County Hearing and Balance

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Getting Hearing Aids
Once you have told us your history and your personal expectations with regard to your hearing, we provide you with detailed advice on the most appropriate products and facilities to meet your requirements:
- Which ear has a problem hearing?
- Which style of hearing aid is most suitable for you: analog, digitally programmable or fully digital?
- Do you want to regulate the volume of the hearing aid yourself, or would you prefer a hearing aid that adjusts automatically to any hearing situation?
- Which aid best suits your hearing loss or your personal situation? A Completely-in-the Ear, In-the-Canal, In-the-Ear (ITE), or behind-the-ear aid (BTE) aid?
Test & Audiometry
In order to adjust your hearing aid to your individual requirements, we first determine your personal hearing profile, or "audiogram." This is done by testing your ability to hear a variety of speech and environmental sounds.
The Ear Impression
Since the various systems produce different hearing impressions, it is important for you to make a comparison yourself. For this purpose we will produce custom-made earmolds based on the exact contours of your ears. We can then ensure that your hearing aid fits perfectly.
The Fitting
To determine the optimum settings for your hearing aids, we use your audiogram, as well as your personal impression of how well you can hear. This adjustment process is carried out using a computer.

When adjusting your hearing aids, we take various measurements to check how well you can hear. Once we teach you how to operate them and instruct you on the energy supply (batteries), you should wear your new hearing aids for a few days in your regular surroundings.

Based upon what you tell us about how well you can hear in your everyday surroundings, we will make any necessary final adjustments to your hearing aids.
Follow-up Care
Once your hearing aids have been fitted to your complete satisfaction, we will provide you with detailed information on how they should be maintained. Of course, you can have your hearing aids checked by us at any time. This will ensure that the sound quality remains as good as ever, and will extend the life of your aids.
Pediatric Services
Since we have a wide range of experience in this field, we are also your best choice to fit children with hearing aids. We pay particular attention to our young patients. In relaxed surroundings, they enjoy having their hearing aid fitted, because we make hearing aid fittings fun. We also offer a range of accessories, tailor-made for our young patients.
Balance Testing
Like many things in life, we rarely give much thought to our sense of balance until something goes wrong with it. Balance disorders range from mild, occasional lightheadedness to severe vertigo that renders an individual unable to get out of bed. Many people consider balance to be a true sixth sense to go along with sight, hearing, touch, taste, and smell. In any case, humans maintainour balance based on input from three primary sources: vision, proprioception, and the vestibular system.
Vision
Obviously, we need to see properly to navigate over and around obstacles in our environment. Our eyes give our brain information about our environment so that our brain can tell the rest of our body what to do.
Proprioception
Also known as somatosensory input, proprioception is information sent to our brain from nerves throughout our body, primarily our legs and neck. Proprioception provides information about the surface we are standing, sitting, leaning, or lying on. Whether this surface is solid or soft, stable or moving is important for our brain to know what to expect and what to tell the rest of our body to do.

Vision and propriception together contribute approximately of one-third of the information to our brain that allows us to maintain good balance. They are external references; they supply us with information about our environment and the objects in it. But how do we know about our own body position and movement? This is the job of our internal reference, the vestibular system.
Vestibular System
The vestibular system is the body's internal balance mechanism, housed within the inner ear. Like the hearing portion of the inner ear (the cochlea), the vestibular organs are housed in a cavity within the temporal bone of the skull. This cavity, which is filled with fluid, is called the labyrinth. The vestibular system includes five distinct structures: three semi-circular canals (anterior, lateral, and posterior), the utricle, and the saccule. Together these structures sense angular and lateral head movement and acceleration based of the movement of the fluid over nerve endings (hair cells) within the labyrinth. The brain receives information from the vestibular organs on each side of the head; the information from one side should be opposite from the information coming from the other side. For example, if you turn your head from right to left, the vestibular organs on the right side will sense head movement away from that side and the organs on the left will sense movement towards that side. When the input from one side does not correspond with the input from the other, severe balance problems can result.
DISORDERS OF THE VESTIBULAR SYSTEM
There are many conditions that can affect a person's balance, some of which have little to do with the vestibular system. Diagnosis of a balance problem may require audiological testing, a neurological examination, and/or other medical tests. It is strongly recommended that you consult your doctor, who will help you decide which tests may be appropriate. Following are some of the more common vestibular disorders.
Labyrinthitis and Vestibular Neuritis
More commonly called an "inner ear infection," both labyrinthitis and vestibular neuritis are viral infections of the inner ear. Labyrinthitis will generally involve sudden onset of both vertigo and hearing loss, whereas vestibular neuritis will cause vertigo without hearing loss.
Meniere's Disease
Named for the French physician Prosper Meniere, this inner ear disorder involves fluctuation of the pressure of the fluid in the inner ear. Symptoms can include vertigo, tinnitus, fullness or pressure in the ear(s), and hearing loss. These symptoms usually come in attacks, often sudden attacks with little or no warning. Meniere's disease will usually start in one ear and will often migrate to the other ear. A progressive, permanent hearing loss often results. Treatment can involve dietary changes and medication.
Benign Paroxysmal Positional Vertigo (BPPV)
This condition involves debris floating in the fluid in the inner ear which, when it moves, causes a false sensation that the head is in motion. Symptoms include short-lived attacks of vertigo following certain head movements, often bending over, looking upwards, or rolling over in bed. Treatment can include a series of head movements, performed by a trained professional, which can move this debris out of the affected area of the inner ear.
Vestibular Migraine
Individuals who suffer from migraine headaches often complain of balance-related symptoms as well. Generally there are no hearing problems associated with this condition, but the person may have a history of motion intolerance such as air sickness or sea sickness. Often the individual has no history of migraine headaches, but does have a history of migraine symptoms such as motion intolerance, light or sound sensitivity, etc. Treatment may include medication.
Vestibular Rehabilitation Therapy
For many balance problems, there is no "quick fix." The brain may need to re-learn how to operate with reduced vestibular function. Sometimes this process can be aided through vestibular rehabilitation therapy (VRT).

VRT is an exciting and successful treatment for dizziness and balance disorders which has emerged over the past several years. This treatment is being used at some of the nation's leading medical and university facilities.

The idea of doing exercises to treat dizziness is not really new - it goes back over 60 years. An English otolaryngologist (ear doctor) found that some of his patients being treated for balance disorders seemed to respond better and more quickly when performing rapid head movements. These movements help the brain to re-learn how to provide adequate balance based upon somewhat faulty information from the balance organs.

VRT usually involves repetitive eye and head movements and will slowly progress towards more complex exercises where the patient is up and moving around. Although many of these exercises can be done at home, certain conditions require the help of a physical therapist at a rehabilitation center. Your audiologist can help in determining which course of therapy will be safest and most effective for you.
Industrial Hearing Services
It is widely known that exposure to loud noise can cause permanent damage to an individual's hearing. Whether this noise is music, gunfire, or machinery, it can irreversible cause damage to the delicate structures of the inner ear which may result in tinnitus, hearing loss, reduced speech discrimination, and other problems. The amount of damage that may be caused is subject to a number of variables, including individual anatomy, the loudness of the noise(s), and the amount of time of exposure.

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