Question
I have a patient in his late 70's who was fitted with binaural hearing aids recently. He reports that whenever he causes the hearing aid to go into feedback by cupping his hand over the hearing aid, he experiences dizziness, and only when doing so in the right ear. I have attempted to mimic loud sounds into this same ear, however the dizziness cannot be elicited. The dizziness appears to be present only with the very specific sound of the feedback caused by cupping the hand over the hearing aid. He has had MRI studies done and everything turned out normal. Any ideas as to what is causing this?
Answer
The patient may be describing Tulio's Phenomena. This has been reported in the presence of Superior Canal Dehiscence Syndrome or SCDS. MRI studies are not very useful in the identification of SCDS. The usual imaging study to identify this entity is a thin cut CT scan which would better image the "missing bony" covering in the superior semi-circular canal. You were on the right track trying to stimulate the right ear with loud sounds. It is possible that the production of feedback by the patient cupping his hand over the ear is producing excessive sound pressure level (dependent on the MPO of the hearing aid) in the small cavity between the ear mold and the TM creating the Tulio's phenomena. A fistula test on the right ear may also elicit the dizziness response. An interesting case to be sure.
Dr. George Cire is a Private Practice Audiologist in Littleton, Colorado. Dr. Cire's clinical interests are in Medical/Diagnostic Audiology, Vestibular Diagnostics and the fitting and measurement of advanced DSP hearing systems. Dr. Cire received his masters degree at LSUHSC in New Orleans and his Au.D at the Arizona School of Health Sciences in Mesa, AZ.
George Cire, AuD
Clinical Manager, Bone Anchored Solutions, Cochlear Americas
George Cire currently works as Clinical Manager of Bone Anchored Solutions for Cochlear Americas in Englewood, Colorado. Prior to joining Cochlear, Dr. Cire has worked as a field specialist for Phonak Hearing Systems and has been a practicing Audiologist for 30 years. He has worked both in stand-alone private practice and as the director of an ENT affiliated Audiology Practice. His specialty interests are in the areas of clinical verification of amplification and vestibular diagnostics and treatment. Dr. Cire received his BA degree from Louisiana Tech University in Ruston, LA, M.C.D. (Master of Communicative Disorders) from Louisiana State University Health Sciences Center, New Orleans, LA and Au.D. from A. T. Still University, Arizona School of Health Sciences in Mesa, AZ.
Related Courses
1https://www.audiologyonline.com/audiology-ceus/course/brief-examination-starkey-s-balance-40035A Brief Examination of Starkey’s Balance Assessment ToolBalance issues are often seen in conjunction with hearing loss and affect a large number of patients seen by hearing healthcare professionals. Many patients are looking for a way to be more proactive with their overall health, especially when it comes to their hearing and vestibular health. This course will examine the basics of Starkey’s newest tool utilizing our onboard sensor technology, Balance Assessment.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comA Brief Examination of Starkey’s Balance Assessment ToolBalance issues are often seen in conjunction with hearing loss and affect a large number of patients seen by hearing healthcare professionals. Many patients are looking for a way to be more proactive with their overall health, especially when it comes to their hearing and vestibular health. This course will examine the basics of Starkey’s newest tool utilizing our onboard sensor technology, Balance Assessment.40035OnlinePT30M
Balance issues are often seen in conjunction with hearing loss and affect a large number of patients seen by hearing healthcare professionals. Many patients are looking for a way to be more proactive with their overall health, especially when it comes to their hearing and vestibular health. This course will examine the basics of Starkey’s newest tool utilizing our onboard sensor technology, Balance Assessment.
2https://www.audiologyonline.com/audiology-ceus/course/quick-guide-to-vng-interpretation-1489Quick Guide to VNG InterpretationThe purpose of this course is to describe the VNG test battery in the context of the anatomy and physiology of the balance system. Examples of common VNG abnormalities will be shown.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comQuick Guide to VNG InterpretationThe purpose of this course is to describe the VNG test battery in the context of the anatomy and physiology of the balance system. Examples of common VNG abnormalities will be shown.1489OnlinePT60M
'Very clear, easy to follow, good material to reference back to in the future'Read Reviews
No CEUs/Hours Offered
The purpose of this course is to describe the VNG test battery in the context of the anatomy and physiology of the balance system. Examples of common VNG abnormalities will be shown.
3https://www.audiologyonline.com/audiology-ceus/course/subjective-evaluation-new-hearing-aid-35584The Subjective Evaluation of a New Hearing Aid FittingThe final judge of the success of a new fitting will of course be the patient, and the criteria that they use may not always be in line with an objective audiological measure. This course will review some of the issues and options at play when having the patient weigh in on the value of the new devices.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comThe Subjective Evaluation of a New Hearing Aid FittingThe final judge of the success of a new fitting will of course be the patient, and the criteria that they use may not always be in line with an objective audiological measure. This course will review some of the issues and options at play when having the patient weigh in on the value of the new devices.35584OnlinePT60M
'Very informative and pragmatic presentation regarding the importance of incorporating a subjective evaluation into the hearing aid fitting process'Read Reviews
The final judge of the success of a new fitting will of course be the patient, and the criteria that they use may not always be in line with an objective audiological measure. This course will review some of the issues and options at play when having the patient weigh in on the value of the new devices.
4https://www.audiologyonline.com/audiology-ceus/course/auditory-wellness-what-clinicians-need-36608Auditory Wellness: What Clinicians Need to KnowAs most hearing care professionals know, the functional capabilities of individuals with hearing loss are defined by more than the audiogram. Many of these functional capabilities fall under the rubric, auditory wellness. This podcast will be a discussion between Brian Taylor of Signia and his guest, Barbara Weinstein, professor of audiology at City University of New York. They will outline the concept of auditory wellness, how it can be measured clinically and how properly fitted hearing aids have the potential to improve auditory wellness.auditory129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comAuditory Wellness: What Clinicians Need to KnowAs most hearing care professionals know, the functional capabilities of individuals with hearing loss are defined by more than the audiogram. Many of these functional capabilities fall under the rubric, auditory wellness. This podcast will be a discussion between Brian Taylor of Signia and his guest, Barbara Weinstein, professor of audiology at City University of New York. They will outline the concept of auditory wellness, how it can be measured clinically and how properly fitted hearing aids have the potential to improve auditory wellness.36608OnlinePT30M
As most hearing care professionals know, the functional capabilities of individuals with hearing loss are defined by more than the audiogram. Many of these functional capabilities fall under the rubric, auditory wellness. This podcast will be a discussion between Brian Taylor of Signia and his guest, Barbara Weinstein, professor of audiology at City University of New York. They will outline the concept of auditory wellness, how it can be measured clinically and how properly fitted hearing aids have the potential to improve auditory wellness.
5https://www.audiologyonline.com/audiology-ceus/course/vanderbilt-audiology-journal-club-clinical-37376Vanderbilt Audiology Journal Club: Clinical Insights from Recent Hearing Aid ResearchThis course will review new key journal articles on hearing aid technology and provide clinical implications for practicing audiologists.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comVanderbilt Audiology Journal Club: Clinical Insights from Recent Hearing Aid ResearchThis course will review new key journal articles on hearing aid technology and provide clinical implications for practicing audiologists.37376OnlinePT60M
