Ear, Hearing & Balance Disorders
Ear, Hearing & Balance Disorder Care at UVM Health
Conditions that affect your sense of hearing or balance can greatly impact your quality of life. At University of Vermont Health, you receive care from compassionate specialists with expertise in ear conditions, hearing loss and balance disorders. Physicians across the region refer their patients to us for our depth of knowledge and skill.
Whether your symptoms are mild or severe, we offer comprehensive testing and treatment in a supportive and caring environment.
Why Choose UVM Health?
Our goal is to address underlying conditions and help you find relief. For complex problems, our providers partner with other specialists across our health system to plan and deliver your care.
As a leading ear, nose and throat (ENT) program in the region, we offer:
- Experienced team: Our board-certified otolaryngologists–head and neck surgeons are fellowship-trained in otology and neurotology. Within these subspecialties, our physicians focus on specific conditions and procedures, providing an even higher level of expertise.
- Dedicated audiologists: Our large team of doctoral-level audiologists works closely with our otolaryngologists to provide a wide range of diagnostic tests and evaluations for hearing devices. We are the only audiology program in the region to offer sedated tests which can improve test accuracy and reduce stress, especially for young children.
- Multidisciplinary care: As part of a health system anchored by an academic medical center, our physicians collaborate across specialties to provide comprehensive care. Our otolaryngologists work closely with neurosurgeons, radiation oncologists and plastic surgeons to treat people with conditions such as skull base tumors.
- Cochlear implant program: Our Cochlear Implant Center is the only one of its kind in Vermont and northern New York.
Conditions We Treat
Your outer ear spans from your ear opening to your eardrum. Conditions that affect this area include:
- Atresia: A malformation of the outer ear canal
- Exostoses: Bony growths in the outer ear canal
- Swimmer’s ear (external otitis): An infection in the outer ear canal
The middle ear includes the eardrum, the bones that transmit sound to the inner ear (malleus, incus, stapes) and the eustachian tubes. The eustachian tubes connect the middle ear to the back of the throat and help balance pressure in the middle ear and drain fluid. Conditions of the middle ear include:
- Cholesteatoma: Skin cysts in the middle ear, behind your eardrum
- Eustachian tube dysfunction: An abnormally open or closed eustachian tube
- Middle ear infection (acute otitis media): An infection that causes fluid to build up behind your eardrum
- Otitis media with effusion: Fluid remains after an infection goes away
- Chronic otitis media with effusion: Fluid comes and goes or remains for a long time, with or without an infection
- Otosclerosis: An inherited disease that causes abnormal hardening of a bone in your middle ear (stapes)
- Ruptured eardrum: A tear in the membrane that separates your outer and middle ear
The inner ear is made up of the labyrinth, an intricate system of fluid-filled structures that control hearing and balance. The vestibular nerve carries signals from your inner ear to your brain. Common inner ear conditions include:
- Acoustic neuroma (vestibular schwannoma): A noncancerous, slow-growing tumor that develops on the vestibular nerve
- Benign paroxysmal positional vertigo (BPPV): Crystals that dislodge in the canals that control balance
- Labyrinthitis: An infection in the inner ear that causes vertigo and hearing loss
- Ménière’s Disease: An inner ear fluid disorder that can cause vertigo and hearing loss
- Superior semicircular canal dehiscence: An abnormal opening in one of the structures in your inner ear that causes dizziness and hearing symptoms
- Vestibular neuritis: Inflammation of the vestibular nerve
Many factors can cause hearing loss, including health conditions, medications, aging and exposure to loud noises and injury. Hearing loss ranges from mild (inability to hear soft sounds) to severe (profound deafness). Hearing loss types include:
- Conductive hearing loss: An issue in your outer or middle ear that prevents sound from reaching your inner ear
- Sensorineural hearing loss: A problem that affects the inner ear or cochlear nerve
- Mixed hearing loss: Hearing loss that is both conductive and sensorineural
The skull base runs from the bones behind your eyes and nose to the bottom and lower back part of your skull. The skull base has many nerves and blood vessels that pass through and travel along it, making its anatomy very complex. Conditions affecting this area include:
- Cerebrospinal fluid leak: A hole in the membrane covering the brain and spinal cord
- Cholesterol granuloma: A noncancerous cyst that forms in the skull bone, near the middle ear
- Encephalocele: A rare defect that causes a sac-like protrusion of the brain and its outer membranes through a hole in the skull
- Facial paralysis caused by tumors: A tumor that affects the nerve that controls your muscles of facial movement
Diagnosing Ear, Hearing & Balance Disorders
The first step for new patients with ear, hearing or balance disorders is to meet with an otolaryngologist–head and neck surgeon. To establish a diagnosis, your physician may recommend additional testing. You may have medical imaging tests, such as X-ray, CT, MRI, or ultrasound, or meet with an in-office audiologist.
Tests we use to check your hearing and balance include:
Our audiologists provide a full range of routine and advanced hearing tests. We see people of all ages, including babies. We have extensive experience assessing the hearing of children with special needs. Tests we offer include:
- Acoustic reflex test: Measures muscle movements in your middle ear in response to loud sounds
- Electrophysiology tests: Measure the function of the inner ear and nerve pathways to the brain. They include auditory brainstem response (ABR) and auditory steady state response (ASSR).
- Otoacoustic emissions (OAE): Checks whether the hair cells in your inner ear are responding to sound
- Pure tone audiometric test: Measures your ability to hear quiet sounds at different pitches
- Tympanometry: Checks the function of your middle ear by measuring the movements of your eardrum in response to a puff of air
Electrophysiology tests such as ABR and ASSR are important tools to help pinpoint the source of hearing loss in young children. When needed, our team performs sedated ABR and ASSR. Your child receives medication to help them sleep through the test while a physician monitors their vital signs. We are the only health system in the region to offer sedated hearing tests.
Balance disorders require specific tests to find their underlying cause. Since balance requires coordination between your inner ears, brain and eyes, balance tests often check how your eyes move.
At UVM Health, you have access to a full range of balance tests along with experts who know how to accurately interpret them. Our test offerings include:
- Dix-Hallpike maneuver: This test is used to diagnose BPPV. During this test, your physician watches how your eyes move in response to a series of head movements.
- Vestibular evoked myogenic potential (VEMP): This test measures the electrical activity in your neck muscles generated by your hearing (vestibular) nerve in response to slight bursts of sound.
- Videonystagmography (VNG): These tests measure your eye movements in response to different stimuli. One test involves stimulating your vestibular nerve with water. We are the only center in the region that offers water testing, which is a more effective stimulant than air.
- Video head impulse testing (vHIT): Tests the function of your inner ear semicircular canals by measuring the ability of your eyes to fixate on a point while the audiologist moves your head in different positions.
Treating Ear, Hearing & Balance Disorders
Once you receive a diagnosis, your physician works with you to develop a treatment plan. Our team always places you at the center of your care, working with you to determine which treatments or devices are appropriate and help you make informed choices that prioritize your needs and preferences.
For a mild condition, your physician may recommend monitoring to track your condition. You may also receive medications, such as:
- Antibiotics to treat infections
- Antinausea medications to reduce dizziness, nausea and vomiting
- Nonsteroidal anti-inflammatory drugs (NSAIDS) to control pain
- Steroids in pill, eardrop or ear injection form to reduce inflammation
Other treatments we offer include:
Hearing aids amplify sound to help with mild or moderate hearing loss. UVM Health audiology clinics provide hearing aids and exceptional care at locations across Vermont and northern New York.
A cochlear implant is for people with sensorineural hearing loss. It converts sound to electrical energy and transmits this energy directly to your hearing nerve, bypassing your inner ear.
Cochlear implants have two components:
- An external processor worn behind the ear
- An internal device placed under your skin that connects to the inner ear through a series of electrodes
We offer a wide range of implant devices and provide two external processors at the time of activation, so you always have a backup. After the implant procedure, we work with you to help you learn to live with your new device and keep it functioning properly.
Bone conduction devices are effective options for people with conductive or mixed hearing loss. They improve hearing by transmitting sound vibrations to your inner ear through your skull bone.
Our team offers implanted and nonsurgical bone conduction solutions, both of which sit behind your ear. Nonsurgical devices stay in place with a headband or adhesive that sticks to your skin. Implanted systems have an external processor and a surgically placed device that is attached to the skull.
Your care includes comprehensive follow-up counseling, rehabilitation and support to help you adapt to your new device.
Balance therapy includes targeted exercises to help reduce dizziness and improve your balance.
We coordinate closely with physical therapists across UVM Health to offer balance therapy, which may include:
- Eye movement training
- Head exercises to help you manage dizziness
- Sitting, standing and walking exercises to improve balance
- Strengthening and stretching exercises
When surgery is the best option for your condition, you’re in skilled hands at UVM Health. Our otolaryngologists have extensive surgical training and experience.
We perform microsurgery for conditions such as acoustic neuromas, encephaloceles and superior semicircular canal dehiscence. Patients and referring physicians look to us for advanced surgical care not provided elsewhere in Vermont and northern New York.
Locations Near You
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111 Colchester Avenue
Main Campus, West Pavilion, Level 4
Burlington, VT 05401
790 College Parkway
Fanny Allen Campus
Colchester, VT 05446-3007
210 Cornelia Street
Suite 401
Plattsburgh, NY 12901-2318
111 Colchester Avenue
Main Campus, West Pavilion, Level 4
Burlington, VT 05401-1473
116 Porter Drive
Middlebury, VT 05753-1419
130 Fisher Road
Suite 3-1
Berlin, VT 05602-9000