At Hearing & Balance, we do not accept patients without a physician's referral.
Please have your physician fill out the referral form found .
preparing for tests
Please do not wear any eye makeup to your appointment – NO mascara or eyeliner
Do not consume alcohol at least 48 hours prior to testing
Do not take sleeping pills, recreational drugs, relaxants, antihistamines, or drugs for dizziness at least 48 hours prior to testing. Please consult your prescribing physician about temporarily stopping any medications
Do not discontinue daily medication for other chronic conditions without consulting a physician or our office
Upon arrival, please let the audiologist know if you have any neck or back problems
It is recommended that you have someone drive you home after the test
Following testing, the results will be faxed to your referring physician within 2 weeks.
The VNG/ENG battery is considered by many to be the gold standard test for vestibular assessment. Our state-of-the-art equipment can capture even the most subtle eye movement abnormalities, many of which would go undetected during a bedside evaluation.
It is a 1 hour comprehensive test of balance function. In order to monitor your eye movements, you will be asked to wear a pair of goggles or you will have sticker electrodes around your face throughout the testing.
What Is Included?
During the first part of the test you will be asked to follow a light from side-to-side and up-and-down.
Here, we are looking for any abnormal eye movements with changing head and/or body position. You will be asked to turn your head to each side and sit-up for 30 seconds.
The Dix-Hallpike Manoeuvre
During this part of the test we are looking for positional vertigo. You will be asked to lie flat on your back with your head extended in one direction. This will be repeated with your head extended in other other direction.
The last part of the test involves putting warm and cool water into your ears. The water will stream into your ears for 25-30 seconds and will immediately come out into a basin. This may cause some dizziness, however, it will not last.
This is an important part of the assessment as it tests the balance system of each ear separately so that we can compare the intensity of the response from each side.
Please note: dizziness from this test typically subsides within a very short period of time and most patients feel well enough to drive themselves home. As a precaution, we recommend that you ask a friend or family member to drive you to the appointment in case the dizziness takes a bit longer to subside.
Vestibular Evoked Myogenic Potentials
The Vestibular Evoked Myogenic Potential (VEMP) test is used to evaluate the balance organs that help with up-and-down and forward-and-backwards movements. Responses are measured from the neck muscles (cVEMP) and the eye muscles (oVEMP) by placing sticker electrodes on the neck and on the cheek.
In total, the c and oVEMP testing takes 45 minutes to 1 hour to complete.
You will have sticker electrodes placed on your forehead, neck and upper chest as well as a foam insert placed in your ear.
You will be asked to turn and hold your head to one side when you hear a sound.
You will have sticker electrodes placed on your forehead, under your eyes/cheek and upper chest as well as a foam insert placed in your ear.
You will be asked to look up when you hear a sound.
VIDEO HEAD IMPULSE TEST (vHIT)
The Video Head Impulse Test (vHIT) is used to assess how well the eye can focus when the head is moving. In order to test this function, you will wear a pair of goggles and be asked to focus on a target in front of you. The clinician will then move your head side to side while you stare at the target. The goggles measure your eye and head movements.
A vHIT takes approximately 30 minutes to complete.
You will be asked to stare at a dot on the wall while the clinician moves your head side to side in quick, short movements.
You will be asked to stare at a dot on the wall while the clinician moves your head up and down in quick, short movements.
At the Centre for Advanced Hearing and Balance Testing, we offer comprehensive diagnostic hearing assessments for all of our patients.
Please for a copy of our referral. You will need to ask your physician to fax the completed referral to (416) 340-3745.
A diagnostic hearing assessment takes approximately 30 minutes to complete.
What Is Included?
We examine your ears, including the external ear canal and the eardrum, to look for signs of blockages (e.g. earwax) as well as ear-related problems that might require medical follow-up (e.g. ear infections).
If significant earwax is present, the audiologists at Hearing & Balance have access to medical-grade microscopes and suction devices for removing it.
We use a machine called a tympanometer to assess how your eardrums are moving. When an eardrum is too floppy or too stiff, it can indicate certain middle ear problems that usually require medical follow-up.
We may also play loud sounds in your ear to assess acoustic reflexes.
This is the step that people most commonly expect when they come in for a hearing test. We play a series of beeps/tones and ask you to respond when you hear one. This way we can determine your hearing thresholds for each ear individually, across the range of frequencies/pitches that are important for speech understanding.
We use the results of this test to establish the severity and type of hearing loss. A hearing loss can be the result of damage to the inner ear and/or auditory nerve (sensorineural hearing loss), problems with the middle ear (conductive hearing loss), or both (mixed hearing loss).
This part of the assessment is divided into two main parts. During the first part, you will be asked to repeat words as we vary the loudness. The purpose is to establish the softest level at which you are consistently able to repeat the words back correctly.
During the second part, we measure your accuracy when repeating words at a comfortable listening level. We also complete tests to establish your most comfortable listening level for speech (MCL), as well as your uncomfortable listening level (UCL; the maximum level you can listen to sounds before they become uncomfortably loud).
At the discretion of the audiologist, other tests may be completed to better understand your individualized needs. An example of this is the speech in noise test (QuickSIN), which is used to evaluate your ability to function outside of a quiet environment.
Auditory Brainstem Response (ABR)
The auditory brainstem response (ABR) test tells us how the inner ear, called the cochlea, and the brain pathways for hearing are working.
You will be seated in a quiet, dark room with electrodes placed on your forehead and behind your ears. A foam insert will be placed in both ears and you will be asked to sit with your eyes closed as you listen to clicking and static sounds.
An ABR test takes approximately 30 minutes to complete.
Similar to an ABR, an electrocochleography (ECochG) test tells us how the inner ear and auditory nerve are working. This test, however, is looking for ear disease that could cause dizziness.
You will be seated in a quiet, dark room with electrodes placed on your forehead, behind your ears and inside your ear canal. A foam insert will be placed in your ear and you will be asked to sit with your eyes closed as you listen to a clicking sound.
An ECOG test takes approximately 30 minutes to complete.
cortical Evoked response
A Cortical Evoked Response test is an objective hearing test that tells us how loud a sound needs to be in order to produce a signal in the auditory cortex (part of the brain that recognizes sound). This allows us to estimate your hearing thresholds.
You will be seated in a quiet room with electrodes placed behind your ears and on top of your head. A foam insert will be placed in both of your ears and you will hear a series of beeps at various loudness levels. We do not want you to fall asleep during this test so you will be asked to bring a book, or we will provide you with a magazine, while the test is being completed.
A cortical test takes approximately 1 hour to complete. We will also do a hearing assessment after the cortical test.
Tel: (416) 340-3666
7th Floor, Eaton North Wing - Room 213
Toronto General Hospital
200 Elizabeth St.
Toronto, ON. M5G 2C4
Monday: 8am - 4pm
Tuesday: 8am - 4pm
Wednesday: 8am - 4pm
Thursday: 8am - 4pm
Friday: 8am - 3pm
*Note: We close for lunch from
12-1pm except for Fridays
To get to us: Take any elevator within the hospital to the 7th floor. We are located near the Eaton Elevators. Once you reach the 7th floor, follow the signs to Hearing & Balance, room 213.
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