The purpose of audiometry is to establish an individual's range of hearing.

It is most often
performed when hearing loss is suspected. Audiometry can establish the extent as well as the
type of a hearing loss. Audiometric techniques are also used when an individual has vertigo or
dizziness , since many hearing and vestibular or balance problems are related. Since those with
facial paralysis may also have hearing loss, audiologic testing may be performed on these
individuals as well.

Read more: Audiometry - Definition, Purpose, Description, Risks

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10.6 Procedure
1. For this test it does not matter if the subject can see what the tester is
doing, and this may actually
be helpful. The tester should certainly be observing the subject’s face at all
times.
2. Starting at a level predicted from the audiogram to be comfortable,
present tone pulses for a 1
second duration followed by at least a 1 second quiet period. Ascend in 5 dB
steps until the subject
indicates that the uncomfortable level has been reached.
3. If the subject shows any distress or flinching during the test, stop
immediately.
Note: It is important to adhere to this procedure in order to avoid the use of
unnecessarily high stimulus
levels. 10.7 Stimuli
It is the responsibility of the audiological professional to consider the Noise
Risk Criteria set by the
Physical Agents Directive and balance this for each individual subject against
the clinical benefits
obtained from ULL measurements. Noise exposure from other audiometric
testing (e.g. masking in
pure tone audiometry, real ear measures, acoustic reflex testing) should also
be considered. (See
Physical Agents Noise Directive, 2003/10/EC).
Testing at two frequencies may be sufficient for some subjects, such as a low
and high frequency e.g.
500 and 2000 Hz.
Because the precise effect of high-intensity pure tone signals on the ear is
not fully understood, it is
also recommended that intensities above 110 dB HL should not be used by a
student or less
experienced tester without supervision from a suitably qualified or
experienced person.
10.8 Recording of results
Record the ULL as the hearing level reached as described above. If the limits
of the audiometer are
reached without the subject reporting discomfort, report the ULL as “greater
than x”, where x is the
maximum available hearing level at the particular frequency. See Section 11
for the recommended
symbols.

Figure 3. Recommended format for audiogram forms.

Pure tone audiogram
Name: Age:
Date: Case No:
 ELECTRONSTAGMOGRAPHY (ENG)

Electronystagmography (ENG) is a computerized test that measures the presence, intensity,

and direction of eye movements (nystagmus) during specific types of stimulation. It is used to
evaluate people with vertigo (a false sense of spinning or motion that can cause dizziness) and
certain other disorders that affect hearing and vision.
Electrodes are placed at locations above and below the eye to record electrical activity. A
standard ENG test battery consists of 3 parts: occulomotor evaluation, positional testing, and
caloric stimulation of the vestibular system. The comparison of results obtained from various
subtests of ENG assists in determining whether a disorder is central or peripheral. A central
disorder is related to your neurologic system and how it interprets balance information. A
peripheral disorder is related to an individual part of your balance system external to your brain
and central nervous system (i.e. inner ear, eyes, joints and muscles). While ENG is the most
widely used clinical laboratory test to assess vestibular function, it should be used in conjunction
with other testing and information to accurately determine a

diagnosis. ENG abnormalities can be useful in the diagnosis and localization of site of lesion;
however, many abnormalities are nonlocalizing; therefore, the clinical history and otologic
examination of the patient are vital in formulating a diagnosis and treatment plan for a patient
presenting with dizziness or vertigo.

Patient Risks with ENG Testing

The greatest risk involved with ENG testing is the likelihood of increased nausea or dizziness
through specific portions of the test or at the conclusion of the test. For this reason we typically
suggest that a friend or family member accompany the patient to ensure their safety returning
home after the test.

We utilize closed-loop water calorics in the final part of our ENG testing. This involves cold or
warm water, enclosed in a balloon, being passed through the middle ear space. Because this can
create some pressure, it can be uncomfortable to some patients. It is also not recommended that
this portion of the test be performed on patients with a history of recent ear drum perforation.

There may be other risks depending upon your specific medical condition. Be sure to discuss any
concerns with your physician prior to the procedure.
Preparing for ENG Testing

• Your physician or a staff member will explain the procedure to you and offer you the
opportunity to ask any questions that you might have about the procedure. We will also
do our best to explain each portion of the test as we progress through the procedure.
•
• You may be asked to sign a consent form that gives your permission to do the procedure.
Read the form carefully and ask questions if something is not clear.
• Because of the possibility of increased nausea, we do suggest not eating 4 hours prior to
your test.
• Avoid consuming caffeine and alcohol for 24 to 48 hours before the test.
• Discontinue taking sedatives, tranquilizers, and any other medications as instructed by
your physician before the test. If you have any questions about a specific medication,
please contact our office.
•
• Clean your ears of excessive earwax. Before the ENG, your ears will be examined for the
presence of wax, inflammation, or other problems that may interfere with the test.
• If you wear eyeglasses and/or a hearing aid, bring them with you to the test.
• Due to the use of adhesive electrodes and the need for a clean site for contact it is
recommended to female patients to minimize or avoid applying facial make-up,
especially around the eyes.
•
• Based upon your medical condition, your physician may request other specific
preparation.