Audiology Services

Comprehensive Diagnostic Evaluations and Treatment for Hearing Loss

provider examining child's ear canal

It is our mission to improve the quality of life for our patients of all ages with hearing and listening difficulties. As a not-for-profit, university heath care center, we are proud to serve our community with the most affordable and personalized care. Our audiology providers combine their extensive clinical expertise with current research-based practices when treating our patients in a state-of-the-art clinical environment.

Treatments

Audiologic Rehabilitation
Audiology Clinic
Central Auditory Processing Evaluation
Cochlear Implant Clinic
Electrophysiology
Hearing Aid Evaluations
Hearing Aid Follow-up
Hearing Aid Problem
Tinnitus
Vestibular Assessment
Vestibular Rehabilitation

Locations

Center for Audiology & Speech Language Pathology

Nave Language Center

1000 Jason Witten Way, Elizabethton, TN, 37643-2970

Testing

Hearing Evaluations
Our team provides comprehensive diagnostic evaluations and treatment for hearing loss for patients of all ages and we are dedicated to the hearing healthcare of our patients. Using the latest equipment and technology, our team provides personalized and timely services for all types of hearing challenges.

Your hearing evaluation is an important first step to determine your hearing status. A hearing evaluation is used to find out how much you are hearing and to decide what technologies and/or treatments can best improve your ability to communicate. This may include hearing aids, assistive listening devices, or further evaluation for other specialized treatments.
- What to Expect During Your Appointment
  
  A typical adult hearing evaluation includes:
  
  Hearing history and current concerns
  
  Otoscopy (assessing the outer ear)
  
  Tympanometry and Reflex testing (assessing the middle ear and auditory nerve status)
  
  Speech Detection and Understanding
  
  Frequency specific threshold determination
  
  Discussion of results and working with you to develop your individualized treatment
- Living with Hearing Loss
  
  Any degree of hearing loss can impact everyday life causing difficulty at home, at work, in places of worship, and in social settings. Our providers are here to provide you and your communication partner with strategies to reduce these known effects of hearing loss. Spouses and significant others are welcome and encouraged to join you in your hearing health journey.
Vestibular Assessment and Treatment
- AIB Patient Self Quiz
  
  If you would answer yes to any of the following questions, a vestibular and equilibrium evaluation should be considered:
  
  A feeling of motion, spinning or falling when moving your head quickly or changing your position? (Ex. Getting in and out of bed)
  
  Uncomfortable trying to get around in the dark?
  
  Walking down the grocery store aisles or through the mall is upsetting?
  
  Your feet just won't go where you want them to?
  
  A sense of unsteadiness? A feeling you are not surefooted?
  
  A fear of falling or stumbling?
  
  Looking at moving objects such as escalators or looking out the side window of a car makes you queasy?
  
  Difficulty keeping your balance as you walk on different surfaces? (Ex. Tile to carpet)
  
  A feeling like you are drifting or being pulled to one side when walking?
  
  No one really understands how frustrating this is?
The Vestibular Evaluation Clinic at the ETSU Nave Center is a diagnostic center where specially-trained audiologists conduct comprehensive assessments includes central, peripheral, and neurodiagnostic evaluations of the Vestibular and Auditory systems as well as postural stability integration.

Our equilibrium experts combine their extensive clinical expertise with current research-based practices when evaluating and treating our patients with precision and care, utilizing both hearing testing, electrophysiological testing, and videonystagmography (VNG), the gold standard for determining ear specific function. Our goal is to provide physicians with accurate data to identify the cause of dizziness, disequilibrium, and vertigo, as part of a complete multidisciplinary approach to patient healthcare.
- What to expect during your appointment
  
  A typical adult vestibular evaluation includes:
  
  Thorough case history addressing all of your hearing and balance concerns
  
  Hearing evaluation (see previous tab)
  
  Sensory organization Performance test (assessing postural stability)
  
  Videonystagmography (VNG) (assessing vestibular function both peripheral and central to establish site of lesion)
  
  Calorics (obtaining ear specific functional data)
  
  Positionals (testing for Benign Paroxysmal Positional Vertigo (BPPV)
  
  Electrophysiological testing:
  
  Auditory Brainstem Response (assessing vestibulocochlear nerve integrity)
  
  Electrocochleography (assessing electrical activity in the cochlea)
  
  Vestibular Evoked Myogenic Potentials (VEMPs) (assessing otolith function)
- Living with balance disorders
  
  According to the CDC, Falls are the leading cause of injury and injury death among adults ages 65 and over and result in more than $50 billion in medical costs every year. Balance is the brain integrating input from the vision, proprioception, and the vestibular systems. Most balance disorders are caused by inner ear (vestibular) abnormalities. Signs and symptoms may include, but are not limited to:
  
  Dizziness
  
  Vertigo (a spinning sensation)
  
  Feeling off balance or as though you are being pulled in one direction or another
  
  Staggering
  
  A “swimmy headed” sensation
  
  Lightheadedness, or a floating sensation
  
  Feeling disoriented with movement
  
  Blurred vision
  
  ETSU’s providers specialize in assessing the integrity and function of the entire vestibular system. From this information we can assist you and your physician in determining the best course of action to meet your unique needs, prevent falls, and improve quality of life.
Cochlear Implant Services
Services provided include candidacy evaluation, follow-up implant mapping, aural rehabilitation and speech and language services for patients of all ages.
- What is a cochlear implant?
  
  A cochlear implant is a device for people with severe-profound hearing loss in both ears. It is surgically inserted in the inner ear. While a hearing aid amplifies sound to make it more audible to the damaged portion of the ear, a cochlear implant directly stimulates the auditory nerve, bypassing the damaged portion of the ear.
- How do cochlear implants work?
  
  The cochlear implant consists of two distinct pieces; one is an internal receiver/stimulator (surgically implanted) and the second is the external speech processor, which is worn on the outer ear (pinna) and looks similar in appearance to a behind-the-ear hearing aid. Surgery is required to place the internal device. The external components are typically fit several weeks after surgery.
  
  How a Cochlear Implant Works:
  
  The microphone on the speech processor captures sound and the processor converts the sound to a digital signal.
  
  The speech processor sends the digital signal across the skin to the internal implant.
  
  The internal implant changes the signal to electrical energy, sending it to the electrode array in the cochlea.
  
  The electrodes stimulate the hearing nerve and the brain interprets this stimulation as sound.
- Who is a candidate?
  
  A multidisciplinary team is essential for the cochlear implant evaluation process. A cochlear implant team typically consists of an implant surgeon who looks at the medical history and explains the procedure to the patient. A CT scan is done to make sure that the cochlea is not ossified and is able to hold the electrode bundle. The audiologist will perform the hearing tests to determine the type of loss, and also monitor hearing aid effectiveness to be sure the patient is a candidate for a cochlear implant. A social worker or psychologist is involved to assess feelings toward hearing loss and reasons for seeking a cochlear implant. Based on the recommendations of all these team members it will be determined whether or not a patient is a candidate for a cochlear implant.
- Evaluation Process
  
  Audiologic Testing
  
  The audiologic testing aspect of cochlear implant candidacy includes a battery of tests. These tests are listed below and are used to determine the type and severity of hearing loss. The hearing aid evaluation is done to determine benefit from a hearing aid versus a cochlear implant.
  
  Pure Tone Testing
  
  Speech Testing
  
  ABR
  
  OAEs
  
  Immittance Testing
  
  Visual Speech Perception
  
  Vestibular Assessment
  
  Tinnitus Assessment
  
  Hearing Aid Evaluation-- 3-6 Months
  
  Psychological Evaluation
  
  This step in the process is conducted by a psychologist to assess feelings about hearing loss, reasons for seeking a cochlear implant, and expectations from the implant.
  
  Medical and Surgical Evaluation
  
  The final step before implantation is conducted by the surgeon of the implant team. The ears are assessed to be sure there are no perforated ear drums or ear infection. A CT and MRI will be done to be sure the inner ear can be implanted.
- Surgery Information
  
  The surgery typically takes one to three hours. General anesthesia is administered. First, an incision is made behind the ear to expose the temporal bone. The surgeon then positions the implant component against the bone. A hole is made in the temporal bone with a microscopic drill, allowing the surgeon access to the cochlea. A small hole is made in the wall of the cochlea and the electrode array is gently guided into the cochlea. The internal receiver is secured in place on the skull bone with sutures and the incision is closed. A sterile dressing is placed on the incision.
  
  Most people stay overnight for observation. This is a relatively low risk surgery, however there are some risks. The most common complication is problems with the wound healing. Less common risks include damage to the nerve that moves the face on the side of the operation, leakage of the fluid around the brain (cerebrospinal fluid), infection of the fluid around the brain (meningitis), temporary dizziness (vertigo), and failure of the device to work.
- Post Implant Rehabilitation
  
  Children
  
  Rehabilitation is a required part of implantation.
  The primary goals of rehabilitation are to develop and improve:
  
  auditory/aural skills
  
  receptive speech and language skills
  
  expressive speech and language skills
  
  incidental learning from the auditory environment
  
  academic achievement
  
  Therapy includes:
  
  Multiple weekly aural and speech-language therapy sessions
  
  Daily therapy sessions at school.
  
  A multidisciplinary, dedicated group is necessary. This group includes a SLP (Speech language pathologist), A/V therapist, educators, parents, family, psychologist, and other providers.
  
  Adults
  
  The focus depends on patient’s previous experience with sound and listening goals. If a person is implanted who lost their hearing 6 months ago they are probably not going to need much post implant therapy. However if an adult that has been deaf since birth is implanted they will probably need quite a bit of post implant therapy.
  Most people do not conduct formal rehabilitation programs with a SLP unless they are not progressing well.
  The cochlear implant manufacturer provides rehabilitation tools to be used either at home or in the clinic.
- Deaf Culture
  
  Many parents of deaf children are hearing therefore they have no idea that there is a deaf culture. There is in fact a very active deaf culture in the United States. It is a culture of its own much like any other minority culture. They have their own language, customs, and beliefs. The language they share is American Sign Language. There are schools that are taught using sign language and these children learn about all the same things children in a regular school would as well as Deaf culture. It is also important to note that the Deaf culture as a whole is opposed to cochlear implants. They feel that there is nothing wrong with being deaf and that it is wrong to perform a surgery on a child when there is nothing wrong with them. Deaf people view negatively those who view deafness as a problem that needs to be fixed.
  
  There are two types of deafness. "Little d deaf" and "big D Deaf." Little d deafness is a medical condition. This is Uncle Carl at the family reunion who can’t hear anyone. Big D Deafness is a culture. A Deaf person is one who associates with the Deaf community and embraces Deafness. A person can be born deaf, get a cochlear implant, learn to use speech and never know about Deaf culture. Other people are born deaf, go to a school for the Deaf and live entirely in the Deaf world. This is a decision that is up to each individual.
  
  However, once a person has a cochlear implant, they are not Deaf, and they are not hearing. They may find this results in feeling a lack of belonging to either world, which may be challenging. It is important to take this into consideration when deciding whether or not to get a cochlear implant.
Aural Rehab

Auditory-verbal intervention is evidence-based and appropriate for children who are deaf or hard of hearing seeking to develop and improve listening, spoken language, and literacy skills through use of hearing technology. Family members are included as part of the process, as they are trained and coached in sessions to help their child generalize skills outside of the therapeutic setting into daily living activities. The LSL professional also collaborates with the child’s audiologist and school professionals to ensure best possible outcomes.

Aural Rehabilitation Clinic
Aural rehabilitation services are provided in addition to the AVT clinic for individuals across the lifespan who are deaf or hard of hearing. These services are appropriate for individuals seeking intervention to “relearn” listening and language skills, following a hearing loss that occurred after development of language skills, with the assistance of hearing technology. A variety of modalities and evidence-based strategies may be used to improve communication skills through these intervention services.

About the Aural Rehab/AVT Clinic
The Auditory-Verbal Therapy (AVT) clinic is supervised by Mrs. Marie Johnson, a speech-language pathologist and a Listening and Spoken Language Specialist, Certified Auditory Verbal Therapist (LSLS, Cert. AVT), conferred through the Academy of the Alexander Graham Bell Association for the Deaf & Hard of Hearing.

Contact Mrs. Marie Johhnson: call 423-439-4585 or email johnsonma@etsu.edu
Hearing Aids and Assistive Listening
Hearing loss is the 3rd most common chronic physical condition in the United States. 38.2 million Americans aged 12 years or older have hearing loss, with greater than 80% of individuals 80+ years old having some degree of hearing loss^1&2. On average, adults wait about 7 years to pursue treatment for hearing loss, with only 20-30% of adults with hearing difficulties actually wearing a hearing aid. Treatment for hearing loss is of high importance with research showing that untreated hearing loss is linked to cognitive decline, dementia, falls, social isolation, depression, and an overall decline in the quality of life at home or work³.

Quick Links (Infographics)
Prescription Hearing Aids
Prescription hearing aids are ordered by an audiologist who has tested your hearing using advanced diagnostic tools. An audiologist is a hearing healthcare professional who has obtained either a Doctorate or Masters degree in audiology. The audiologist will help you select a hearing aid from a variety of styles that will best fit your lifestyle and communication needs. These styles include custom fit hearing aids that are personally fit to your ears.

They will program your hearing aids to ensure they fit comfortably in your ears and provide maximum benefit. Often, these measures include real ear measurements, an evidence-based practice, where the audiologist will insert thin tubed microphones into your ear canal, along with your hearing aids to measure the output of each hearing aid in reference to your hearing test. The goal of this measurement is to ensure that the hearing aids can be best programmed to meet your hearing needs, as demonstrated by your hearing test. Typically, an audiologist will also have follow-up appointments for fine-tuning and maintenance.

Over the Counter (OTC) Hearing Aids
On August 16th, 2022, the Food and Drug Administration (FDA) established regulatory category for over-the-counter (OTC) hearing aids in an effort to increase the availability and affordability for adults aged 18 and over with perceived mild to moderate hearing loss. These devices will be available starting as soon as mid-October in pharmacies, department stores such as Walmart, and online.

Hearing aid associations such as the American Speech-Language-Hearing (ASHA) Association and the American Academy of Audiology (AAA) have stressed that those with hearing loss understand the important steps in determining the best type of hearing aid for you.

Knowing if OTC Hearing Aids are a Good Fit for You:

It is highly recommended to receive a comprehensive hearing evaluation by an audiologist first. This evaluation will give you information such as the severity and type of hearing loss you may have. With this information, your audiologist cam determine whether or not OTC hearing aids will be a good fit.

Who will OTC hearing aids work for?

OTC hearing aids will work for those 18 years and older who have a mild to moderate hearing loss. They are not effective for those who a moderate to severe hearing loss, nor should OTC hearing aids ever be worn by children. For children and adults with greater than a moderate loss, seeing an audiologist for prescription hearing aids is highly recommended.

OTC hearing aids are not recommended for those:

• Children/anyone under the age of 18.
• Hearing losses greater than moderate severity
• Chronic ear discharge
• Hearing loss and ringing present in/or worse in one ear
• Ear pain or discomfort
• Fullness of the ear
• Vertigo or severe dizziness
• Ear deformities

References
¹Goman, A. M., & Lin, F. R. (2016). Prevalence of hearing loss by severity in the United States. American Journal of Public Health, 106(10), 1810─1822.
² Masterson, E. A., Bushnell, P. T., Themann, C. L., & Morata, T. C. (2016). Hearing impairment among noise-exposed workers—United States, 2003─2012. Morbidity and Mortality Weekly Report (MMWR), 65(15), 389─394.
³ The Lancet Commission. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. ASHA, 2022.
Tinnitus Management
Tinnitus is the perception of a sound — a tone, crickets, steam whistle, sea shell, or any number of other sounds — that is experienced by millions of people even though there is no external event producing the sound. In the vast majority of cases, tinnitus is not a symptom of anything serious. Unlike typical sounds the tinnitus sensation originates in the head of its owner, and that's why nobody else seems to hear the sound even though it may seem fairly loud to the person who "owns" it.

What's that Ringing? - TED Talk Video (August 2020) by Dr. Marc Fagelson, Ph.D.
- What to expect during your appointment
  
  The tinnitus clinic provides counseling and sound therapy options for patients bothered by the sensation of tinnitus. Dr. Fagelson started providing counseling and sound therapy for patients with bothersome tinnitus in 2001. Counseling includes discussion of the specific problems being caused by tinnitus, as well as its neural mechanisms and sources that make the tinnitus occur and continue. Many patients with tinnitus also experience hearing loss, and in those cases, sound therapy including hearing aids may be an option. Some patients find their tinnitus influences depression and anxiety, and in those cases, counseling can include coping strategies as well as referrals onward to psychology.
  
  Initial appointments are scheduled for two hours in order to allow the patient enough time to convey in full the influences and effects of tinnitus. Many people believe there is no cure for tinnitus, however our clinical activity targets a patient's ability to manage the tinnitus effects. In this way, clinician and patient share the objective of co-existing with tinnitus in a way that minimizes its impact on a person's life.

Pediatrics

Auditory Brainstem Response
The Auditory Brainstem Response (ABR) test is a helpful tool in determining a child’s ability to hear. An ABR is often ordered if a newborn fails the hearing screening test given in the hospital, or for older children if there is a suspicion of hearing loss that was not confirmed through more conventional hearing tests. The test uses a special computer to measure the way the child’s hearing nerve responds to different sounds. Electrodes will be placed on the child’s head and connected to a computer. As sounds are made through the earphones, the electrodes measure how the child’s hearing nerves respond to them.

The audiologist looks for certain neurological "markers" as the child’s hearing nerves respond to sounds. The softest intensity or loudness level at which these markers appear roughly corresponds to the child’s hearing level in that frequency range. By interpreting a computer printout of your child’s responses, the audiologist can tell if your child has a hearing problem.
- How to prepare for your child's appointment
  
  ABR testing can be completed only if the child is sleeping or lying perfectly still, relaxed and with his or her eyes closed.
  
  If your child is younger than 6 months of age, the ABR test usually can be done while he or she naps. Most young babies will sleep through the entire test if they are brought to the appointment ready for a feeding and a nap. Try to keep your baby awake and hold off feeding him or her until you get to the appointment.
  
  If your child is older, the ABR test usually can be done while your child is awake if he or she can relax and lie still. The test will be done in a special sound-treated suite in the Audiology department.
- What comes next?
  
  The audiologist will let you know the test results and discuss the next steps with you. These results will be shared with the child’s primary care provider. Hearing loss has many causes: some are genetic or non-genetic. A combination of genetic and non-genetic factors also can cause hearing loss. For many, the cause of hearing loss is unknown.
- More information
  
  American Speech-Language and Hearing Association (ASHA)
  
  Tennessee Newborn Hearing Screening Program
  
  US Center for Disease Control (CDC) on Hearing Loss
Auditory Processing Disorder
Listening is a very complex process. The actions of the outer ear, middle ear, and inner ear send sounds via the auditory nerve to the brain. The brain then interprets the auditory information; for example it tells us that a particular sound is a dog barking or a bird singing. Essentially, the ear works fine, but the brain cannot process what it hears.

Hearing is a sense; listening is a skill.

A child who can hear well, but cannot understand the sounds may have Auditory Processing Disorder (APD). Five out of 100 school-aged children are believed to have some form or degree of APD related deficits. Children with APD often have academic difficulties such as reading (both decoding and comprehension), spelling, writing, following directions and participating in class discussions.
- Symptoms of APD
  
  Difficulty understanding when listening
  
  Difficulty following auditory directions
  
  Difficulty remembering multi-step instructions
  
  Difficulty understanding in noisy situations
  
  Difficulty following conversations in a group setting
  
  Difficulty taking notes in the classroom setting
  
  Reading and spelling difficulties
  
  Short attention span/easily fatigued
  
  Verbal IQ lower than performance IQ
- What to expect during your child's appointment
  
  A standard hearing test assesses how well a patient detects the presence of a sound. Auditory processing is much more complicated and requires more complicated testing. During an APD evaluation, patients will listen to stimuli that are much more complicated to process than what is heard during a traditional hearing test. Individuals will be required to listen to different types of auditory stimuli which include tones, words, sentences and noises. The individual must be 8 years or older, have normal or near-normal peripheral hearing, and be able to understand test directions and concentrate for at least 20 minutes at a time during testing.
- What comes next
  
  If testing outcomes reveal a positive APD diagnosis, there are individualized treatment plans to overcome specific auditory deficits. These treatment plans include the use of one-on-one training or computer-assisted software programs. Our department can provide educational recommendations for educational accommodations if necessary.
- More information
  
  American Speech-Language and Hearing Association (ASHA)
  
  ETSU's Auditory Processing Program Brochure
Pediatric High Risk Clinic

This interdisciplinary clinic is located in the ETSU Health Pediatrics Clinic. Infants are referred to this clinic from neonatal intensive care nurseries across the East Tennessee region. The interdisciplinary team includes audiology, speech language pathology, nursing, nutrition, child development and neonatology/pediatrician. Families travel to this clinic from southeast Kentucky, southwest Virginia, northwest North Carolina and northeast Tennessee.

Infants seen in the ETSU High Risk Clinic have previously stayed in the NICU longer than five days and often present with birth history factors that increases the risk of hearing loss. Infants seen in the clinic are monitored until 2 years old.

Please contact the ETSU Center for Audiology and Speech-Language Pathology for any further information.

Services

Audiologic Rehabilitation
Audiology Clinic
Central Auditory Processing Evaluation
Cochlear Implant Clinic
Electrophysiology
Hearing Aid Evaluations
Hearing Aid Follow-up
Hearing Aid Problem
Tinnitus
Vestibular Assessment
Vestibular Rehabilitation

Providers

Shannon Bramlette, Au.D., CCC-A

Ashley Brown, Au.D., CCC-A
Kendal Fox Eden, Au.D., CCC-A
Marc A. Fagelson, Ph.D.

Marcy K. Hite, Au.D., Ph.D., CCC-A

Patient Forms

Adults

Adult Case History Questionnaire

Pediatrics

For Parents

A Guide to Your Child's Hearing

Why ETSU Health?

The Audiology program serves as a center for excellence in providing direct clinical services and community education and outreach programs. Through these activities, the program strives to improve the quality of life for individuals affected by speech, language, hearing and balance challenges across the life span.

Billing & Financial Assistance

Insurance Patients: The clinic accepts private insurance including Medicare and Medicaid. The patient is responsible for checking with their insurance plan if their plan covers evaluations and treatment at our clinic, including getting prior authorization if the need be. Medicare and Medicaid patients must have a physician referral in order for the clinic to bill your insurance. If you do not have a physician referral, you will be responsible for the billed charges if they are denied by your insurance company. Insurance patients will receive a statement after the insurance has processed the claim

Cash Pay Patients: Patients without insurance selecting the cash pay program may also be eligible for a sliding fee scale based upon their annual income. In order to be eligible, patients must apply for a sliding fee scale by completing a Fee Assistance Form. Please email Ms. Freda Buck, clinic site coordinator, by emailing buckfm@etsu.edu or calling (423) 439-4355.

The Clinic shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operation. Clients have the right to file a complaint against the Clinic or the Department of Audiology & Speech-Language Pathology through the Council of Academic Accreditation of the American Speech Language Hearing Association. The complaint process can be found by clicking here.