Introduction

The Ear-, Nose - & Throat (ENT) Doctor have referred you to the Audiology Department for a specialised hearing test.

What will happen at my appointment?

We may first take a short medical history from you and look in your ears to ensure that your ears are not blocked with wax or discharge.

We will then proceed to prepare you for the test. The test procedure is non-intrusive and will cause you no discomfort.

You will be required to lie on a bed and relax. The Audiologist will clean your skin with a wipe and scrub. Four electrodes are then placed on your head, one behind each ear and two on your forehead. An adhesive strip on the electrode places these electrodes on to your skin.

A set of inserts sponges are then placed in your ears and the lights are turned off to help you relax. You will hear clicking sounds through the inserts. You do not respond to these sounds, you just relax and the electrodes do all the recordings.

It is very important that you do not make any noise during the test and keep still. The Audiologist will tell you when the test has finished and you can go home.

We will analyse your results and write a report to the ENT doctor. The ENT will send you a follow up appointment and the results will be discussed with you in the ENT follow up appointment.

How long will my appointment take?

Approximately between 60 – 90 minutes. We aim to see you on time but occasionally clinics can be unavoidably delayed. We will keep you informed of any delay to your appointment.

How do I prepare for my appointment?

Before the appointment, please ensure your ears are free of wax. Wax can block ears and affect the results of your hearing test. If your ears are blocked with wax, please see you practice nurse or GP for wax removal prior to your appointment.

If you wear glasses, please bring them along with you.

If you are eligible for hospital transport, please contact us to arrange it for you.

If you need an interpreter, do contact us for this to be arranged. We cannot guarantee availability of interpreters for all languages, so please arrange this well in advance.

Please ensure your phone is switched off before this test to avoid interference with equipment, which can affect your test results.

You are welcome to bring a relative, close friend or carer with you to your appointment.

If you would prefer not to have a hearing assessment, please contact us as soon as possible so that we can offer this valuable appointment to someone else.

Can I cancel my appointment?

If you need to cancel your appointment, please call us as soon as possible. If you cancel your appointment more than two times, you will be discharged back to your GP and will need to be referred to our service again.

If you fail to attend this appointment, you will be discharged back to your GP’s care and will need a new referral in line with the Trust Policy.

Notes about your appointment

We are a teaching hospital so, on occasion, there may also be a student present in the appointment or a student supervised by an audiologist may see you. If you are not comfortable with this, please let us know when you check in for your appointment at the audiology reception desk.

We always try to see our patients at the time of their allocated appointment. Please ensure you arrive on time for your appointment.

Introduction

You were recently seen in the Audiology clinic regarding your difficulty hearing with your hearing aids. The Audiologist may have suggested that we assess you for assistive devices as available and supplied by your local social team. The purpose of this appointment is to demonstrate some devices to you.

What will happen at my appointment?

You will be asked some questions about your ears and your hearing difficulties at home. We will then proceed to demonstrate assistive devices such as an amplified and flashing doorbell, TV loop system and the TV echo link system.

After this, we will complete the referral form for the relevant social services team. You will receive a copy of this form. We will send the form to the social services team and they will contact you to arrange delivery / installation of the devices.

If you need any help regarding maintenance or replacement of the devices in the future, you will need to contact your social services team directly.

Hounslow Adults Social Care:
020 8583 3100 / adultsocialcare@hounslow.gov.uk

Richmond Adult Access Team:
020 8891 7971 / adultsocialservices@richmond.gov.uk

Ealing Deafplus:
0756 4500 534

Surrey (Spelthorne) sensory services:
0137 237 7701

How long will my appointment take?

Approximately one hour. We aim to see you on time but occasionally clinics can be unavoidably delayed. We will keep you informed of any delay to your appointment.

How do I prepare for my appointment?

You must bring your hearing aids with you to the appointment otherwise, we will not be able to carry out the assessment.

If you wear glasses, please bring them along with you.

If you are eligible for hospital transport, please contact us to arrange it for you.

If you need an interpreter, do contact us for this to be arranged. We cannot guarantee availability of interpreters for all languages, so please arrange this well in advance.

You are welcome to bring a relative, close friend or carer with you to your appointment.

If you would prefer not to have this assessment, please contact us as soon as possible so that we can offer this valuable appointment to someone else.

Can I cancel my appointment? 

If you need to cancel your appointment, please call us as soon as possible. If you cancel your appointment more than two times, you will be discharged back to your GP and will need to be referred to our service again.

If you fail to attend this appointment, you will be discharged back to your GP’s care and will need a new referral in line with the Trust Policy.

Notes about your appointment

We are a teaching hospital so, on occasion, there may also be a student present in the appointment or a student supervised by an audiologist may see you. If you are not comfortable with this, please let us know when you check in for your appointment at the audiology reception desk.

We always try to see our patients at the time of their allocated appointment. Please ensure you arrive on time for your appointment.

Patient Advice & Liaison Service (PALS)

We value your opinion. If you have concerns or wish to give feedback about services, your care or treatment, we invite you to contact the PALS office:

Introduction

Your GP has referred you to the Audiology Department for a hearing assessment.

What will happen at my appointment?

We will ask you some questions about your ears and general health. We will talk through situations you are having difficulty hearing in. It would be helpful if you can give this some thought before you attend.

We will examine your ears to see if they are healthy. You will listen to a series of sounds presented through headphones and be asked to press a button every time you hear a sound. This allows us to measure the quietest sounds you are able to hear. Occasionally we may also do a pressure test to check how well your eardrums are moving and if you have any fluid behind your eardrum. All procedures will only be carried out with your consent.

Your test results will be explained and the treatment options available to you will be discussed. If you need have hearing aids and you choose to proceed, a further appointment will be booked to fit your hearing aid(s) and show you how to use them.

Depending on the outcome of your hearing assessment, we may refer you on to the Ear, Nose and Throat Department (with your consent). We will write back to your GP with the outcome of your hearing assessment.

How long will my appointment take?

Approximately between 45 minutes to one hour. We aim to see you on time but occasionally clinics can be unavoidably delayed. We will keep you informed of any delay to your appointment.

How do I prepare for my appointment?

Before the appointment, please ensure your ears are free of wax. Wax can block ears and affect the results of your hearing test. If your ears are blocked with wax, please see you practice nurse or GP for wax removal prior to your appointment.
If you wear glasses, please bring them along with you.

If you are eligible for hospital transport, please contact us to arrange it for you.
If you need an interpreter, do contact us for this to be arranged. We cannot guarantee availability of interpreters for all languages, so please arrange this well in advance.

You are welcome to bring a relative, close friend or carer with you to your appointment.

If you would prefer not to have a hearing assessment, please contact us as soon as possible so that we can offer this valuable appointment to someone else.

Can I cancel my appointment?

If you need to cancel your appointment, please call us as soon as possible. If you cancel your appointment more than two times, you will be discharged back to your GP and will need to be referred to our service again.

If you fail to attend this appointment, you will be discharged back to your GP’s care and will need a new referral in line with the Trust Policy.

Notes about your appointment

We are a teaching hospital so, on occasion, there may also be a student present in the appointment or a student supervised by an audiologist may see you. If you are not comfortable with this, please let us know when you check in for your appointment at the audiology reception desk.

We always try to see our patients at the time of their allocated appointment. Please ensure you arrive on time for your appointment.

Patient Advice & Liaison Service (PALS)

We value your opinion. If you have concerns or wish to give feedback about services, your care or treatment, we invite you to contact the PALS office:

Introduction

If you have been referred to see the hearing therapy team it is because the Audiologist or ENT Doctor feels that you might benefit from further advice and guidance on how to manage your condition. It is an opportunity to speak with the Audiology team about your condition.

People referred to this service are concerned about a condition such as:

What will happen at my appointment?

You will be asked some questions about your ears, general health and specific information about your related condition as mentioned above. We will give you advice on how to manage your condition. We might refer you to other services who can help further. Most people who attend this appointment are given information and reassurance about their condition and are able to manage it better afterwards. You will receive leaflets about your condition to take home with you.

How long will my appointment take?

Approximately one hour. We aim to see you on time but occasionally clinics can be unavoidably delayed. We will keep you informed of any delay to your appointment.

How do I prepare for my appointment?

Before the appointment, please ensure your ears are free of wax. Wax can block ears and affect the results of your hearing test. If your ears are blocked with wax, please see you practice nurse or GP for wax removal prior to your appointment.

If you wear glasses, please bring them along with you.

If you are eligible for hospital transport, please contact us to arrange it for you.
If you need an interpreter, do contact us for this to be arranged. We cannot guarantee availability of interpreters for all languages, so please arrange this well in advance.

You are welcome to bring a relative, close friend or carer with you to your appointment.

If you would prefer not to have this appointment, please contact us as soon as possible so that we can offer this valuable appointment to someone else.

Can I cancel my appointment?

If you need to cancel your appointment, please call us as soon as possible. If you cancel your appointment more than two times, you will be discharged back to your GP and will need to be referred to our service again.

If you fail to attend this appointment, you will be discharged back to your GP’s care and will need a new referral in line with the Trust Policy.

Notes about your appointment

We are a teaching hospital so, on occasion, there may also be a student present in the appointment or a student supervised by an audiologist may see you. If you are not comfortable with this, please let us know when you check in for your appointment at the audiology reception desk.

We always try to see our patients at the time of their allocated appointment. Please ensure you arrive on time for your appointment.

Patient Advice & Liaison Service (PALS)

We value your opinion. If you have concerns or wish to give feedback about services, your care or treatment, we invite you to contact the PALS office:

Introduction

You had a hearing assessment on ______________ at the Audiology department.

These are the results of your hearing test

The chart below will help you to get a general view where specific speech and environmental sounds lie. From top to bottom, you can see that sounds are getting louder, and from left to right, the tone of each sound is getting higher in pitch. This may help you and your family to understand the difficulties you are experiencing during communication.

What type of hearing loss do I have?

• Normal hearing with a slight loss at some levels
• Mild hearing loss: This means you may have difficulty following speech, especially in noisy situations. This type of loss is often noticed by family or friends first rather than one self.
• Moderate hearing loss: You have difficulty following speech and misses other quiet sounds. Amplification is very successful for this loss but you will also need to use good listening tactics. Lip-reading classes could benefit people with this hearing level.
• Severe hearing loss: Difficulty hearing speech even in quiet surroundings and you may not hear general noises such as traffic, unless they are loud. Amplification is very successful for this loss, but you will need to use good listening tactics. Lip-reading classes could benefit people with this hearing level.
• Profound hearing loss: Inability to hear most sounds unless they are very loud. Amplification is often useful but you will also need to rely on good listening tactics and concentration. Lip-reading classes would also be useful for people with this hearing loss. Patients in this category may also use British sign language and watch sign assisted programs.

Notes about your appointment

We have discussed your hearing test results with you and made the following recommendations:

• We discussed why a hearing aid may not be suitable for your hearing levels at present.
• We discussed why a hearing aid would be beneficial for you. However, at present, you decided not to have a hearing aid fitted.
• You may benefit from using communication tactics to help you hear better. Sometimes friends and family also need to adapt their communication. Please see the leaflet on communication tactics we have given as well.
• You need to be seen by the Ear, Nose & Throat Specialist for the following reason:

_____________________________________________
_____________________________________________
_____________________________________________

We recommend you have your hearing re-tested every three years or sooner if you notice any further hearing difficulties.

When you would like to have a new hearing test your GP will need to make another referral to the Audiology Department through the NHS electronic referral service.

Introduction

You have recently seen the ENT Specialist and they have requested we fit you with a behind-the-ear NHS digital hearing aid.

What will happen at my appointment?

We will ask you some questions about your ears and general health. We will talk through situations you are having difficulty hearing in. It would be helpful if you can give this some thought before you attend.

Your latest hearing test results will be used to create a computer prescription, and the hearing aids will be programmed accordingly with a fine-tuning test. This method used is called Real Ear Measurement and it involves placing a fine, soft and flexible tube into the outside of your ear canal. You will hear medium, soft and loud sounds which enables us to see how the hearing aid performs in your ear and to ensure a good match to your hearing test. Further simple checks will be carried out to ensure that the sound is comfortable for you and to ensure the hearing aid fit comfortably.

We will show you how to use and maintain the hearing aids and you will receive a new hearing aid guidance book (written instructions).

After the appointment we will book you a follow-up appointment within 6 – 8 weeks (either face-to-face or on the telephone) to see how you are getting on with the hearing aids.

How long will my appointment take?

Approximately between 45 minute to one hour. We aim to see you on time but occasionally clinics can be unavoidably delayed.

How do I prepare for my appointment?

Before the appointment, please ensure your ears are free of wax. Wax can block ears and affect the results of your hearing aid fitting. If your ears are blocked with wax, please see you practice nurse or GP for wax removal prior to your appointment.

If you wear glasses, please bring them along with you.

If you are eligible for hospital transport, please contact us to arrange it for you.

If you need an interpreter, do contact us for this to be arranged. We cannot guarantee availability of interpreters for all languages, so please arrange this well in advance.

You are welcome to bring a relative, close friend or carer with you to your appointment.

If you would prefer not to have a hearing aid fitting, please contact us as soon as possible so that we can offer this valuable appointment to someone else.

Can I cancel my appointment?

If you need to cancel your appointment, please call us as soon as possible. If you cancel your appointment more than two times, you will be discharged back to your GP and will need to be referred to our service again.

If you fail to attend this appointment, you will be discharged back to your GP’s care and will need a new referral in line with the Trust Policy.

Notes about your appointment

We are a teaching hospital so, on occasion, there may also be a student present in the appointment or a student supervised by an audiologist may see you. If you are not comfortable with this, please let us know when you check in for your appointment at the audiology reception desk.

We always try to see our patients at the time of their allocated appointment. Please ensure you arrive on time for your appointment.

Patient Advice & Liaison Service (PALS)

We value your opinion. If you have concerns or wish to give feedback about services, your care or treatment, we invite you to contact the PALS office:

Welcome to the Adult Audiology department at West Middlesex University Hospital.  You have now transitioned from the Paediatric Hearing Aid services to the Adult Hearing Aid services. As part of this transition we received a letter from your GP for a reassessment of your hearing and an appointment has been booked for you by your GP practice.

These appointments can be booked at West Middlesex University Hospital or any of our outreach clinics at Feltham Centre for Health, Teddington Memorial Hospital or Whitton Corner Health and Social Care Centre. At this reassessment appointment, we will carry out a full audiological assessment (patient history, ear examination & hearing test). Currently our department supply Sivantos hearing aids. If you are happy with your Paediatric hearing aid, you can continue to use them however if it becomes faulty, we will have to switch your hearing aid over to Sivantos. You will also receive a Guidance Book with all the details you need.

After your reassessment, you will have a follow up to see how you are getting along with your Hearing Aid. This can be done either during a booked 30-minute appointment with an Audiologist or you can choose to receive a phone call. The Audiologist will discuss this with you at your reassessment appointment. After your follow up appointment, we recommend you have a reassessment every three years. For your three year review you will need to request a reassessment referral from your GP each time. Please note adult NHS Audiology services does not carry out annual reassessments.

For any maintenance on your hearing aid, you must book a repair appointment. We can offer you an emergency appointment within 48 hrs. at West Middlesex University Hospital (limited availability). You can also choose a specific day (Monday – Friday) and outreach clinic if required, if there is still availability. For any Adult Audiology service appointment, you must contact the Audiology Reception at West Middlesex Hospital. Please note our Audiology services at the outreach clinics are only available on the following days:

• Feltham: Wednesdays depending on availability
• Whitton: Monday or Tuesdays depending on availability

Please note these clinics can get booked up in advance. If you wish to be seen at one of these clinics you must request this every time you phone for an appointment. If you do not request this, you will receive an appointment at West Middlesex University Hospital by default. You need to contact the Audiology reception at West Middlesex to book an appointment for these locations.

If you need a retube of your hearing aid mould or Signia replacement life tubes, you can walk-in to the Audiology Reception at West Middlesex Hospital (there is a 24hr turnaround for this service). You can also phone us to have these posted out to you if you are able to do this yourself.

If you require to be seen at the Feltham Health Centre, you need to contact the Audiology reception at West Middlesex to book an appointment for this location. 

You can collect hearing aid batteries with your battery book at:

• Main reception desk at entrance of West Middlesex University Hospital
• Audiology reception desk at West Middlesex University Hospital (OPD 5)
• St. David’s Practice at Feltham Centre for Health

Alternatively, you can collect batteries from other local clinics. Please consult your Hearing Aid Guidance Book which will be issued to you at the reassessment appointment r see our website for further details. We can also post these out to you upon request.

Assistive Listening Devices:
We can carry out an assessment for a loop system / echo link device for your television or amplified doorbell. Please request an assessment for these devices from the Audiology Reception at West Middlesex University Hospital. Please note this service cannot take place at any of our outreach clinics.

After the assessment, we will send a form of to the relevant Social Services team in either Hounslow or Richmond. They will then contact you to arrange delivery & instalment if relevant. If the devices break down you must contact the Social Services team for replacement or maintenance.

• Hounslow Adult Social Care: 020-8583-3100 / adultsocialcare@hounslow.gov.uk
• Richmond Adult Access Team: 020-8891-7971 / adultsocialservices@richmond.gov.uk
• Ealing Deafplus: 0756 4500 534

Our contact details are:

Address: Outpatients 5, 1^st Floor, East Wing, West Middlesex University Hospital, Twickenham Road, Isleworth, TW7 6AF.

Telephone: 020-8321-5681

Email:          caw-tr.wm-audiologydepartment@nhs.net

Audiology reception opening hours (for enquiries only):

• Monday – Thursday: 8:30 – 12:30pm & 1:30pm – 5:00pm
• Fridays: 8:30 – 12:30pm & 1:30 – 4pm
• Saturdays*: 8:30 – 12pm (phone consultations only)

*Please note that we are not open on any Saturdays linked to a bank holiday weekend*
**Patients are seen by an appointment ONLY!! Unless you require just a retube**

Introduction

You, your GP or your ear, nose and throat (ENT) specialist has requested a reassessment of your hearing and hearing aid by the Audiology department.

What will happen at my appointment?

At your appointment, we ask you some questions about your ears, general health and any situations in which you are having difficulty hearing. We will look into your ears and check that they are healthy and free of wax. We will carry out a new hearing test first.

We will explain the hearing test results to you and then use the results to create a computer prescription to program your hearing aids accordingly with a fine-tuning test. This method used is called Real Ear Measurement and it involves placing a fine, soft and flexible tube into the outside of your ear canal. You will hear medium, soft and loud sounds which enables us to see how the hearing aid performs in your ear and to ensure a good match to your hearing test. Further simple checks will be carried out to ensure that the sound is comfortable for you and to ensure the hearing aid fit comfortably.

We will show you how to use and maintain the hearing aids and you will receive a new hearing aid guidance book (written instructions).

After the appointment we will book you a follow-up appointment within 6 – 8 weeks (either face-to-face or on the telephone) to see how you are getting on with the hearing aids.

How long will my appointment take?

Approximately between 45 minutes to one hour. We aim to see you on time but occasionally clinics can be unavoidably delayed. We will keep you informed of any delay to your appointment.

How do I prepare for my appointment?

Before the appointment, please ensure your ears are free of wax. Wax can block ears and affect the results of your hearing test. If your ears are blocked with wax, please see you practice nurse or GP for wax removal prior to your appointment.

If you wear glasses, please bring them along with you.

If you are eligible for hospital transport, please contact us to arrange it for you.

If you need an interpreter, do contact us for this to be arranged. We cannot guarantee availability of interpreters for all languages, so please arrange this well in advance.

You are welcome to bring a relative, close friend or carer with you to your appointment.

If you would prefer not to have a hearing reassessment, please contact us as soon as possible so that we can offer this valuable appointment to someone else.

Can I cancel my appointment?

If you need to cancel your appointment, please call us as soon as possible. If you cancel your appointment more than two times, you will be discharged back to your GP and will need to be referred to our service again.

If you fail to attend this appointment, you will be discharged back to your GP’s care and will need a new referral in line with the Trust Policy.

Notes about your appointment

We are a teaching hospital so, on occasion, there may also be a student present in the appointment or a student supervised by an audiologist may see you. If you are not comfortable with this, please let us know when you check in for your appointment at the audiology reception desk.

We always try to see our patients at the time of their allocated appointment. Please ensure you arrive on time for your appointment.

Patient Advice & Liaison Service (PALS)

We value your opinion. If you have concerns or wish to give feedback about services, your care or treatment, we invite you to contact the PALS office:

Swim moulds policy

• You have requested a swim mould or a set of swim moulds
• To fit you with swim moulds, we need to take an impression of your ear—this involves inserting a small sponge into your ear and filling it with impression material to capture the shape of your ear.
• If you suffer from tinnitus, the volume may increase when the impression material is in your ear, but should return to its original level once it's removed.
• It takes about 2–3 weeks for the laboratory to make the moulds.
• We will send you a letter with instructions on arranging payment and collection once the moulds are ready.
• Each individual swim mould costs £20.

Please note: Swim moulds are not 100% waterproof.

Collection information

You have recently had an impression taken of your ear for a swim mould. Your swim moulds are now ready for collection.

• Each individual swim mould costs £20.
• You can arrange for collection and payment of the swim moulds at the same time.
• To schedule your collection, please call us at 020 8321 5681 or email us at caw-tr.wm-audiologydepartment@nhs.net.
• The opening times and details of the cashier's office to make payment are detailed in the accompanying letter.
• After paying at the cashier's office, you'll receive a receipt. Bring this receipt to your swim mould collection appointment, where we'll fit the swim moulds.
• We'll show you how to fit the swim moulds. If they're not a good fit, we'll retake the impressions.
• If you find the swim moulds are a poor fit within two weeks of the fitting, contact us and we'll retake the impressions at no extra charge.

Please note: Swim moulds are not 100% waterproof.

Introduction

Your GP has referred you to the Audiology Department for a tinnitus assessment.

What will happen at my appointment?

We will ask you some questions about your tinnitus, ears and general health. We will talk through difficulties you are having with your tinnitus. It would be helpful if you can give this some thought before you attend.

We will examine your ears to see if they are healthy and then complete a hearing test. Occasionally we may also do a pressure test to check how well your eardrums are moving and if you have any fluid behind your eardrum. All procedures will only be carried out with your consent.

We will explain the hearing test results to you. We will advise you on what tinnitus is and why we think you may have it. Tinnitus is rarely an indication of a serious condition and mostly experienced as a symptom of something else. The causes of tinnitus are still not fully understood, but tinnitus can be associated with various causes including hearing loss, exposure to loud noise, ear infection, stress, anxiety and depression.

We will advise you on how to cope with your tinnitus through evidence based self-management techniques. These can be very helpful in management of tinnitus. We will give you information leaflets about everything we will discuss so you can go through it again at home.

Depending on the outcome of your hearing assessment, we may refer you on to the Ear, Nose and Throat Department (with your consent) for further investigations. We will write back to your GP with the outcome of the appointment.

How long will my appointment take?

Approximately one hour. We aim to see you on time but occasionally clinics can be unavoidably delayed. We will keep you informed of any delay to your appointment.

How do I prepare for my appointment?

If you would prefer not to have a hearing reassessment, please contact us as soon as possible so that we can offer this valuable appointment to someone else.

Before the appointment, please ensure your ears are free of wax. Wax can block ears and affect the results of your hearing test. If your ears are blocked with wax, please see you practice nurse or GP for wax removal prior to your appointment.

If you wear glasses, please bring them along with you.

If you are eligible for hospital transport, please contact us to arrange it for you.

If you need an interpreter, do contact us for this to be arranged. We cannot guarantee availability of interpreters for all languages, so please arrange this well in advance.

You are welcome to bring a relative, close friend or carer with you to your appointment.

Can I cancel my appointment?

If you need to cancel your appointment, please call us as soon as possible. If you cancel your appointment more than two times, you will be discharged back to your GP and will need to be referred to our service again.

If you fail to attend this appointment, you will be discharged back to your GP’s care and will need a new referral in line with the Trust Policy.

Notes about your appointment

We are a teaching hospital so, on occasion, there may also be a student present in the appointment or a student supervised by an audiologist may see you. If you are not comfortable with this, please let us know when you check in for your appointment at the audiology reception desk.

We always try to see our patients at the time of their allocated appointment. Please ensure you arrive on time for your appointment.

Patient Advice & Liaison Service (PALS)

We value your opinion. If you have concerns or wish to give feedback about services, your care or treatment, we invite you to contact the PALS office:

Introduction

The Ear-, Nose - & Throat (ENT) doctor have referred you to the Audiology Department at West Middlesex University Hospital for video nystagmography, a specialised balance test.

What will happen at my appointment?

The Audiologist will go through your completed questionnaire, which is attached. A pressure test will be carried out of your ears to ensure that your eardrums are normal. This is a simple test and will not cause any discomfort. If there is a problem with this test the VNG will not be carried out, and an appointment will be made for you to see the ENT doctor.

For the test, a set of goggles is placed over your eyes. These goggles have cameras in them to record your eye movements, you will also be asked to lie down on a bed, throughout the three parts of the test. It is important that you keep your eyes opened during the test. The test is carried out in darkness. The reason for this is that if you are dizzy you will focus on an item to stop the dizziness, if the room is in darkness you are not able to do this, therefore allowing the cameras to record your eye movement.

The VNG test is divided into three parts. The Doctor does not always request all three parts of the test:

EYE TRACKING: The room will be in darkness and you will be requested to follow lights on a light bar. It is important in this part of the test, that you track the moving lights, with your eyes and do not move your head.

POSITIONAL TESTING: Again, the room will be in darkness. You will be moved into various positions on the bed.

CALORIC TESTING: This part of the test takes the longest time. This is where we irrigate your ears with water, which creates a dizzy spell.

Your body is at a constant temperature of 37 degrees centigrade. We initially irrigate water into one of your ears at 44 degrees centigrade, which is 7 degrees above your body’s temperature. You may feel that the water is very warm, but it is 7 degrees centigrade above your body temperature and gives an illusion of being very warm. We irrigate your ear canal for 30 seconds. During this time you may start to feel dizzy, the dizziness will last only for a few minutes; it will give the sensation of being on a merry-go-round. Again, you will be in darkness and we will request that you keep your eyes open so that the cameras can record your eye movements. We then repeat in your other ear. We then decrease the temperature of the water to 30 degrees centigrade and repeat the procedure on both ears. You have a short rest between each irrigation, before we start the next side.

We will analyze your results and write a report to the ENT doctor. The ENT will send you a follow up appointment and the results will be discussed with you in the ENT follow up appointment.

How do I prepare for my appointment?

Do not take anti-dizziness tablets or sedatives for at least 48 hours beforehand. You must continue to take essential medications. If you are not sure about this, please contact your doctor.

Do not eat or drink tea/coffee for four hours before the test.

Do not drink alcohol for 24 hours beforehand.

It is not wise to drive a car/operate machinery immediately after the test.

Please refrain from wearing eye make-up as this can interfere with recording eye movements. If you wear glasses, please bring them along with you.

How long will my appointment take?

Approximately 90 minutes. We aim to see you on time but occasionally clinics can be unavoidably delayed. We will keep you informed of any delay to your appointment.

Can I cancel my appointment?

If you need to cancel your appointment, please call us as soon as possible. If you cancel your appointment more than two times or if you fail to attend, you will be discharged back to your GP. You will need to be referred to our service again if you want another appointment in line with the Trust Policy.

What is eustachian tube dysfunction?

The prolonged failure to equalise pressure in the middle ear. This inadequate ventilation of the chamber behind the eardrum can be the result of sinus, throat, nose and ear conditions, including common colds and allergies.

What are the symptoms?

The main symptom is muffled or dull hearing, often described as being underwater or ears with cotton wool.

Ear pain can be due to a pressure difference causing the drum to over stretch. Other symptoms include fullness in the ear (pressure), tinnitus (ringing), dizziness, popping or clicking noises.

Treatment

If the symptoms are mild usually it will resolve on its own.

Yawn or open your mouth widely as if you were yawning. Eating and drinking may also mobilise the Eustachian tube to allow some air travel through the tube.

Valsalva and Toynbee manoeuvres can be done to push some air into middle ear, take a deep breath, pinch your nose and close your mouth, and gently pop your ears. Do not be very forceful. Some balloons and auto-inflation devices are designed to direct air to the middle ear and promote emptying of middle ear fluid and are available over the counter or online.  

Nasal decongestants may be used if there is some blockage. This is available over the counter. GP may prescribe steroid nasal sprays for persistent inflammation.

Steam inhalations with menthol, eucalyptus, or other oils in boiling water in the sink with a towel over the head or any other kind of inhalation device.

Sucking a boiled sweet such as menthol or eucalyptus to unblock the nose.

Taking antihistamines if the swelling is caused by allergies.

If the symptoms persists for over 3 weeks it is advised to see a specialist to investigate it further.

What is Otitis Externa?

Otitis externa is a condition of the outer ear caused by inflammation of the skin in the ear canal, with or without associated infection. If infective, it could be caused by bacteria or yeasts- fungal infection. This condition can be a single episode, a recurrent condition or a chronic persistent issue.

Common causes

• Getting water in the ear whilst swimming, having a bath or shower as this may allow germs in the water cause infection in the ears or what is also known as “Swimmer’s ears”.
• Getting shampoo or soap into the ear canal can cause irritation of the skin.
• Damage of the ear skin, trauma caused by cotton buds, scratching or fiddling with the ear.
• Hot and humid environment may encourage bacterial growth
• Skin conditions such as eczema or psoriasis
• A wax build up causing irritation or water getting trapped behind the wax build up.
• Wearing ear plugs, hearing aids or head phones preventing ventilation in the ears
• Over the counter drops can cause irritation of the skin of the canals

Dos and don’ts to prevent Otitis Externa

• To avoid getting water, soap or shampoo in the ear when having a bath or shower, place a cotton wool coated with Vaseline in the ear bowl to prevent water entering the ear. Do not push the cotton wool down into the canal.
• Do not stick anything in the ears even when they are itchy, do not use cotton buds.
• Misuse or overuse of over-the-counter eardrops can cause irritation of the skin, if you get discomfort in the ears better get them checked and discuss the use of eardrops with an ENT specialist, GP, nurse.
• Use earplugs if swimming, drops can be used to pervert water trapping in the ears
• Do not have ear syringing or water irrigation if you have inflamed ear canals
• Keep ears dry

Treatment

Your GP may refer you to a specialist for further advice if symptoms are severe or they have failed to respond to treatment. The treatment choice may include antiseptic, antibiotic or antifungal eardrops, steroids drops or a combination of them.

Micro-suction may be required to clear discharge and debris, and sometimes the treatment may require instillation of a cream/ointment in the canal, insertion of a ribbon gauze impregnated in medication or a pope wick. In some cases, oral antibiotics may be prescribed in addition to topical treatment.

Water precautions are paramount in the management of otitis externa to prevent infections caused by waterborne germs. 

Ear care information

• Ears are designed to clean themselves (skin migration and jaw movements facilitate emptying  wax)
• Some wax is meant to remain in the ear canal, it provides protection against dust, dirt and infections
• Do not use cotton buds to clean your ears, it can push the wax further down the canal, potentially result in wax impaction and ear canal trauma or bud stuck in the canal.
• “Don’t stick anything in the ears smaller than the elbow” is a popular saying to prevent traumatic scratches and the mechanical wax build up pushing the wax like play-doh further down the ear canal, even when it is itchy, as this can cause blockage and impaction of the wax preventing the evacuation of wax-debris.
• Generally, avoid over the counter eardrops as some of the preparations can irritate the sensitive ear canal skin. Ear care professionals can give guidance in the use of eardrops.
• Avoid getting water, soap or shampoo into the ear when having a bath or shower. Place a piece of cotton wool coated in Vaseline to prevent entry of water. Ear plugs may be used for swimming if having recurrent ear infections. Keep your ears dry especially if you have a tympanic membrane perforation or any skin condition such as eczema or psoriasis.
• If the skin of your ears is very dry and itchy moisturizers can be used around the bowl of the ear and the entrance of the ear canal.
• If the ears are very dry and itchy oil eardrops/spray can be used sparingly.
• If experiencing discomfort and being unsure about the state of the ears  it is advised to get them check by your GP and/or refer  to the ear specialist to assess the ears. 
• Ear micro-suction can be performed to clear wax/debris from the canal, allow examination and manage different ear conditions, especially where water irrigation is not advised, e.g. drum perforations, ear surgery, skin conditions and recurrent ear infections, unilateral deafness 

Advice for patients

• Do not engage in strenuous activity
• Avoid hot food and drink
• Avoid going to a crowded area
• Do not blow or rub your nose hard
• Check if patient has been prescribed for saline solution for nasal douches.  if yes advice patient to continue , If no ask doctor to prescribe  the saline solution  for patient to use
• If you experience a nose bleed, sit upright, pinch your nose to apply pressure and put ice pack to the bridge of nostrils
• If bleeding does not stop then report to A&E
• Look for signs of infection (e.g. offensive nasal discharge). Report to A&E for treatment

If you experience any difficulty, please contact:

Ear nose & throat clinic
Outpatient 5, 1st Floor
West Middlesex University Hospital

T:  020 8321 5628/020 8321 5904

Advice given to the patients

• Do not engage in strenuous activity
• Get up from bed gentle to avoid dizziness
• Change cotton wool twice a day and ensure the BIPP pack is in in situ
• Patient to come for removal of BIPP pack in 1 week or 2 weeks post operation by the doctor’s instructions
• There may be slight bleeding but if bleeding occurs excessively then report to A&E to be seen by the doctor.
•  Look for signs of infection (e.g offensive ear discharge or discharge form the stitches area). Report to A&E for treatment

If you experience any difficulty, please contact:

West Middlesex University Hospital

Ear, Nose and Throat Clinic
Outpatients 5, 1st Floor

Tel:  0208 321 5628 /  0208 321 5904

Introduction

You have recently been seen in the Tinnitus clinic and you have opted to try a Tinnitus Sound masker device to aid management of your tinnitus through sound therapy.

What is the purpose of a tinnitus masker?

Tinnitus is rarely an indication of a serious condition and mostly experienced as a symptom of something else. The causes of tinnitus are still not fully understood, but tinnitus can be associated with hearing loss, exposure to loud noise, ear infection, stress, anxiety and depression. To help reduce tinnitus awareness, a TSG device can be used as part of sound therapy in the self-help techniques recommended for coping with tinnitus.

The aim of sound therapy is not to drown out the tinnitus but to provide a constant non-intrusive external and alternative sound for the brain to focus on. The aim is to distract you from your tinnitus and lessen the attention paid to the tinnitus.

For sound therapy to be successful in the long term, we set the volume of the TSG sounds at just below the level of your tinnitus. This is so that we don’t mask your tinnitus completely. Research shows that listening to masking sounds, while still being able to hear your tinnitus at a very low level, will help you to ‘train’ your brain to ‘filter out’ your tinnitus.

This process however takes time to develop and be successful. To enhance this we recommend you use the device daily for a minimum of 6-8 hrs continuously.

Your tinnitus masker

There are different types of sounds available. Today you have chosen to have the following programmes on your device:

Programme 1: _______________________
Programme 2: _______________________
Programme 3: _______________________

Every time you switch the device on, it will be on programme 1 by default.

You can use the rocker switch to change to any other program by simply pressing on the bottom button for 5 seconds and then letting go. It will then change to the next programme. Please repeat until you reach the desired programme.

To switch the device off, open the battery compartment and leave it open until you wish to use the device again. If you have a rechargeable version, just place them back into the charger.

To switch the device on, just close the battery compartment. If you have a rechargeable version, just remove them from the charger.

The thin tube needs to be replaced every 6 months. You can also collect new batteries at the same time. You can have this done without an appointment by dropping your device off at our reception desk during the following opening times:

Monday – Thursday: 8:30am - 5:00pm
Friday: 8:30am - 4:00pm

You can then collect the device the next working day. Alternatively, if you can do it yourself you can phone us and we will post you a new tube and batteries.

If you wish to have any adjustments made to the device you need to book an appointment with a relevant Audiologist.

Please note: this device is on loan to you from the NHS. If you no longer use the device, you must please return it to our reception desk. If you lose this device, you will be liable to charge to have it replaced.

Patient Advice & Liaison Service (PALS)

We value your opinion. If you have concerns or wish to give feedback about services, your care or treatment, we invite you to contact the PALS office:

Introduction

This booklet has been designed to give you information about thyroid and parathyroid disorders and their treatments. These are two different conditions but are treated with a similar surgery. We hope it will answer some of the questions that you or those who care for you may have. This booklet is not meant to replace the discussion between you and your medical team, but aims to help you understand more about what is discussed.

What is the thyroid gland and what does it do?

The thyroid gland is a small, butterfly-shaped gland located at the front of the neck (below the Adam’s apple). A gland is a group of cells which produces a substance such as sweat, saliva or tears. There is a variety of them all over the body.

The thyroid gland uses iodine (found in small quantities in many foods) to produce thyroid hormone which controls many aspects of health, including:

• The rate at which the body’s cells work - the ‘metabolic rate’
• Body weight and temperature
• Heart rate and blood pressure
• Mental alertness
• Growth in children

If too much thyroid hormone is present in the circulation, the body’s cells will work faster than normal - this is called ‘hyperthyroidism’ i.e. the thyroid gland is overactive.

If too little thyroid hormone is in circulation, the cells will work slower than normal - this is called ‘hypothyroidism’ i.e. the thyroid gland is underactive.

What type of disorder may affect the thyroid gland?

Overactive thyroid

If your thyroid gland is overactive you may experience one or more of the following symptoms:

• Restlessness
• Anxiety and sleep disturbance
• A fast heart rate
• Increased appetite with weight loss
• Diarrhoea
• A dislike for hot weather
• Staring eyes

Blood tests will confirm the diagnosis. You may be prescribed medication to control the effects of the excess hormone.

If the medication does not cure the disease, you may be given radioiodine treatment which involves taking a tablet. Your endocrinologist will give you information about this, and see also the patient information leaflet ‘Treatment using radioiodine’.

Surgery is another option if radioiodine and/or medication are not appropriate. The advantages and disadvantages of each option will be discussed with you by your endocrinologist and surgeon.

Underactive thyroid

If your thyroid gland is underactive you may experience one or more of the following symptoms

• Tiredness
• Poor appetite, weight gain and constipation
• A dislike of cold weather
• Swollen lips and a puffy face
• Slow heart rate

Are there any alternatives to this treatment?

This will depend on your existing medical condition. Your hospital doctor will discuss the options with you if appropriate.

What will the scar be like?

Almost all patients ask about the scar resulting from surgery. Fortunately the majority of our surgery can be performed by making a small incision in the neck of 4-6 cm in length (1.5-2.5 inches).

This heals very well in the vast majority of patients. It can sometimes be difficult to see the scar once full healing has taken place, three or so months after surgery.

Are there techniques that can avoid a scar in the neck?

We have pioneered a technique in the UK using the Da Vinci robot which leaves a scar in the armpit instead of the neck. This technique cannot be recommended to all patients and is mostly appropriate for patients who have a tendency to heal poorly with thick and pigmented scars. This will be discussed with you by your surgeon. The length of hospital stay and complications are the same as in conventional surgery.

Is there anything I need to do to prepare for my operation?