Symptoms of a balance disorder

There are three common symptoms that you may experience if you have a vestibular disorder:

Vertigo

Here you may feel like the world is revolving around you or like you are revolving in space. There is a sense of spinning even while you are standing or sitting still.

Dizziness

This is a disturbed sense of your placement in relation to the world around you; a sense of unsteadiness that comes with moving your head. It is often accompanied by giddiness or lightheadedness.

Disequilibrium

Here you may feel a sense of unsteadiness or imbalance that is worsened by movement or environmental influences.

SELF-BALANCE & DIZZINESS QUESTIONNAIRE:

Do you feel…

A sensation of motion, spinning, or falling when moving your head quickly, or changing your position (for example, when getting in and out of bed)? Yes No
Uncomfortable trying to walk in the dark? Yes No
That walking down grocery store aisles or through a mall is disturbing? Yes No
Your feet just won’t go where you want them to? Yes No
A sense of unsteadiness? A feeling that you are not surefooted? Yes No
Difficulty keeping your balance as you walk on different surfaces, e.g. from tile to carpet? Yes No
That you are drifting or being pulled to one side when walking? Yes No
That no-one really understands how frustrating all this is? Yes No

If you answer ‘Yes’ to two or more of these questions, it’s time to consider a vestibular and equilibrium evaluation. The good news, however, is that in 90% of cases, these balance disorders can be successfully treated once they are properly diagnosed.

Again, if you have two or more of these symptoms, please contact us today. We can help.

Our Assessments

Here’s what you need to know about Tami Mehl Audiology diagnostic assessments:

  • They usually require approximately 3 hours of your time.
  • We conduct an extensive evaluation involving several professionals. The team usually includes an audiologist, ear nose and throat (ENT) specialist and/or a neurologist.
  • The assessment may leave you feeling slightly dizzy or off-balance, so it’s a good idea to arrange for someone else to drive you home afterwards.

Tami Mehl Audiology carries out a wide range of assessments. Yours may include:

  • Diagnostic hearing assessment
  • Posture and gait assessment (using Computerized Dynamic Posturography or CDP)
  • Positional and positioning assessment
  • Videonystagmography (VNG)
  • Auditory Brainstem Response (ABR) testing
  • Vestibular Evoked Myogenic Potentials (VEMPS)
  • Video Head-Impulse Test (vHIT)
  • Dynamic Visual Acuity (DVA) & Gaze Stabilization Test (GST)

Please click here to download a PDF containing more info on the above assessments.

Please click here to download our list of instructions if you’ll be undergoing a VNG.

Possible Causes

There are several causes of vertigo, dizziness and/or balance disorders and the exact cause of your specific condition can only be determined as part of an extensive evaluation by an audiologist, ear nose and throat (ENT) specialist and/or a neurologist.

Having said that, we’ve found that vertigo and dizziness are generally caused either by the ear and/or nerves (peripheral system) or by central disorders. Other causes include medical disorders, infections, anaemia, diabetes mellitus, psychiatric disorders or drugs.

To read up on some of the medical disorders that can cause these conditions, click here.

Vestibular Rehabilitation Therapy

Vestibular Rehabilitation Therapy (VRT) is an exercise-based programme for reducing the symptoms of disequilibrium and dizziness that are associated with a vestibular pathology (disease or disorder).

Why exercise rather than medication? Research has found that, over the long term, medications that suppress vestibular function can cause drowsiness and limit a person’s ability to function fully. VRT is an alternative treatment protocol, involving specific exercises that eliminate or significantly reduce the symptoms of disequilibrium and dizziness and promote recovery.

New Treatment! Tami Mehl Audiology is one of the few vestibular practices internationally to offer treatment for Mal de Debarquement Syndrome (MdDS) – a rare, disabling movement disorder characterised by the continuous sensation of rocking or swaying while on solid ground. This treatment has been proposed by Mount Sinai Hospital and our success rates have yielded the same results as those reported by Mount Sinai Hospital, of over 70%!

To read more about Vestibular Rehabilitation Therapy (VRT), please click here for a PDF.

Why test newborn hearing?

A child with undetected hearing loss may not be able to develop the normal speech and language needed for learning. What’s more, children whose hearing loss is not identified until they are two or three years old may also suffer from permanently impaired speech and language skills. These can lead to learning, social and emotional difficulties.

Tami Mehl Audiology believes in the early identification of hearing loss, to allow for intervention, if needed, at a young age.
 All babies can and should have their hearing tested before leaving the hospital after birth, or before their six-week check-up with the paediatrician. Screening is available at most hospitals, as soon as 12 hours after birth.

Babies who’ve been in NICU

If your baby has spent time in NICU, we strongly recommend an additional screening test, called an Auditory Brainstem Response or ABR. During this test, sounds are played into the baby’s ears and electrodes are gently placed on the baby’s head to detect responses.

The test measures how the hearing nerve responds to sounds and can identify babies with hearing loss.
 If a baby seems to have hearing loss, he or she is referred for diagnostic testing. Hearing aids and therapy may be needed to help the baby listen and speak.

Our type of hearing screening

How do you test a baby’s hearing? Better Balance & Hearing uses Oto-Acoustic Emissions (OAE) in our hearing screening. This type of special electrophysiological testing does not require a behavioral response from the baby. During this test, a miniature earphone and microphone are placed in the ear, sounds are played and the baby’s response is measured.

If the baby hears normally, an echo is reflected back into the ear canal and is measured by the microphone. If a baby has fluid in the ear from after birth, an ear infection or a possible hearing loss, no echo can be measured and further testing may be required.

Where do we test babies?

Tami Mehl Audiology offers neonatal hearing screening at these maternity units:

If you have a concern, question or related issue, please contact us today. We can help.

Why test children’s hearing?

Hearing loss, in varying degrees, affects three in every 100 children under the age of 18. Both hearing and speech are essential tools for children to be able to learn, play and develop social skills. They learn to communicate by imitating sounds they hear. So, if a child has a hearing loss that is undetected and untreated, they can miss a lot of the speech and language around them, resulting in delayed speech or language development, social problems and academic difficulties.
This is why we believe in paediatric audiology.

How we screen kids’ hearing

Tami Mehl Audiology offers a wide range of age-appropriate testing and evaluation services for newborns, infants, toddlers, school-age children and adolescents.

For example, for infants we use a type of electrophysiological testing, known as known as an Oto-Acoustic Emission (OAE), that does not require a behavioural response. During this test, a miniature earphone and microphone are placed in the ear, sounds are played and the baby’s response is measured. If the baby hears normally, an echo is reflected back into the ear canal and is measured by the microphone.

To read more about newborn hearing, please click here to download a PDF.

For babies of 6 months or older, we use a mix of electrophysiological and behavioral testing to detect hearing loss. The behavioral testing used is similar to that of a standard test battery, with modifications, such as Visual Reinforcement or Conditioned Play Audiometry.

To read more about types of paediatric hearing loss, please click here for a PDF.

To access our pre-school and school-aged children checklists, please click here.

Auditory processing issues

Would you say that, despite having no hearing loss, your child doesn’t seem able to process the information he or she hears, in the same way as other children?

There’s a chance that your child has Central Auditory Processing Disorder (CAPD), a complex problem affecting school-aged children. In CAPD cases, the child’s ears and brain don’t fully coordinate and so he or she can’t process auditory information normally.

Symptoms of CAPD range from mild to severe and take many different forms. However, if the auditory deficits aren’t identified and managed early, children with CAPD may have speech and language delays and experience significant academic problems.

Take this quick CAPD quiz:

CENTRAL AUDITORY PROCESSING DISORDER (CAPD):

Does your child experience…

Difficulty hearing in noisy environments (e.g. the classroom)? Yes No
Difficulty following long conversations? Yes No
Difficulty hearing conversations on the telephone? Yes No
Difficulty learning a foreign language or challenging vocabulary words? Yes No
Difficulty remembering spoken information (i.e. auditory memory deficits)? Yes No
Difficulty taking notes? Yes No
Difficulty maintaining focus on an activity if other sounds are present? Yes No
A difficulty with organisational skills? Yes No
Difficulty following multi-step directions? Yes No
Difficulty in directing, sustaining, or dividing attention? Yes No
The difficulty with reading and/or spelling? Yes No
Difficulty processing nonverbal information (e.g. lack of music appreciation)? Yes No

If you’ve answered ‘Yes’ to one or more questions, please contact us today. We can help.

What’s hearing loss?

A hearing loss is more than the inability to hear loudly enough. People with a hearing loss experience problems in hearing and localising a sound source. They may also have a discrimination loss – that is, difficulty discriminating words from each other, even if they are fairly loud. They can hear the words, but fail to understand the spoken message.

How the normal ear works


Hearing loss can affect people of all ages and can occur anywhere in the auditory system. If it occurs in the outer or the middle ear, it is a ‘conductive’ hearing loss. If it occurs in the inner ear or in the nerve fibres, it is a ‘sensorineural’ hearing loss.

Causes of hearing loss

The most common type of hearing loss is the natural deterioration of hearing with age. However, in our continuously developing digital era, frequent exposure to loud noises and music can be detrimental to hearing, regardless of age. In addition, hearing loss can occur:

  • as a result of infection during gestation;
  • through infection;
  • after a head injury;
  • if the eardrum is perforated;
  • as a result of untreated diabetes;
  • as a result of untreated hypertension;
  • as a result of some cancer treatments; or
  • as a result of taking certain medications.

Other disturbances in the auditory system can include tinnitus or hyperacusis.

Take this quick hearing quiz:

HEARING QUESTIONNAIRE:

Do you…

Find that people mumble when they talk? Yes No
Have difficulty hearing on the telephone? Yes No
Have to turn up the volume of the television to hear what’s being said? Yes No
Sometimes miss what’s being said to you? Yes No
Often have to ask people to repeat themselves? Yes No
Misunderstand when people talk and sometimes respond incorrectly? Yes No
Ask others to repeat what they’ve just said? Yes No
Have a buzzing / zinging / roaring sound in your ear/s? Yes No
Have difficulty hearing in crowds/restaurants? Yes No
Have difficulty hearing speech when there is background noise? Yes No
Often have to strain to hear conversations? Yes No
Have dizziness/vertigo? Yes No

If you’ve answered ‘Yes’ to three or more questions, please contact us today. We can help.

Untreated hearing loss

Let’s say that you suspect you may have a hearing loss, but you put off having it diagnosed. This could have serious social, emotional, physiological and psychological effects on you:

  1. Feelings of irritability, negativity or anger
  2. Fatigue, tension, stress or depression
  3. Avoidance or withdrawal from social situations
  4. Damaged interpersonal relationships
  5. Reduced alertness and increased risk to personal safety
  6. Impaired memory and ability to learn new tasks
  7. Reduced job performance
  8. Diminished psychological and overall health

The most serious effect is auditory deprivation – a serious condition that occurs when the auditory nerve and other areas of the brain responsible for processing and interpreting sound are deprived of sound and begins to atrophy or weakens further.

In addition, new studies have shown a significant link between untreated hearing loss and dementia. Even individuals with mild hearing losses are nearly twice as likely to develop dementia compared to those with normal hearing.

Therefore, the key to hearing better for longer is keeping the hearing mechanism active. One way to do this is to use hearing aids – even if the hearing loss is minimal.

Feel free to watch this Youtube video on what a hearing loss sounds like. Or contact us.

Tami Mehl Audiology performs the following range of professional hearing tests.

1. Diagnostic Hearing Tests

Pure Tone Audiometry

This is the key hearing test for identifying an individual’s hearing levels. During this test, the patient will need to indicate a response to a sound. Both air and bone conduction audiometry are needed, to identify the type, degree and configuration of the hearing loss.

Speech Audiometry

Word lists are presented to the patient who must repeat the words read to him/her. The patient’s performance during this test aids the audiologist in determining the type of hearing loss as well as provides valuable insight into the individual’s levels of comfort to speech and word recognition abilities.

Eustachian Tube Function Testing

A functional and patent Eustachian tube is necessary for ideal middle ear sound mechanics. This test assesses the changes in middle ear pressure under varying circumstances in order to determine Eustachian tube function.

Immittance Audiometry
Tympanometry

A small probe is inserted into the outer ear canal, slight pressure is built up in the ear, and measurements are represented in the form of a tympanogram. Tympanograms show the functioning of the middle ear and can indicate eardrum perforations, abnormal pressure, fluid build-up and increased/decreased mobility of the eardrum and middle ear structures.

Acoustic Reflexes

Acoustic reflex measurements are carried out to measure the involuntary muscle contraction that occurs in the middle ear in response to loud sounds.

2. Electrophysiologic Tests

These are measures to partially estimate hearing function and to determine which function of the auditory system is at fault. They’re commonly used for children who can’t be tested behaviorally (due to age, developmental delay, or other medical conditions), as well as adults who are unable to participate in a standard test battery (due to cognitive impairment).

Diagnostic Oto-Acoustic Emissions

This test assesses the outer hair cell functioning of the cochlea. It is commonly used to screen newborn hearing and to assess tinnitus.

Auditory Brainstem Response (ABR)

This test gives the audiologist information about the cochlea and neural pathways for hearing. ABRs are common to test hearing in the following populations:

  • To assess or screen ‘at-risk’ infants, like babies who have not passed the OAE assessment, have spent more than five days in NICU, have a low birth weight, or have low APGAR scores
  • To assess difficult-to-test populations, including children with cerebral palsy, developmentally delayed children or children with medical conditions
  • To confirm hearing loss in medico-legal cases
  • To diagnose auditory disorders, such as auditory neuropathy
  • To conduct intra-operative monitoring; for example, during the removal of tumours on the 8th cranial nerve (vestibulocochlear nerve)

Electrocochleography (ECochG / ECOG) Test

This test is used to confirm the diagnosis of Meniere’s Disease, as well as during intra-operative monitoring or to assist in the diagnosis of auditory neuropathy disorder.

If you’d like more information on any of our testing, please contact us today. We can help.

With advances in technology, approximately 95% of people with a sensorineural hearing loss can be helped with hearing aids. There are many myths surrounding hearing aids. This section addresses some of the more common ones.

The hearing aid myths

  1. Hearing loss affects only “old people” and is a sign of ageing.
    Did you know that, in fact, 65% of people with hearing loss are younger than 64? It can affect all age groups.
  2. My hearing loss is normal for my age.
    Okay. But it happens to be “normal” for overweight people to have high blood pressure. This doesn’t mean they shouldn’t receive treatment for the problem.
  3. If I had a hearing loss, my family doctor would have told me.
    Not true! Only 14% of doctors in first-world countries routinely screen for hearing loss. Since most people with hearing impairments hear well in a quiet environment, like a doctor’s office, your doctor may never recognise the extent of your problem. Special training and an understanding of the nature of hearing loss are required to diagnose a hearing problem.
  4. I have one ear that’s ‘down’ a little, but the other one’s okay.
    Everything is relative. Nearly all patients who believe that they have one “good” ear actually have two “bad” ears. When one ear is slightly better than the other, we learn to favour that ear for the telephone, group conversations, etc. This can give the illusion that “the better ear” is normal when it isn’t. Most types of hearing loss affect both ears fairly equally and about 90% of patients are actually in need of hearing aids for both ears.
  5. My hearing loss can’t be treated/fixed.
    Many people with hearing the loss in one ear, a high-frequency hearing loss or nerve damage have been told they can’t be helped. This may have been true years ago, but with modern technology, 95% of people with a sensorineural hearing loss can be helped.

Selecting hearing aids

Whether it’s just been confirmed that you need a hearing aid or you’ve been wearing hearing aids for many years, our audiologists specialise in helping you to select the most appropriate solution for your needs, in the context of your lifestyle and personal goals.

Tami Mehl Audiology is proudly independent of any hearing aid manufacturer or commercial company. This enables us to choose any brand of hearing aid available in South Africa and to attend regular and diverse training, to stay on top of industry developments.

We strongly advise every patient to ‘test drive’ a selection of appropriate hearing aids and to accept a hearing aid trial period. This is an important part of making an informed choice. In addition, once you buy your hearing aid, its servicing will always be a priority for us.

Technology and styles

Tami Mehl Audiology supplies a vast selection of programmable hearing aids that use digital processing and directional microphones for better hearing. Our spectrum of devices includes both entry-level hearing aids and the latest in blue-tooth and wireless technology, which helps us to find the optimal solution for you as an individual living in the digital era.

There are many styles of hearing the instrument, including completely-in-the-canal, in-the-canal, in-the-ear and behind-the-ear. Most hearing aid technology is available in your choice of these styles and our audiologists will help you to determine which will work best for you.

Feel free to download our helpful PDF on hearing aid technology and price ranges.

Some of the hearing aids that are available to you:

If you’d like more information on hearing aids, please contact us today. We can help.

Diagnosing Tinnitus

Do you have a constant or occasional sense of:

  • ringing
  • buzzing
  • whistling
  • humming
  • clicking
  • hissing in your ears?

This condition is called tinnitus – and you don’t have to live with it.

If you’d like more information on tinnitus, please contact us today. We can help you.

Tinnitus is typically caused by hearing loss, noise exposure or medication (over 200 different kinds, including aspirin).

Treating Tinnitus

There are several ways to treat tinnitus:

Hearing aids

Hearing aids can partially mask tinnitus and can enhance hearing at the same time. Sound therapy with hearing aids exercises the auditory portion of the brain and creates stimulation in areas with hearing loss. There are also hearing aids available that feature tinnitus and relaxation programmes, incorporating peaceful background sounds for tinnitus sufferers.

Counselling
The use of hearing aids and sound therapy to treat tinnitus must be accompanied by education, counselling and stress management. We at Tami Mehl Audiology find it beneficial to include professionals from other disciplines.

Unpacking hyperacusis

Often tinnitus is associated with hyperacusis, an increased or over-sensitivity to sound. This condition is characterised by abnormal discomfort in response to sounds that are tolerable for those with normal hearing.

Although hyperacusis may follow a blow to the head or exposure to loud noise, for many people its onset is baffling because it occurs independently of other identifiable disorders. Having said that, hyperacusis is a recognised symptom of several conditions and is sometimes associated with:

  • noise trauma
  • head injury
  • reactions to drugs
  • viruses
  • allergic reactions
  • auto-immune disorders
  • chronic ear infections
  • hearing loss
  • brain injury
  • post-traumatic stress disorder
  • migraines
  • some types of depression
  • vitamin B6 deficiency
  • Tay-sach’s Disease
  • chronic fatigue syndrome
  • neurological disorders
  • autism
The first step in managing hyperacusis involves a full audiological work-up by a qualified audiologist who has a special interest in this area. Contact us today to make a booking.

Tami Mehl Audiology can perform hearing and vestibular assessments for medico-legal purposes, such as when a client is involved in a motor vehicle accident. Audiograms can also show when an individual is suffering from industrial deafness as a result of excessive exposure to workplace noise. This is known as a noise-induced hearing loss (NIHL).

If you’d like to discuss our medico-legal services, please contact us today. Thank you.

Your Content Goes Here

  • South African Association of Audiologists
  • HPCSA