Ear, Nose and Throat

Audiology is the assessment and treatment of hearing-related  problems. Audiologists at the Eye and Ear are allied health professionals who work with patients to assess, monitor and improve their hearing and balance issues through diagnostic testing and / or treatments.

View this presentation to learn more about hearing loss and the Eye and Ear’s Audiology Department.

A balance disorder is a condition that causes dizziness or unsteadiness, and can be associated with vertigo, nausea, vision problems, fatigue, tinnitus, falls and hearing loss. The brain controls balance using feedback received from the inner ear, eyes, and sensors in the joints, muscles and tendons that sense position or movement. Conditions affecting one or more parts of this balance control system can cause a balance disorder.

The Royal Victorian Eye and Ear Hospital’s Balance Disorders and Ataxia Service specialises in balance disorders, including those of a central and peripheral vestibular origin, providing diagnosis and/or management. The service caters for common balance disorders such as intractable BPPV, migrainous vertigo and vestibular neuritis, as well as more complex diseases such as the cerebellar ataxias, multiple system atrophy (particularly of the cerebellar type), oculomotor disorders and peripheral vestibulopathies.

This presentation on Neuro-otololgy testing, by Brooke Paisley (Manager of Audiology, Speech and Balance Services at the Eye and Ear) looks at neuro-otology testing for diagnosis and rehabilitation at the Eye and Ear.

The following video, ‘An Approach to the Vertiginous Patient‘ is presented by Dr David Szmulewicz, Head of the Balance Disorders & Ataxia Service at the Royal Victorian Eye and Ear Hospital.

Dr Szmulewicz has also delivered the a presentation on ‘An Approach to the Dizzy Patient‘ at the Eye and Ear’s Emergency Workshop training and demonstration day for external clinicians.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo, usually causing intense, brief episodes of dizziness or vertigo associated with moving the head. In the following videos produced by praxhub*, Dr Szmulewicz presents a neuro-otologist’s quick guide for GPs on BPPV (16 minutes) and an abbreviated version (4 minutes). Password 1234 to play.

*We partner with praxhub so that GPs can earn RACGP and ACCRM CPD points for watching Eye and Ear videos via the free praxhub portal. You must be a medical practitioner registered with the Australian Health Practitioner Regulation Agency (AHPRA).

Presentation by Dr. David Szmulewicz at the Eye and Ear Hospital Research Forum on 31 July 2024, on New Genes, Diseases and Treatments For Complex Balance Disorders

Complex balance disorders (or cerebellar ataxias) often involve multiple components of our balance system, including the inner ear balance system (vestibular apparatus), brain balance centre (cerebellum), and the nerves which carry information back from the legs (peripheral nerves). Our team at the Eye and Ear Hospital have been the clinical leads on the discovery of the two most common inherited diseases of this type, laying the foundation for development of gene therapies.

 

Cochlear Implant Candidacy Guidelines

by Dr. Jaime Leigh

The Cochlear Implant Clinic at the Royal Victorian Eye and Ear Hospital has been a world leader in cochlear implant research and clinical practice since its establishment in 1985. As part of this ongoing work, the Clinic develops and maintains evidence-based guidelines to assist clinicians in identifying adults and children who are likely to benefit from cochlear implantation.

The current guidelines were first published in the International Journal of Audiology in 2016 (Leigh, Moran, Hollow & Dowell) and were updated in August 2024 to reflect contemporary post-operative outcomes achieved by cochlear implant recipients. The 2024 update applied the same evidence-based methodology as the 2016 guidelines, analysing 12-month post-operative speech perception performance of a large cohort of recipients implanted at the Eye and Ear, to ensure that candidacy criteria continue to reflect the outcomes today’s recipients can reasonably expect. Recommendations are set so that a candidate meeting the criteria has at least a 75% chance of improved speech perception in the implanted ear following surgery.

Audiometric guidelines

A cochlear implant is likely to improve detection of sound if:

• Unaided pure-tone average (PTA) is 70 dBHL or worse in the worse-hearing ear
• Hearing has been stable for more than three months following a sudden sensorineural hearing loss (SSNHL)

Speech perception and language guidelines

Guidelines are based on the distribution of speech perception scores from post-lingually deafened adults using CI600-series implant systems and from children implanted under three years of age using Nucleus 24 or Freedom systems, all with a minimum of 12 months’ device experience. Cochlear implantation is recommended (in conjunction with the audiometric criteria above) when:

• Post-lingually deafened adults and older children: a CVC phoneme score of 63% or worse in the worse-hearing ear
• Pre-lingually deafened adults: evidence that auditory cues assist communication
• Children: evidence that auditory cues assist communication and that the child is not meeting expectations for oral language development

Medical and developmental guidelines

Cochlear implantation is an option for adults and children when:

• There is evidence that an auditory nerve is present and accessible to a cochlear implant electrode
• The surgical procedure can be performed with minimal risk to the patient
• There is evidence that the patient has sufficient cognitive ability to respond to external stimuli

Further information

• 2016 published guideline: Leigh JR, Moran M, Hollow R & Dowell RC. Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults. International Journal of Audiology 2016; 55(sup2): S3-S8. Access the paper via the International Journal of Audiology.
• 2024 updated guidelines (one-page summary): Eye and Ear CI Candidacy Guidelines
• Referral pathways and clinical information: see the Victorian Cochlear Implant Program page.

Cochlear Webinar 2023

The purpose of these webinars was to raise awareness of the benefits of cochlear implants and promote referrals to our CI service. The target audience was Audiologists and Audiometrists in the community.

Victorian Cochlear Implant Program – Case Discussions: David’s journey

This webinar with Dr Jaime Leigh (Audiologist and Senior Clinician in the Cochlear Implant Clinic), Cordelia Khoo (Audiologist in the Cochlear Implant Clinic), Lisa Singer (Audiologist and Market Expansion Manger at Cochlear Ltd) and David, talks through the experience of cochlear recipient David through the Victorian Cochlear Implant Program.

Victorian Cochlear Implant Program – Case Discussions: Surgical

This webinar with Dr Jaime Leigh (Audiologist and Senior Clinician in the Cochlear Implant Clinic), Dr Claire Iseli (Otologist and Cochlear Implant Surgeon) and Alice McConchie (Audiologist and Market Expansion Manger at Cochlear Ltd) focuses on the medical and surgical considerations of cochlear implants.

Cochlear implant

Warning: Graphic content, materials provided for viewing by health professionals only.

This video is part of a cochlear implant surgery and shows the electrode array that is implanted surgically into the cochlea, the hearing organ of the inner ear. It uses electrical current to bypass damaged or missing portions of the inner ear and stimulates remaining auditory hearing nerve fibres. A microphone, processor, and transmitting coil are worn externally to provide the power and signal to the internal device.transmitting coil are worn externally to provide the power and signal to the internal device.

Click here to watch the video
(warning: graphic content)

This procedure was performed by Robert Briggs, Head of Otology and Medical Director of the Cochlear Implant Clinic at The Royal Victorian Eye and Ear Hospital.

Cochlear Implant Outcomes For Older Adults

Attached is the presentation given by Ms Jaime Leigh, PhD, (Cochlear Implant Clinic)   at the Audiology Australia & New Zealand Audiological Society Trans-Tasman Online Conference in May 2020.

The presentation details the benefits of cochlear implantation for older adults and highlights that age alone should not be a limitation or deterrent for CI referral and surgery. Cochlear implantation can be done safely and provides significant benefits to recipients. The findings from the study detailed in this presentation confirms that cochlear implantation has a place in the clinical management of older adults, where audiologically suitable, and may lead to improved quality of life for these individuals as a result of improvements in communication ability.

World’s First Drug Eluting Cochlear Implant

An overview by Professor O’Leary of the world’s first drug eluting cochlear implant made by Cochlear Ltd, from its inception in the University’s laboratories at the Eye and Ear, through to the premarket clinical trials. 31 July 2024

Tinnitus

Tinnitus is a physical condition, experienced as noises or ringing in the ears or head when no such external physical noise is present. Click here to watch a GP education session on tinnitus presented by Dr Claire Iseli, ENT surgeon at the Royal Victorian Eye and Ear Hospital.

Hearing Loss

Click here to watch a GP education session on hearing loss presented by Dr Claire Iseli, ENT surgeon at the Royal Victorian Eye and Ear Hospital.

Assessment of the Ear

Click here to watch a GP education session on the assessment of the ear presented by Prof Stephen O’Leary, ENT specialist at the Royal Victorian Eye and Ear Hospital.

Stapedectomy

This video of a stapedectomy shows the surgical procedure performed to correct otosclerosis, a disease of the ear in which abnormal growth of bone interferes with movement of the stapes bone, leading to a progressive loss of hearing.

Click here to watch the video
(warning: graphic content)

This procedure was performed by Robert Briggs, Head of Otology and Medical Director of the Cochlear Implant Clinic at The Royal Victorian Eye and Ear Hospital.

The guidelines are intended to assist GPs by providing primary care management information for low acuity conditions that do not require the specialty services of the hospital. They were developed by specialists and allied health staff at The Royal Victorian Eye and Ear Hospital and reviewed by our GP Liaison Officer.

Guidelines for ENT conditions:

•    Dizziness
•    Dizziness tests and maneuvres
•    Otalgia
•    Hearing Aids
•    Hearing Loss
•   Impacted wax
•   Tinnitus

The guidelines are not intended for use by the general public. Consumers wanting to utilise the Eye and Ear outpatient services will need to be referred by their GP, optometrist or audiologist.

The Royal Victorian Eye and Ear Hospital is not responsible in any way for application of these guidelines to patient care at your facility and the guidelines should not be relied upon in diagnosing or treating any particular medical condition.

They are guidelines only for informational purposes and your professional judgment must always prevail. These guidelines may not be reproduced without permission.

If a GP or referrer is still unclear about when to refer, or is concerned that their patient requires an urgent referral, then we encourage you to telephone our Outpatient Booking Unit to discuss with one of our triage staff (within business hours only), or to call the hospital reception and speak to the Eye or ENT Admitting Officer to get immediate over the phone advice (24/7).

Nasendoscopy Tutorial

Nasendoscopy is a diagnostic procedure that is usually performed in the clinic setting to assess the structures of the nose and throat. It involves a thin, flexible tube with a small telescopic camera which is passed through the nostril. The endoscope can be manoeuvred to help obtain a good view of the nose and throat in order to investigate foreign bodies, malignancies and other issues of the upper aerodigestive tract.

In this video, the nasendoscopy tutorial is provided by Dr Philip Michael, ENT specialist at the Eye and Ear.

 

Removal of Ear Wax and Conditions of the Ear

This training package is a competency based training program for Specialist Clinic nursing staff to enhance their ENT knowledge and provide patient care in the ear care clinic.