Auditory Diagnostic Testing
Diagnostic Testing
Basic Comprehensive Audiogram
Electrocochleography (ECoG)
Auditory Brainstem Response (ABR)
Otoacoustic Emissions (OAE)
Vestibular Evoked Myogenic Potentials (VEMP)
Moving Platform Pressure Test (PPT)
Computerized Dynamic Posturography (CDP)
Vestibular Autorotation Test (VAT)
Rotational Chair Testing
The Epley Omniax
Videonystagmography (VNG)
Labroratory Test
Radiographic Studies (CT Scans, MRI, etc.)
Tympanic Membrane Displacement (TMD)
Diagnostic Testing
Because the hearing and balance functions of your inner ears are closely related, it is important to comprehensively evaluate the hearing and balance systems whenever either system is affected.
Basic Comprehensive Audiogram
Basic Comprehensive Audiogram is a hearing test that is administered in a soundproof room and requires foam ear inserts or a set of headphones. You will be able to see the audiologist who is administering the tests, and you will have voice contact through a microphone. A series of beeps/tones are presented to evaluate the softest levels one can hear at certain frequencies/pitches. In addition, a series of words are also presented to determine the softest level one can understand. These words help determine scored percentages of speech discrimination abilities. These tests will be repeated at certain intervals to determine stability, patterns of deterioration and/or patterns of improvement.
The following tests are administered by inserting a probe into the outer ear canal. The patient will feel pressure changes and sounds while measurements are determined.
Tympanogram is a mechanical test to determine eardrum movement, middle ear fluid, eardrum perforations, function of middle ear bones, etc.
Acoustic Reflex Testing is used to measure the middle ear muscles and bones response to intense sound.
Acoustic Reflex Decay is used to measure the sustainability of the middle ear muscle contraction.
Electrocochleography (ECoG)
This test measures early electrical responses of the inner ear and hearing nerve. It is helpful in cases of inner ear pathologies. During this test, a soft electrode is deeply placed in the outer ear canal with other electrodes placed on forehead. These electrodes are fed into a computer where sound signals are emitted to the patient’s ears. These impulses of sound are computerized and evaluated.
Auditory Brainstem Response (ABR)
This test evaluates the electrical conduction of the hearing nerve and brainstem pathways. It measures the speed of the electrical impulses that are carried along the acoustic (hearing) nerve and brainstem. During this test, insert electrodes are placed deep in the ear canal and on the patient’s forehead. The patient then relaxes or sleeps as sounds are given through earphones placed over the patient’s ears. These impulses of sound are tracked electronically and recorded as they travel from the inner ear to the brain.
Otoacoustic Emissions (OAE)
Sounds must pass through external, middle and inner ear structures within the hearing system before the brain decodes them. This test is used to monitor the function of the outer hair cells within the organ of hearing in the inner ear. You will sit in a chair, and a small probe will be placed in your ear canal. A series of tones are generated which will stimulate the outer hair cells in different regions within the organ of hearing. These hair cells generate an acoustic response, which is measured by the probe. The response is averaged over time and graphed on the computer screen.
Vestibular Evoked Myogenic Potentials (VEMP)
Vestibular Evoked Myogenic Potential (VEMP) is used to determine the integrity of a sensor in the inner ear.
The cVemp testing procedure consists of placing electrodes to the middle third of the anterior (front) neck muscles (sternocleidomastoids) and the forehead. With the patient in a supine (laying back) position, the patient is instructed to hold their head up with no support surface using their anterior neck muscles thus creating a muscle contraction. Tones are then repetitively presented to each ear. Patients are instructed to contract their neck muscles during acoustic stimulation and relax between sound stimulation.
The oVemp test is performed by introducing tones into the ear as well. However, electrodes are placed around the eye to measure eye muscle contraction.
Moving Platform Pressure Test (PPT)
Under normal conditions, changes in pressure outside the body do not cause balance disturbances, because the inner ear is sealed. When a microscopic opening is present, the balance system of the inner ear that is affected will be abnormally stimulated when pressure changes occur. This causes certain symptoms and postural responses that can be recorded.
While you stand on the Computerized Dynamic Posturography platform, an ear probe that is connected to a pressure device is inserted into the ear canal to enable the presentation of air pressure changes. Changing the air pressure in the ear canal causes a corresponding change of pressure in other parts of the ear as well. If a defect is present, certain symptoms or postural changes may result, and these may help verify inner ear dysfunction.
Computerized Dynamic Posturography (CDP)
Posturography tests the interrelationship of all parts of the balance system – the inner ear, vision, and muscles and joints. This test can help determine if one or more of these three systems is abnormal.
To perform the test, you will be asked to stand on a platform surrounded on three sides with a panel painted with pink clouds, blue sky and ocean. You will be fitted with a safety harness, which will prevent you from falling if you should lose your balance during the test. To fit this harness, you need to wear pants.
Electronic sensors and computer monitors record shifts in your body weight that occur while you maintain your balance. These gauges are mounted under the platform. Body sway is also recorded. At times, the platform and/or walls may also move slightly so that your responses to these changes can be monitored. All information is then analyzed by computer to determine the function of your balance system.
Vestibular Autorotation Test (VAT)
Rotation tests evaluate how inner ear control of eye movement is working. Rotation (turning) of the head stimulates part of the inner ear, which then sends messages to the brain, which then causes the eyes to move in a certain direction. This reflex permits clear vision during head motion. The VAT gives information about the faster response of the inner ear while the rotating chair test provides information about the slow speed responses of this system.
This test takes place seated while the patient moves their head side to side or up and down and focuses on a spot on the wall.
Rotational Chair Testing
Rotation tests also evaluate how your systems of eye movement are working. Rotation of the head stimulates part of the vestibular system known as the vestibular-ocular reflex. This reflex responds to rotation by generating eye movements that allow you to maintain clear vision as your head moves.
Testing takes place in a darkened booth. A microphone and speaker in the booth allow you to have voice contact with the technician who is seated at the computer console just outside the door.
The patient is seated in a computerized chair that turns gently from left to right. For your safety, you will be securely harnessed in the chair, and your head will be restrained against a headrest. Your eye movements are recorded as the chair turns by goggles.
During testing, the technician will ask you a series of simple questions; this is called “tasking.” Tasking is designed to keep your mind busy, so you stay alert during testing.
The Epley Omniax
The Epley Omniax multi-axial positioning device is a very effective and useful alternative for both the diagnosis and treatment of complex/atypical BPPV. Developed by Vesticon, the Omniax received FDA approval in 2008. With the Omniax, the patient is seated and harnessed in a chair that allows for 360-degree rotation in any direction while monitoring eye movement with infrared videography. The chair is controlled by the accompanying computer that records video, eye tracings and position. Although many standard maneuvers are programmed into the Omniax (e.g. Epley, Barrel roll, Dix-Hallpike, etc.), many less commonly used maneuvers and a free-style component are included. The Omniax has been shown effective in the treatment of routine case of BPPV, but in the author’s opinion, it is most useful in the tertiary care, diagnosis and treatment of complicated BPPV. The Omniax is well-tolerated by most patients and is preferred by many over the table-maneuvers.
Videonystagmography (VNG)
One easily measured response of the balance system is nystagmus – a rapid, involuntary eye movement. By stimulating the inner ear and nervous system and then carefully measuring eye movements, the physician can learn a great deal about any abnormalities in the vestibular system. This procedure is called VNG, short for videonystagmography, and it means the video recording of eye movements. VNG testing is really a battery of tests that contribute significantly to the information the doctor needs for diagnosis.
During these tests, your eye movements are recorded by the goggles around the eyes. Your eye movements will be recorded and analyzed during the following stimuli:
- Light Targets
- Positions
- Pressure Changes
- Sound stimuli
- Thermal Stimulation
- Vibration
Labroratory Test
Blood studies may be performed to rule out conditions such as anemia, diabetes, hypothyroidism, infections or other conditions that may be interfering with the coordination of brain impulses.
Radiographic Studies (CT Scans, MRI, etc.)
If there is reason to suspect that dizziness could stem from a tumor or cyst, the patient may undergo a CT scan or MRI. X-ray pictures are taken of the brain from several different angles. These images are then combined by a computer to give a detailed view that may reveal the damaging growth. CT scans may be helpful in evaluating inner ear structural abnormalities even if the MRI is normal.
Tympanic Membrane Displacement (TMD)
By measuring eardrum movement in response to different sounds, this test gives information about inner ear fluid and spinal fluid pressure. This procedure is non-invasive, well tolerated, and does not cause dizziness.
What Our Patients Are Saying
When I leave here after a visit, I always do so knowing I have answers to my questions, and I’m confident in what I learned. There is a plan that works for me!
He saved my hearing after I was struck by lightning in 1997. Excellent physician and great bedside manner.
I have nothing but wonderful things to say about Dr.G and staff. I have been coming for 10 years now and they have always taken excellent care of me and seen to my every need. I was in a desperate way when I first found them, after seeing so many doctors who never could diagnose me. So very grateful that he was able to help me. Just the most professional group of people and the most caring I've ever come across. Love them all.
Amazing experience with Dr. Gianoli and his staff. They have been helpful and supportive at every step. Our son couldn't walk without assistance and after surgery, he can walk on his own again!
Traveling from Michigan to Louisiana after 2 years of various doctor visits was definitely worth it! My inner ear issue was finally discovered after thorough testing. A treatment plan was set up and I'm on my way to recovery. For 2 years I lived with dizziness that was unexplainable and undiagnosed - even after several visits to my local ENT and a handful of visits to the emergency room.
I have been searching for answers for two years and spent tens of thousands of dollars trying to figure out why I have all of these symptoms. Dr. Gianoli and his staff have spent so much time with me, testing, talking, and trying to find the root cause and we finally have a plan. I am in tears knowing that someone believes me and actually can SEE what I am feeling.
I am very satisfied with Dr. Gianoli's professionalism. I would recommend him to anybody who has ear problems without hesitation. He is a good hearted man that truly cares about his patients.
The obvious concern for the patient is overwhelming. Everything thoroughly examined and explained. Dr Gianoli ended my 3 year search for what was going on. All other health care systems gave up or said It was in my head, they are right, it was in my ears. Dr Gianoli and his ENTIRE staff worked diligently and nonstop for all the tests. He went thru results, concerns, and solutions. I was truly at my wits end and didn't know what I would do next. Don't delay like I did, listening to others... Go see the center.
Worth the trip from Michigan. Very kind, caring and compassionate. Listen to me and my symptoms. I have been struggling in the dark for 20 years and 11 months.
After 25 years of seeing 50+ Physicians/specialist connected to 3 hospital systems I’ve had my first success in diagnosing and curing my balance issues, one issue cured and one to go. I have come to appreciate what Dr Gianoli and his staff can do for people like myself who struggle with inner ear issues, an answer to prayer.
Wish he could Take insurance I wanted to do my surgery but With him not taking insurance Im out of luck I will continue suffering from Non Stop Dizziness due Superior Semi Circular Dehiscence 😞
I am so very very grateful for Dr. Gianoli’s medical knowledge and care! My life has been greatly improved with his treatment and will continue to get better!! Dealing with vestibular challenges are so very difficult, Dr. Gianoli is the doctor I had been wishing for. So grateful he studies and is an expert in the specialty he does, it has changed my life. We happily travelled from Michigan to his office, very worth it!! He is a kind man and an excellent doctor. Just so very grateful. Thank you.
The staff is professional and kind. Testing is explained. Everyone takes their time, which is nice. Dr. Gianoli is very professional, takes his time when with you and explains everything thoroughly. Much different then other practitioners I've seen. They care about my health.
Dr. Gianoli is one of a kind! 10 stars!! He truly cares about his patients, he takes the time to listen to you, and explains all results thoroughly. He has performed tests that other doctors had not done, nor even offered as an option. Instead of throwing an inaccurate diagnosis at you just to get you out the door as fast as possible so he/she can get to his next patient; Dr. Gianoli and the amazing staff, takes the time to invest in your care, getting you healthy again. (edited to add this after going through treatment) Finding Dr. Gianoli has been life changing. Before seeing him I was having to use a walker to walk, could not drive, could not look up, fell constantly....my quality of life was non-existent. Now I am back to functioning like normal! Dr. Gianoli gave me my life back and my entire family and I are forever grateful for his awe-inspiring knowledge and dedication.
Dr Gianoli its Great Doctor and understands his patients very well He is very Good With SSCD (Superior Semi-Circular Canal Dehiscence) he is very professional and the staff are very helpful
Dr. Gianoli took me from bed ridden from Vestibular issues to working again! He is personable, professional, experienced and dedicated, in my opinion to helping every person who walks theough the door as are his whole staff! I highly recommend him and Dr. Soilleu !
Dr. Gianoli has a unique and exceptional technical capacity at diagnosis and treatment of neuro-otology related conditions. At the same time he has amazing "bedside manner" and ways of working with patients and their families. He is down to earth and makes very complex issues understandable. He is patient and compassionate from the moment you meet him. The doctor and staff at the Ear and Balance Institute in Covington, LA did intensive comprehensive evaluation that shed light on a condition I have been struggling with since a traumatic brain injury 2.5 years ago. They were all kind, compassionate, and professional and spent many hours with me. Other specialists told me my condition was not treatable and that I would need to just live with it, unable to do many simple things I used to be able to do. I am confident that with Dr. Gianoli I will have great improvement in functioning and quality of life.
Dr. Gianoli and his staff are always prompt, professional and cordial each and every time we have appointments. My wife would not let anyone else touch her ears. Thanks for such an excellent practice.
The office staff and medical professionals are all wonderful. The Audiologist is very knowledgeable and properly prepares the patient for testing. Dr. Gianoli provides results of his examination and tests in a very thorough and understandable manner and takes the time to answer any questions and/or concerns. I always feel I am in very capable hands in dealing with my medical issues.
dr. gianoli changed my life quality in a very positive way!! ..after first SCDS surgery method in johns hopkins all the bad symptoms came back! dr. gianoli did in a revision surgery a perfect work! seemed to me like a wonder.. i come from switzerland in europe. nobody else was able to do this great job!!!
After 3.5 years of chronic balance, vision and hearing problems and bouncing from one uncaring doctor to another, I traveled to the US to see Dr. Gianoli. I finally have a diagnosis and I know what steps need to be taken in order to get my life back. Dr. Gianoli seems to be far more knowledgeable and experienced than any other ENT I have dealt with. He is also very approachable, has great bed side manners and genuinely cares about his patients. His staff couldn't be more professional and welcoming. No wonder this place has the reputation it has and welcomes many foreign patients.
It has been a pleasure to be evaluated & educated by Dr. Gianoli. His staff is professional & very friendly. We are thankful we were referred to him. I highly recommend him!!
I’ve had a great experience with Dr. Gianoli and staff, he is very thorough and spends a good deal of time answering your questions and explaining his diagnosis. My PLF was treated and I’m feeling much better. Highly recommend Dr. Gianoli.
Absolutely the best and most caring doctor I've seen since my TBI 8 years ago. He will not settle for Occam's easiest and simplest answer to any balance problem. Dr. Gianoli is determined to find the answer, not simply the most likely answer. Vastly different in the field of medicine. Having a diagnosis based on fact and not theory makes an immeasurable difference to my outlook on life. I am very thankful I found Dr. Gianoli. I now have a future in front of me.
Dr Gianoli is very thorough each and every visit. I am now 4 years a patient with him and have been more than pleased with the results I have achieved with Dr Gianoli.
We were very pleased with Dr. Gianoli. He was very accessible before our appointment, responding to my questions via email. It will be several weeks before we see if the treatment is effective, but we are very encouraged. Everyone we encountered was very helpful.
The amount of time with the doctor and his staff spends is a very big plus for me. I do not rushed. That is hard to find now-a-days.
I love DR. Gianoli and Kacey and the entire staff. I have been a patient for 11 years. Their kindness and compassion is just as much a part of their treatment as their high level of expertise.
I really appreciated the time Dr. Gianoli and his staff spent with me. There was no rush to get to the next patient. Thanks for the care and concern!
Great experiences with everyone, staff and Dr. Gianoli. Everyone was very professional and explained all procedures to me thoroughly.
I previously tried seeing several doctors and specialists in DFW for my vestibular neuritis without success. He is a expert in his field, easy to talk to and he has certainly changed my life.
Dr Gianoli and his staff have been wonderful to deal with in the diagnosis and treatment of my SCDS. I have had a complete resolution of my debilitating symptoms, and am back to living life without dizziness. Dr Gianoli is a miracle worker, in my opinion! He gave me back my life!
Overall, this has been the most thorough medical exam I have ever had for my symptoms. Dr. Gianoli and his staff have all been very understanding and compassionate throughout my appointments and testing.
Came for yearly check-up. As always, it was a pleasure to see Dr Gianoli. After almost 6 years of being a patient here, he has become a friend, as well as my doctor. I have made enormous steps back towards health, and I remain so very thankful to have found Dr Gianoli, who, in my opinion, is the best Neurotologist in the country...and I should know...he was the 37th doctor I went to in search for answers to my vestibular problems.
Dr. Gianoli is very thorough in running tests and making a diagnosis. He truly cares about his patients and takes a personal interest in their progress.
Dr. Gianoli and his staff were very thorough in their testing and diagnosis, and he spent as much time with my wife and I as necessary to explain their diagnosis, treatment options and to answer any questions we had.
When no other physician could accurately diagnose the cause of my hearing loss and dizziness, Dr. Gianoli not only diagnosed but performed a minor surgery that has eliminated the debilitating dizzy spells and nausea which accompanied them.
He has an excellent manner and is very detailed in his explanation of the problem. I felt very comfortable with him, as he is easy to talk to.
If you have an inner ear problem, this is the place to go. The Staff and doctor were very helpful and informative during the visit. All procedures were explained in detail. Doctor took time to explain results and most beneficial treatment.
Very professional I would recommend him to anyone with inner problems. Seems to be very knowledgable in his profession.
Dr. Gianoli was instrumental in helping me with my vertigo. I am still under his care but now only have to see him on a yearly basis as I no longer have problems with vertigo. I still have hearing loss but this is a permenent condition for me and that will be for the rest of my life. But I honestly feel that Dr. Gianoli has healed my vertigo condition. The entire staff is very friendly and helpful. They go beyond the call of duty to do everything they can to make you feel comfortable during your visit.
In 2000, I was diagnosed with Otosclerosis. Dr. Gianoli determined that the left ear was much worse than the right. He operated on my ear that same year. The results were immediate with a marked improvement in hearing. A few years later I began to notice the same gradual degradation in my ability to hear in my right ear with an increased level of tinnitus. I would go to Dr. Gianoli every few of years for testing and evaluation. We both came to the conclusion earlier this year (2014), that it was time I had the procedure done in my right ear. He operated on me on March 13th. Everything went well and my hearing is much improved! A positive side effect is that the level of tinnitus is greatly reduced to the point that I am most often unaware of it. Thanks Dr. G!!
Very thorough, patient, efficient. Wait time at a minimal. Staff and doctor make you feel comfortable.
Very professional and knowledgable. Honest and straight-forward. The treatment, ie surgery, from Dr. Gianoli changed my quality of life.
Dr. Gianoli and his staff are fantastic! Appointments are easy to schedule and you are always seen promptly upon arrival. Office visits are thorough and you are never rushed. I currently travel 1+hour to see Dr. Gianoli, however, I would easily travel 10 hours for care and treatment. He has quite literally saved my life by diagnosing and treating my condition. Thanks to Dr. Gianoli I am able to drive, work and have a family.
Dr. Gianoli's professional manner and medical expertise is exceptional. His treatment of my condition was life changing, I do not know what I would have done without him.
Contact
1401 Ochsner Blvd.
Suite A
Covington, LA 70433
Phone: 985-809-1111
Fax: 985-809-1119
