder is any condition that makes you feel dizzy or unsteady, even without actual movement. This is of special concern to older adults, putting them at greater risk of falling, which can lead to serious injury such as a hip fracture. Studies show between 12 and 67 percent of elderly individuals who fracture a hip die within a year. Figuring out what is causing dizziness is important, regardless of your age.

Because the inner ear is responsible for balance, most cases of dizziness originate here. The inner ear contains the labyrinth, a bony maze-like structure consisting of the cochlea, semicircular canals and vestibule. The latter two make up the vestibular system, which detects the position and movement of the head in relation to gravity and transmits this information to the brain. This process enables balance and reflexive eye movements. Abnormal vestibular signals cause the body to make incorrect adjustments, leading to dizziness or vertigo.

Dizziness causes you to feel faint or lightheaded. It may be accompanied by disequilibrium (loss of balance), nausea, confusion, disorientation and a floating sensation. This is the result of your brain sensing movement when none is occurring, which is often caused by a quick drop in blood pressure. There are many other conditions that may be responsible including ear infections, neurological disorders, anemia, inner ear abnormalities and more.

The key to treating dizziness and balance disorders is finding the underlying condition responsible for your symptoms. This requires a thorough examination by your doctor and may include diagnostic testing. Treatment may consist of medication, physical or occupational therapy, surgery, vestibular rehabilitation and lifestyle modification.

Custom Earmolds

Earmolds and fittings are an essential service for the health of the ear. Although we primarily provide custom molds to fit hearing aids, we also do fittings for sound plugs, earpieces, earbuds and swimmer’s plugs.

Hearing aids come in shapes and sizes as unique as people’s ears. We offer a variety of earmold styles including canal (or dome) earmolds, which are made to fit inconspicuously in the ear canal; full-shell earmolds, which are built to prevent feedback and falling out; half-shell earmolds, which only cover the bottom half of the concha bowl; skeleton earmolds, designed for comfort; and semi-skeleton earmolds, similar to skeleton but without the back ring. Each of these styles is custom molded to the patient’s ear for comfort and effectiveness.

We also create custom earmolds to help protect the ears from hearing loss. People who have jobs in noisy locations, such as airports or construction sites, benefit from custom-fit sound plugs to prevent damage caused by noise exposure. Swimmers need earplugs to prevent water blockage, which can cause temporary hearing loss. There are certain earplugs for hunters that protect the ears from the loudness of gunfire while allowing safe sounds to be heard naturally. Musician plugs maintain the integrity of the music playing while reducing sounds to safe levels.

Others who may be at less risk for occupational hearing loss can still benefit from having custom-molded ear equipment. For example, doctors may have custom molded stethoscopes and office workers may benefit from custom earpieces for their phones. The purpose of these custom fittings is to provide comfort for the patient.

Our goal is to care for our patients’ whole hearing health. Please contact us to learn more about earmolds and hearing protection.


Tinnitus is described as an irritating buzzing, humming or ringing in the ears. What many don’t realize is that it is usually a symptom of a greater problem rather than a disease itself. The first step in treating tinnitus is to diagnose the underlying issue.

Some common causes of tinnitus include impacted wax in the external ear, an infection, middle ear or nerve tumors, circulation disorders, noise-induced hearing loss of the inner ear, migraines and epilepsy. It is important to see an audiologist for tinnitus symptoms to identify or prevent hearing loss.

Tinnitus is nearly impossible to evaluate objectively. The doctor will ask a series of questions such as which ear is experiencing the symptoms, whether or not it is constant, if you can describe it, how loud does it seem, what conditions affect it or make it worse and how much it disrupts your daily life.

Usually tinnitus is merely an irritation, but it also can be a symptom of hearing loss. Audiologists can work with ENT doctors to determine if a hearing aid is necessary. Hearing aids and tinnitus maskers can work together to both override tinnitus symptoms with more tolerable sounds and assist with regular hearing.

It is best to treat the underlying cause of tinnitus, but the cause cannot always be determined. This means there is not always a specific cure. Some alternative treatment options include hypnosis, counseling, relaxation therapy, biofeedback and tinnitus maskers, which are like hearing aids or white noise machines. Self-help groups are another option for those suffering from mild forms of tinnitus. They can provide resources and support to help people feel more in control. Your audiologist can help determine what treatment option is best for you.

BAHA Mapping

A bone-anchored hearing aid (BAHA) is a surgically implanted hearing aid that works by transmitting soundwaves directly through the skull rather than through air waves passing through the ears. People with normal hearing can hear sounds coming through both air waves and through bone. Those with outer or middle ear damages, however, are often unable to process sound waves through air. This is where BAHA comes in.
BAHA consists of three parts: a titanium fixture, an abutment and an external sound processor. The fixture is surgically implanted into the bone behind the ear so that only the abutment is visible. The sound processor, which “catches” the vibrations of sound waves, transfers the waves through the fixture into the bone and then to the inner ear or cochlea. It allows the user to still hear sounds naturally, similar to how one hears their own voice.

The audiologist will fit and program the BAHA device’s external components to your unique hearing situation. The programming system is called mapping; maps are programs that are customized for the user’s implant. Frequent customized mapping provides the best hearing experience for the user. The way the audiologist performs mapping is by using beeps to adjust the device’s processors.

BAHA is suitable for those with conductive hearing loss, unilateral hearing loss, single-sided deafness and mixed hearing losses due to damages to the middle or outer ear. This is because the BAHA system bypasses these features and transfers sound directly from outside the head into the inner ear.

It is possible to test the BAHA system to see if it will work for you. Your doctor can connect the BAHA sound processor to your head via headband, which will provide a similar hearing experience as the implant.

Hearing Test

The process of hearing requires interaction between the ears and the brain. Hearing tests determine whether or not the two are working together, and if not, what exactly needs to be fixed.

Sound waves travel through the ear canal and into the eardrum. These waves move at a certain speed (frequency) and have a certain height (amplitude). Faster frequencies emit a higher pitch, and taller waves produce louder sounds. These characteristics translate to nerve impulses against the eardrum, which then are sent to the brain. This is the process of hearing.

There are many types of hearing tests that determine what kind of hearing deficiency a patient has. Most require the patient to verbally or physically respond to various types of sounds. Different testing methods are used depending on the patient’s age, the doctor’s concerns and other factors.

One of the most common testing methods is pure-tone audiometry testing. This test determines what volume of sound a patient can hear at different frequencies. The audiologist presents a tone through the speakers, and the patient indicates whether or not they can hear it. This test establishes whether a patient is impaired from hearing specifically high or low tones.

A variation of pure-tone audiometry testing is speech testing, sometimes referred to as “whispered speech test.” The concept is the same, except instead of tones, the doctor will say or play words at quieter and quieter volumes to determine at what point the patient can no longer hear soft noises and discriminate between common sounds used in speech.