AudiologyOnline Phone: 800-753-2160


Sonic Radiant - January 2021

Fistula Testing with Posturography?

Lewis M. Nashner, ScD

January 16, 2006

Share:

Question

Is it possible to do a Fistula test using computerized dynamic posturography and your office tympanometer? I know there are some manufacturers with specific equipment designed to be an addition to your CDP machine, but I am inquiring as to just the regular old tympanometer.....What protocol would you use, and what CPT code for billing? Or, is this not advisable?

Answer

Yes, one could do the CDP Pressure Test (we prefer this name because the test documents abnormal couplings between the middle and inner ear spaces, which may or may not be caused by a fistula) with an office tympanometer. If one used this method, one could run 3 trials of condition 5 without pressure stimulation, and 2 sets of 3 trials each, while stimulating one ear, for a total of nine trials. One could use both the three condition 4 and the three condition 5 trials (6 trials total) and two consecutive tests to obtain the necessary minimum of 9 trials total. Of course, it would be best to randomize trials among control, left, and right ear stimuli.

There are several problems with this approach. One, is that control over the stimulus onset, waveform, and amplitude is limited. Another problem is that the patient knows when an ear is being stimulated. Finally, a positive response can be judged only by observing gross increases in sway over the 20-second stimulus trials, compared to the control trials. If trials have been randomized, the operator will have to manually record the conditions of each trial and then manually score the results on a trial by trial basis.

With the hardware/software automated system, brief stimuli (1.5 sec) are delivered at random times. Tubes are inserted in both ears so that stimulus deliveries can be randomized between the two ears. Control trials are interspersed at random between the stimulus trials. Then, sway responses are stimulus onset averaged and analyzed to document changes in sway correlated with the brief stimuli. Onset averaged results are then compared to averages of the control trials. We perform two types of analysis to identify significant differences between control and stimulus trials. First, amplitude differences between control and stimulus trials are analyzed for statistical significance. Second, autocorrelations are performed to quantify the extent and significance of any synchronization between stimulus and sway response onsets. These are more reliable methods for determining a positive response.

I don't have good information on billing...sorry.

Dr. Lewis M Nashner is currently President and CEO of Neurocom International, Inc. He is past Senior Scientist and Chairman of the Neurological Sciences Institute, Oregon Health & Sciences University, and remains an Adjunct Professor of Physiology at that institution. During his research career, Dr Nashner published extensively in the area of human motor control and human balance. Since founding Neurocom, his research has focused primarily on clinical applications for technology in diagnosis and treatment of balance and mobility disorders.



Lewis M. Nashner, ScD


Related Courses

Vestibular Schwannoma: Medical and Surgical Evaluation and Management
Presented by Christopher Welch, MD
Recorded Webinar
AudiologyOnline

Presenter

Christopher Welch, MD
Course: #36879Level: Intermediate1 Hour
  'I found the treatment options and the reasons for a patient to choose one or the other really fascinating'   Read Reviews
This course reviews the common symptoms and findings associated with vestibular schwannoma, as well as workup and differential diagnosis for lesions of the cerebellopontine angle. A discussion of the natural history of vestibular schwannoma and general current paradigms for treatment are included.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Vestibular Schwannoma: Comprehensive Evaluation, Management, and Intraoperative Monitoring
Presented by Crystal Pitts, AuD, CCC-A, Christopher Welch, MD, Gregory Mannarelli, AuD
Recorded Webinar
AudiologyOnline

Presenters

Crystal Pitts, AuD, CCC-AChristopher Welch, MDGregory Mannarelli, AuD
Course: #36901Level: Advanced3 Hours
  'Content and presenters'   Read Reviews
Experienced providers from Michigan Medicine will detail the patient journey from identification through intervention for vestibular schwannomas. This series will provide an overview of diagnostic auditory and vestibular evaluations relevant to vestibular schwannomas, medical and surgical management of these tumors from the perspective of a neurotologist, as well as intraoperative monitoring considerations.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Neurotology for Audiologists
Presented by Daniel Zeitler, MD, FACS
Recorded Webinar
AudiologyOnline

Presenter

Daniel Zeitler, MD, FACS
Course: #39015Level: Advanced1 Hour
  'Speaker was very engaging'   Read Reviews
This course discusses various otologic diseases and how audiologists can participate in the care.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Vestibular Care for Diabetic Patients
Presented by Melissa Newell, AuD
Recorded Webinar
AudiologyOnline

Presenter

Melissa Newell, AuD
Course: #37736Level: Intermediate1 Hour
  'I see a lot of PWD come through our hospital for audiology examinations'   Read Reviews
Vestibular dysfunction and significant fall risks are more prevalent in the diabetic population. Learn about the pathophysiology and epidemiology of diabetes to improve your understanding of the impact this disease can have on balance function.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Grand Rounds: Cases in Medical Audiology, presented in partnership with The Ohio State University
Presented by Gail Whitelaw, PhD, Abigail Smiles, AuD, Breanna Langenek, BA, Devan Lander, BS, Hailey Long, BA, Theodora Bowman, BA
Recorded Webinar
AudiologyOnline

Presenters

Gail Whitelaw, PhDAbigail Smiles, AuDBreanna Langenek, BADevan Lander, BSHailey Long, BATheodora Bowman, BA
Course: #38797Level: Advanced1.5 Hours
  'Interesting and varied case studies'   Read Reviews
This course focuses on cases that incorporate aspects of medical audiology and considerations for audiologists providing patient care in this population.

View this Course for FREE.
Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

Only $129/yr

Learn More

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.