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Ears of Texas, PA is a specialized medical and surgical practice that focuses on the discipline of Neurotology. The office is specifically designed to treat all disorders related to the ear and skull base, including all forms of hearing loss, chronic ear disease, otosclerosis, balance disorders (caused by the many different inner ear problems or associated with problems in the central nervous system), facial nerve dysfunction, acoustic tumors, skull base tumors, and concussion injuries.
Our facility and staff are an important reflection of our practice and the quality of care you can expect to receive. All of the technical staff have at least a doctoral or masters degree, and collectively possess many years of experience. The focus of this practice is you, the patient. Our goal is to treat you with the best possible care. The office is equipped with the latest state-of-the-art diagnostic and rehabilitation equipment to evaluate and treat your individual disorder as it relates to the ear.
Since many chronic ear, eustachian tube, or balance disorders are affected by allergies, we offer allergy testing, with a registered nurse, and treatment. To rehabilitate hearing loss, through physician directed licensed audiologists, we provide all the latest forms of listening assistive devices including digital, and analog hearing aids, implantable hearing aids, and cochlear implantation for those patients who cannot benefit with conventional amplification. Dr. Krueger will be able to offer the latest surgical treatments for your balance or specific type of hearing or ear problem, when indicated.
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COMPREHENSIVE HEARING TEST
A comprehensive hearing test consists of three components, each designed to evaluate different parts of the hearing mechanism: pure tone testing, speech testing, and impedence testing. Each component is important in the overall assessment of a patient’s hearing function as well as for the screening for many other disorders.
Pure Tone Hearing Test
This test determines your ability to hear sounds. The high, mid, and low frequency sounds are presented as pure tones, at various levels of loudness. Some are presented through the ear canal and others are presented through a bone vibrator placed behind the ear, allowing assessment of air conduction and bone conduction thresholds. These tests determine the status of both the inner ear (hair cell) or auditory nerve and middle ear conduction mechanism separately. This test is preformed in a hearing booth (sound proof) with head phones on to eliminate any outside noises.
Speech Testing
Speech testing provides information regarding your ability to understand words. Two different types of speech are presented. In the test, a series of words are heard at a degree of loudness to test the ability to hear simple words (i.e., speech reception threshold). A second group of words are heard at a comfortable listening level to determine the ability to accurately repeat different words (i.e., speech discrimination). This test is also preformed in a hearing booth (sound proof) with head phones on to eliminate any outside noises.
Impedance Testing
Impedance testing consists of a number of different tests. These tests evaluate the mechanical sound transmitting properties of the middle ear structures (impedance), the pressure in the middle ear (tympanometry), and some properties of the auditory nerve and reflexes carried by the auditory nerve (acoustic reflexes). These tests also aid in the evaluation of eustachian tube function and middle ear muscles. In impedance testing, a small tipped probe is placed into the ear canal. A low-pitched sound is then delivered to the ear, accompanied by small pressure changes which are similar to changes in altitude. |
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| An AUDITORY BRAINSTEM RESPONSE (ABR) is an examination that can only be ordered by your physician. This is one of many tests that may be recommended for the evaluation of dizziness, balance problems, hearing loss, ear pressure and/or ear noises (tinnitus). The ABR test allows us to determine how well electrical impulses are generated by the inner ear and travel to the brainstem. Specifically, the test helps to determine whether or not there is a blockage in the transmission of electrical signals to the brain. A small percentage of patients may have benign growths on the nerve leading from the ear to the brain (acoustic neuroma). This test can help determine if such a benign growth is present or if your symptoms are due to other causes. The ABR test is administered by placing electrodes in your ear canal or on your earlobes and on your head and forehead. Sounds called acoustic clicks are presented to each ear individually. The electrodes are used to pick up the electrical responses of the ear to the sounds as they travel from the ear through the nerve and up into the brainstem. The test is similar to a brain wave test (EEG) except that you hear the acoustic clicks during the examination. The procedure is painless and you may sleep during the examination. It usually takes about 45 minutes to apply the four electrodes and perform the test. It also will objectively determine the degree of hearing loss in a patient who cannot respond to conventional hearing tests, such as with an infant.
A second portion of this test is the (Latency Intensity Evoked Functions), a series of clicks or tones are presented at varying intensities to objectively assess an individual’s hearing. Small electrodes are taped to the skin near the ear to record the electrical responses of the brain to different sound stimulation. This information is fed into a computer, which can then analyze the responses to determine the location and type of hearing disorder. It can also be used to determine the degree of hearing loss: mild, moderate or server.
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OTOACOUSTIC EMISSIONS (OAE’s) measure the reflection of sounds that are generated by the inner ear hair cells. This measurement allows objective information regarding the function of the inner ear and conductive mechanism of the middle ear without requiring responses from the patient. OAE’s can be measured by presenting a series of very brief sounds (clicks or tones) to the ear through a probe that is inserted in the outer portion of the ear canal. The probe contains a loudspeaker that generates clicks and a microphone that measures the resulting sounds that is produced in the cochlea and is then reflected back through the middle ear into the outer ear canal. The resulting sound that is picked up by the microphone is digitized and processed by specially designed hardware and software. If there is damage to the outer hair cells or problems with the eardrum or middle ear (such as perforations or fluid) producing mild hearing loss, then OAE’s will not be present. Generally, if OAEs are present, the hearing is 35db or better.
Figure: Otoacoustic Emission Pathway
This chart shows an OAE's route from the probe, through the ear, and back to the probe. The two types of Otoacoustic Emissions: All OAE’s are divided into two broad categories: 1) Spontaneous 0toacoustic Emissions [SOAE]—emissions occurring without the presentation of an activating stimulus, and 2) Evoked Otoacoustic Emissions [EOAE]—emissions occurring as a direct result of an activating stimulus |
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CENTRAL AUDITORY TEST BATTERY
This test battery is comprised of several special tests designed to assess the various auditory functions of the brain. The main use is to rule out a central auditory processing disorder (CAPD), in which a person has difficulties understanding speech not attributable to a hearing loss, particularly in noisy background situations. These tests fall into two major categories: behavioral tests and electrophysiologic tests. The behavioral tests are often broken down into four subcategories, including monaural low-redundancy speech tests, dichotic speech tests, temporal patterning tests, and binaural interaction tests. The selection of tests will depend upon a number of factors, including the age of the child, the specific auditory difficulties the child displays, the child's native language and cognitive status, and so forth. For the most part, children under the age of 7 years are not candidates for this type of diagnostic testing. In addition, central auditory processing assessments may not be appropriate for children with significant developmental delays (i.e., cognitive deficits).
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ELECTRONEURONOGRAPHY (ENoG)
Electroneuronography is an electrical test used to evaulate facial nerve function when there has been complete paralysis for less than three weeks. This is a test used to stimulate the nerve just below the ear and record a waveform generated by the facial muscle, called the CAP or compound action potential. The involved side is compared to the opposite uninvolved side. The amplitude of the waveforms are compared, and if the amplitude on the involved side is <=90% of the uninvolved side, surgical decompression of the facial nerve has shown to be effective in improving long-term outcomes for Bell's palsy.
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ELECTRONYSTAGMOGRAPHY(ENG)/VIDEONYSTAGMOGRAPHY (VNG)
ENG/VNG consists of a series of tests used to evaluate the function of the vestibular system by
evaluating known reflexes between the inner ear and movements of the eye. The patient is fitted with electrodes around the eyes (in ENG) or laser goggles (in VNG) that monitor eye movements during various eye movements and manuevers aimed at stimulating the vestibular system.Learn More.. |
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VESTIBULAR AUTOROTATION (VAT)
The Vestibular Autorotation Test (VAT) is a computerized test based on 18 seconds of active head movements to evaluate both the horizontal and vertical vestibulo-ocular reflex (VOR). The VOR is the oculomotor control system that stabilizes our eyes during head rotation, causing the eyes to move in the opposite direction of the head. This natural reflex stabilizes are vision and prevents images from moving as our head and/or body moves. The main purpose of the VOR is to allow clear vision during movement by sending signals to move the eye muscles to compensate for the small rapid head movements that occur in everyday life. The VAT tests the normal, everyday range of motion and speed where many balance disorders occur. The VAT is used to determine very specific problems, aiding both the physician and physical therapist in developing an individualized treatment and recovery plain. The VAT can be used in diagnosis and also monitoring changes during vestibular rehabilitation.
The test itself is patient-friendly: children, adults, and older populations can all easily perform the test without discomfort. The patient wears a strap around their head (much like the inside of a baseball cap) with a sensor to monitor head motion, while electrodes or video goggles monitor eye movements. There are two basic instructions for the patient: you are asked to look at the target and move your head to the computer-generated tone for 18 seconds each trial while moving your head side to side and slowly increasing your speed with the tone and then do the same thing while moving your head up and down direction. |
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Computerized Dynamic Posturography (CDP) is designed to better assess a patients particular balance problem. It allows our physician the ability evaluate a patient based on their three different balance systems: visual, somatosensory, and vestibular.
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SPORT KAT TESTING
The SportKAT testing units is an objective tool used to both diagnosis and rehabilitate a patients balance. The unit allows for many different testing levels, patterns and protocols. Therapists may use the built-in training modes allowing for an unique training protocols when specific deficits are identified during the test phase. The system enables positive visual feedback to the patient and automatically calculates adequate pressure based on the patient's weight and level of difficulty. The SportKAT 3000 is an incredibly valuable tool in the diagnosis, evaluation and rehabilitation of patients with balance and neurosensory deficits. |
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MIDDLE LATENCY EVOKED FUNCTIONS
Middle latency-response testing is similar to the brainstem auditory evoked response (or ABR), but evaluates the auditory system central to the brainstem. This evoked response is obtained with electrodes places on the scalp while a computer evaluation, ABR test is occurring. These evoked responses have the advantage of providing information at specific frequencies which can be related to hearing thresholds at a specific level. |
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COCHLEAR IMPLANT EVALUATION
The cochlear implant evaluation consists of a series of tests designed to determine if a patient with a profound hearing loss is an appropriate candidate for cochlear implantation. This testing uses various environmental sounds and electrophysiological measures to determine if the patient would benefit more from a hearing aid or a cochlear implant. |
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COMPUTERIZED NEUROPSYCHOLOGICAL TESTING
ImPACT for Athletes
ImPACT is a software tool developed to help sports-medicine clinicians evaluate the recovery process following a concussion. The ImPACT program evaluates and documents multiple aspects of neurocognitive functioning including memory, brain processing speed, reaction time and post-concussive symptoms. The computer based test is completed in roughly 20 min, allowing for user-friendly injury documentation that facilitates the tracking of the injury from the field through the recovery process from concussion.
NeuroTrax for General Population
NeuroTrax – Neuropsychological testing evaluates cognitive function, which is the term to describe brain function in terms of component processes (such as attention, memory, hand-eye coordination, and reaction time). While the ability to perform normal activities of daily living (ADL's) is usually taken for granted, it depends on complex brain function and sensory input information from our exterior environment. This computer based program allows our physicians the ability to measure and track a patient’s cognitive function and progress throughout their medical treatment. |
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IMMUNOTHERAPY “ALLERGY SHOTS”
Immunotherapy is commonly referred to as “Allergy Shots”, a preventive treatment program used to desensitize patients from substances to which you are allergic. Research has shown that allergy shots can reduce symptoms of: allergic rhinitis (hay fever), migraines, tinnitus (ear noise), chronic ear infections, fatigue as well as dizziness brought on by Meniere’s or hydrops. First, the doctor or allergist will ask you questions about your environment and symptoms to determine if allergy testing is necessary and will help your symptoms. These tests are conducted to identify the specific allergens that are causing your symptoms, addressing the cause of the problem. Learn More... |
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