ENT & Audiology

The ear, nose and throat (ENT) specialists have referred you to the audiology department at West Middlesex University Hospital for a specialised hearing test.

How do I prepare for my appointment?

If you require hospital transport your GP needs to arrange this as it is your first appointment with audiology.

If you wish to bring a family member, carer or friend to this appointment please feel free to do so.

What will happen at my appointment?

At this appointment we will verify your personal details. 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. These electrodes are placed on by an adhesive strip on the electrode.

A set of inserts 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. The Audiologist will tell you when the test has finished and you can go home.

Who will I be seen by?

All hearing assessments are carried out by a qualified Audiologist, who is registered with the Registration Council for Clinical Physiologists. We are a teaching hospital so on occasion there may also be a student present in the appointment. If you are not comfortable with this, please let us know when you check in for your appointment at the Audiology Reception desk. 

How long will my appointment take?

The appointment will be allocated 90 minutes. We aim to see you on time but sometimes Audiology clinics can be unavoidably delayed. We will keep you informed if there is a delay to your appointment.

What happens after my appointment?

At the end of the appointment you will be asked if you have a follow up ENT 

appointment to obtain the results of the test. If you do not have an appointment one will be arranged for you.

If you have any queries regarding your ENT appointment to obtain the results of your test you must contact the ENT department on 020 8321 5904.

Can I cancel my appointment?

If you need to cancel this appointment, you are only allowed to cancel your appointment twice. If you cancel a 3rd time you will be discharged back to your GP and will need a new referral.

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

Please keep in mind appointment availability for this test is very limited.

PLEASE ARRIVE ON TIME FOR YOUR APPOINTMENT.

PLEASE ENSURE YOU REPORT TO THE AUDIOLOGY RECEPTION DESK.

PLEASE ENSURE YOUR MOBILE PHONE IS SWITCHED OFF PRIOR TO BEING CALLED INTO THE CONSULTING ROOM TO ENSURE IT DOES NOT INTERFERE WITH THE RECORDINGS.

Why do I have this appointment?

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 either the Hounslow Social Services Sensory Team or the Richmond Adult Social Care Access Team.The purpose of this appointment is to demonstrate some devices to you.

Please bring your hearing aids with you to this appointment.

What will happen at my appointment?

At this appointment we will verify your personal details. 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.

Please ensure your mobile phone is switched off before you are called into the consulting room.

Please note: The audiology team only assess you for these devices. The Social Services team supply and install the devices. If you need any help in the future regarding maintenance of the devices you need to contact the Social Services team.

Helpful contact information:

• Hounslow Adult Safeguarding, Social Care and Health
  General enquiries: 020 8583 3100

• Richmond Adult Access Team
  General enquiries: 020 8891 7971
  E: adultsocialservices@richmond.gov.uk

Who will see me?

All assistive devices appointments are carried out by a qualified audiologist or  rehabilitation officer. The audiologist is registered with the Registration Council for Clinical Physiologists. We are a teaching hospital so on occasion there may also be a student present in the appointment. If you are not comfortable with this, please let us know when you check in for your appointment at the audiology reception desk.

How long will my appointment take?

The appointment has been allocated for 60 minutes. We aim to see you on time but sometimes audiology clinics can be unavoidably delayed as someone in front of you may need more time. We will keep you informed if there is a delay to your appointment.

How do I prepare for my appointment?

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

If you require hospital transport please contact us well in advance to arrange this.

If you wish to bring a family member, carer or friend to this appointment please feel free to do so.

Can I reschedule my appointment? 

If you need to reschedule or cancel your appointment, you are only allowed to do this twice. Please contact us soon as possible to rebook your appointment. Please note the hearing clinic has limited availability. If you miss your appointment, you will be discharged back to your GP’s care and will need a new referral. 

Your GP has referred you to the Adult Hearing Aid Department at West Middlesex University Hospital for an assessment of your hearing. 

What will happen at my appointment?

At this appointment we will verify your personal details. You will be asked some questions about your ears, general health and any situations in which you are having difficulty hearing.

We will then look into your ears and check that they are healthy and free of wax. 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.

We will explain the hearing test results to you. If you decide that you would like to try hearing aids we will demonstrate what type is suitable for your specific hearing loss levels. All of our hearing aids are the latest digital behind-the-ear style. We recommend, if appropriate, that a hearing aid is worn in each hear with a relevant hearing loss as this provides better perception of speech and sound localisation.

Depending on the level of hearing loss, we may need to take impressions of your ears on the same day. This is a painless procedure which involves having a small sponge and some soft putty inserted into you ear for a few minutes.

If you decide to proceed with having a hearing aid fitted, we will schedule your next appointment for you. Depending on the outcome of your hearing assessment, we may refer you to the Ear, Nose & Throat Department (with your consent). We will send your GP a letter regarding the outcome of your hearing assessment. 

Who will I be seen by?

All hearing assessments are carried out by a qualified Audiologist, who is registered with the Registration Council for Clinical Physiologists. We are a teaching hospital so on occasion there may also be a student present in the appointment or you may be seen by a student supervised by an Audiologist. If you are not comfortable with this, please let us know when you check in for your appointment at the Audiology Reception desk.

How long will my appointment take?

The appointment will be allocated 30 minutes. We aim to see you on time but sometimes Audiology clinics can be unavoidably delayed. We will keep you informed if there is a delay to your appointment.

How do I prepare for my appointment?

Please ensure your ears are free of wax. If your ears are blocked with wax or you have an active infection in your ear we will not be able to carry out the hearing test.

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.

If you require hospital transport your GP needs to arrange this as it is your first appointment with Audiology.

If you wish to bring a family member, carer or friend to this appointment please feel free to do so.

Can I cancel my appointment?

If you need to cancel this appointment, you are only allowed to cancel your appointment twice. If you cancel a 3rd time you will be discharged back to your GP and will need a new referral.

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

PLEASE ARRIVE ON TIME FOR YOUR APPOINTMENT. PLEASE ENSURE YOUR MOBILE PHONE IS SWITCHED OFF PRIOR TO BEING CALLED INTO THE CONSULTING ROOM.

What is hearing therapy?

If you have been referred to see the hearing therapy team it is because the audiologist (hearing specialist), ENT (ear, nose and throat) consultant, or GP think that you might benefit from further advice and guidance on how to manage your condition.

This appointment is an opportunity to speak with one of the specialist team about your condition. People referred to this service are concerned about a condition such as:

• Tinnitus (hearing sounds that come from inside your body, rather than from an outside source)
• Hyperacusis (being very sensitive to certain sounds)
• Hearing loss
• Auditory Processing Disorder (APD) (hearing difficulties caused by the brain not processing sounds in the normal way)

What will happen at my appointment?

At this appointment we will verify your personal details. You will be asked some questions about your ears, general health and specific information about your Tinnitus, Hearing loss, APD or Hyperacusis.

We will give you advice on how to manage your condition. We might refer you to other services that 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. 

Please ensure your mobile phone is switched off before you are called into the consulting room.

Please note: We cannot provide MRI results at your appointment. 

Who will see me?

All hearing therapy appointments are carried out by a qualified audiologist or  rehabilitation officer with advanced knowledge and experience in counselling people with tinnitus, hearing loss, APD or hyperacusis. The audiologist is registered with the Registration Council for Clinical Physiologists. We are a teaching hospital so on occasion there may also be a student present in the appointment. If you are not comfortable with this, please let us know when you check in for your appointment at the audiology reception desk.

How long will my appointment take?

The appointment has been allocated for 60 minutes. We aim to see you on time but sometimes audiology clinics can be unavoidably delayed as someone in front of you may need more time. We will keep you informed if there is a delay to your appointment.

How do I prepare for my appointment?

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

If you require hospital transport please contact us well in advance to arrange this.

If you wish to bring a family member, carer or friend to this appointment please feel free to do so.

Can I reschedule my appointment?

If you need to reschedule or cancel your appointment, you are only allowed to do this twice. Please contact us soon as possible to rebook your appointment. Please note the hearing clinic has limited availability. If you miss your appointment, you will be discharged back to your GP’s care and will need a new referral. 

Your GP has referred you to the Adult Audiology and Hearing Aid Department at West Middlesex University Hospital for an assessment of your hearing.

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.

These are the results of your hearing test:

• Mild hearing loss: 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: Often have difficulty following speech and misses other quiet sounds. Amplification is very successful for this loss the hearing aid user also needs to use good listening tactics. Lip-reading classes could benefit people with this hearing level.

• Severe hearing loss: Unable to hear speech even in quit surroundings and may not hear general noises such as traffic, unless they are loud. Amplification is very successful for this loss, but the hearing aid user also needs to use good listening tactics. Lip-reading classes could benefit people with this hearing level.

• Profound hearing loss: Unable to hear most sounds unless they are very loud. Amplification is often useful but the hearing aid used will also need to rely on good listening tactics. Lip-reading classes would also be useful for people with this hearing loss. Patients in this category may also use BSL sign language and watch sign assisted programs.

You have recently seen the ENT Specialist and they have requested we fit you with a hearing aid at the Adult Hearing Aid Department at West Middlesex University Hospital.

What will happen at my appointment?

At this appointment we will verify your personal details. You will be asked some questions about your ears, general health and any situations in which you are having difficulty hearing.

We will then look into your ears and check that they are healthy and free of wax.

We will programme the latest digital behind-the-ear hearing aid to match your hearing test results. The 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.

A full explanation of how to use your new hearing aid will be given along with a new hearing aid guidance book and batteries for your new hearing aid.

We will offer you a telephone or appointment based follow up appointment. Please refer to your new guidance book for more details.

We will send your GP a letter to confirm you have been fitted with a hearing aid. 

Who will I be seen by?

All hearing aid fittings are carried out by a qualified Audiologist, who is registered with the Registration Council for Clinical Physiologists.

We are a teaching hospital so sometimes there may also be a student present in the appointment or you may be seen by a student supervised by an Audiologist. If you are not comfortable with this, please let us know when you check in for your appointment at the Audiology Reception desk.

How long will my appointment take?

The appointment will be allocated 30-45 minutes. We aim to see you on time but sometimes Audiology clinics can be unavoidably delayed. We will keep you informed if there is a delay to your appointment.

How do I prepare for my appointment?

Please ensure your ears are free of wax. If your ears are blocked with wax or you have an active infection in your ear we will not be able to carry out the hearing test.

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

If you require hospital transport please contact us well in advance to arrange this.

If you wish to bring a family member, carer or friend to this appointment please feel free to do so.

Can I cancel my appointment?

If you need to cancel this appointment, you are only allowed to cancel your appointment twice.  If you fail to attend this appointment, you will be discharged back to your GP’s care & will need a new referral. This is in line with the Hospital Trust Policy.

PLEASE ARRIVE ON TIME FOR YOUR APPOINTMENT.

PLEASE ENSURE YOUR MOBILE PHONE IS SWITCHED OFF PRIOR TO BEING CALLED INTO THE CONSULTING ROOM.

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 Siemens 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 Siemens. 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 15-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 this you will need to request a reassessment referral from your GP.

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. 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: Most Wednesdays
• Teddington: Every Tuesday morning
• Whitton: Every 2^nd Monday morning

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.

If you need a retube of your hearing aid mould or Siemens replacement life tubes, you can walk-in to the Audiology Reception at West Middlesex Hospital or OPD reception desk at Teddington Memorial Hospital.

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
• St. David’s Practice at Feltham Centre for Health
• OPD Reception desk at entrance of Teddington Memorial Hospital

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. 

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

Opening hours:

• Monday – Friday: 08:30 – 12:30pm & 1:30pm – 5:00pm
• Saturdays*: 08:30 – 12pm   

*Please note that we are not open on Saturdays over the Easter weekend or on bank holiday weekends. We are also closed on any Saturday that fall between Christmas & New Year.

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 adult hearing aid department at West Middlesex University Hospital.

Your appointment letter confirms the date, time and location of your appointment.

What will happen at my appointment?

At your appointment we will verify your personal details. You will be asked 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. 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. We will explain the hearing test results to you.

We will programme the latest digital behind-the-ear hearing aid to match your hearing test results. The 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 enable us to see how the hearing aid performs in your ear.

A full explanation of how to use your new hearing aid will be given along with a new hearing aid guidance book. We will offer you a follow-up appointment by telephone or face-to-face. Please refer to your new guidance book for more details.

Depending on the outcome of your hearing assessment, we may refer you to the ENT department, with your consent. We will send your GP a letter summarising the outcome of your hearing assessment.

Who will be seeing me?

All hearing assessments are carried out by a qualified audiologist, who is registered with the Registration Council for Clinical Physiologists.

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

How long will my appointment take?

Your appointment will take 30–45 minutes. We aim to see you on time but sometimes audiology clinics can be unavoidably delayed. We will keep you informed if there is a delay to your appointment.

How do I prepare for my appointment?

Please ensure your ears are free of wax. If your ears are blocked with wax or you have an active infection in your ear we will not be able to carry out your hearing test.

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

If you require hospital transport please contact us well in advance to arrange this.

If you wish to bring a family member, carer or friend to this appointment please feel free to do so.

Can I cancel my appointment?

If you need to cancel your appointment, please call the department on 020 8321 5681. 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, in line with Trust policy.

Notes about your appointment

• Please bring your current hearing aid with you to your appointment
• Please arrive on time for your appointment
• Please switch off or silence your mobile phone before entering the consultation room

Swim moulds policy

• You have requested a swim mould or a set of swim moulds
• In order for you to be fitted with swim moulds an impression needs to be taken of your ear.
• This involves putting a small sponge into your ear and filling your ear up with impression material in order to obtain the shape of your ear.
• If you suffer from Tinnitus, when the impression material is in your ear the Tinnitus may increase in volume, however when the impression material is taken out it should return back to its original level.
• It takes approximately 2-3 weeks for the moulds to be made by the laboratory.
• We will send you a letter when they have been made with instructions on what to do to organise payment and collection of the swim moulds.
• The swim moulds cost £20 per one.
• Please note swim moulds are not 100% waterproof.

Collection Information

You have recently had an impression taken of your ear for a swim mould. This is to inform you that the swim moulds are ready for collection.

• The cost of Swim Moulds is £20 per one.
• You can organise collection of the swim moulds and payment at the same time.
• If you decide, when you will attend phone us on the Audiology Telephone Number 020 8321 5681 or email caw-tr.wm-audiologydepartment@nhs.net to arrange the appointment time.
• It is explained on the letter with this information sheet, the times that the cashier’s office is open for payment.
• When you have paid the cashiers office, they will issue you with a receipt, you take this receipt to the ‘collect of swim mould’ appointment and we will fit the swim moulds.
• We will instruct you on how to fit the swim moulds. If they are not a good fit we will retake the impressions.
• When you have been given the swim moulds, if you find they are a poor fit contact us within 2 weeks of the fitting, and we will retake the impressions with no extra charge.

Please note swim moulds are not 100% waterproof.

Your GP has referred you to the Adult Audiology Department at West Middlesex University Hospital. 

What will happen at my appointment?

At this appointment we will verify your personal details. You will be asked some questions about your ears, general health and specific information about your tinnitus.

We will then look into your ears and check that they are healthy and free of wax. 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.

We will explain the hearing test results to you. We will advise you on what tinnitus is and why we think you 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 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-help 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 recommend hearing aids, refer you for Cognitive Behavioural Therapy or refer you on to the Ear, Nose & Throat Department (with your consent). We will send your GP a letter regarding the outcome of this appointment.

Who will I be seen by?

All hearing assessments are carried out by a qualified Audiologist with advanced knowledge and experience in helping people with tinnitus. The Audiologist is registered with the Registration Council for Clinical Physiologists. We are a teaching hospital so on occasion there may also be a student present in the appointment. If you are not comfortable with this, please let us know when you check in for your appointment at the Audiology Reception desk.

How long will my appointment take?

The appointment has been allocated for 60 minutes. We aim to see you on time but sometimes Audiology clinics can be unavoidably delayed as someone in front of you may need more time. We will keep you informed if there is a delay to your appointment.

How do I prepare for my appointment?

Please ensure your ears are free of wax. If your ears are blocked with wax or you have an active infection in your ear we will not be able to carry out the hearing test.

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.

If you require hospital transport your GP needs to arrange this as it is your first appointment with Audiology.

If you wish to bring a family member, carer or friend to this appointment please feel free to do so.

Can I cancel my appointment?

If you need to cancel this appointment, you are only allowed to cancel your appointment twice. Please contact us soon as possible to rebook your appointment. Please note, this clinic only runs on Wednesday and Thursday mornings.  If you fail to attend this appointment, you will be discharged back to your GP’s care & will need a new referral. This is in line with the Hospital Trust Policy.

PLEASE ARRIVE ON TIME FOR YOUR APPOINTMENT. PLEASE ENSURE YOUR MOBILE PHONE IS SWITCHED OFF PRIOR TO BEING CALLED INTO THE CONSULTING ROOM.

The ear, nose and throat (ENT) specialist has referred you to the Audiology Department at West Middlesex University Hospital for a specialised balance test. 

How do I prepare for my appointment?

Please follow these instructions:

• 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.

How long will my appointment take?

The appointment will be allocated 2 hours. We aim to see you on time but sometimes Audiology clinics can be unavoidably delayed. We will keep you informed if there is a delay to your appointment.

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.

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

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.

What happens after my appointment?

At the end of the appointment you will be asked if you have a follow up ENT appointment to obtain the results of the test.

If you do not have an appointment one will be arranged for you. If you have any queries regarding your ENT appointment to obtain the results of your test you must contact the ENT department on 020 8321 5904.

Your child has been seen in the ENT Clinic and the ENT clinic have requested that we carry out a more age related test for your child. If this appointment is not convenient please contact us to rebook.

If you wish to bring a family member/friend to this appointment please feel free to do so. If you need an interpreter, do contact us and this can be arranged. If you require hospital transport do contact us.

This test is called, Visual Reinforcement Audiometry (VRA). The test lasts approximately 30 minutes and we may have to bring your child back for a repeat test if we are unsure of the accuracy of the responses.

The test is carried out by two qualified audiologists registered with The Registration Council for Clinical Physiologists.

The test is carried out in a Sound Proof Room.

Initially we will take a Medical History regarding your child’s hearing. Their ears will be examined; this involves looking into their ear with a special light.

You will be requested to hold your child on your knee and one Audiologist will sit in front of you and engage your child with some toys. The second Audiologist will be in another room presenting various noises and rewarding your child with a picture on the screen when they look towards the sound.

We do request that you do not give your child any clues of where the sound is or when the sound is presented.

If you are sensitive to loud sounds it may be a good idea if you request ear plugs we do provide them.

Please do not worry if your child does not look towards some of the sounds, as on occasions children are not interested in the test.

When the Audiologist has completed the test it will be checked if your child has a follow up ENT appointment. If there is no ENT appointment one will be organised for you. Please note the Audiologists will not be able to give you the results, the ENT doctor will do this at the ENT appointment.

What is eustachian tube dysfunction?

Unequal pressure between the air in the middle ear (beyond the eardrum) and the outside. It means that the Eustachian tube is failing to equalise the pressure and the ventilation of the middle ear sometimes because of colds, sinus, throat or ear infections; allergies, flying or pressure changes.

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.

You may also experience 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 maneuver 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 autoinflation 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 inflammation affects the ear canal and does not go further than the eardrum. This condition can be a single episode, recurrent condition or a chronic persistent issue.

Common causes

• Getting water, shampoo or soap into the ear canal causing irritation of the skin
• Water getting into the ear while swimming, having a bath or shower (water sometimes carries germs). Sometimes called swimmer ears.
• Damage of the 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

• 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.
• Avoid inserting anything in the ears even when they are itchy, do not use cotton buds.
• Avoid over the counter eardrops as some of these can cause irritation of the skin
• Discuss the use of eardrops with an ENT specialist, GP, nurse.
• Use earplugs if swimming, prevention eardrops
• Do not have ear syringing or water irrigation if you have inflamed ear canals
• Keep ears dry

Treatment

The choice of treatment can be antibiotic eardrops, steroid eardrops, or a combination of both. Sometimes it’s a cream inserted into the canal or ribbon gauze soaked in medicated cream, or a pope wick which is a little sponge absorbing the eardrops and spreading the medication in the canal. Sometimes micro suction is recommended to clear debris and discharge for medication to work more effectively. Sometimes oral antibiotics are prescribed, in addition to the topical 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 ear specialist will offer a treatment of choice based on clinical judgement.

Water precautions are paramount in the management of otitits externa. 

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.
• Avoid inserting anything in the ears (smaller than the elbow), even when itchy as doing so can cause blockage by 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 microsuction 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

You have recently been seen in our Audiology clinic and you have opted to try a Tinnitus Sound Generator (TSG) device.

What does a Tinnitus sound generator do?

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 TSG device daily for a minimum of 6-8 hours continuously.

My Tinnitus sound generator

• 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 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.
• To switch the device on, just close the battery compartment.
• 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 at our reception desk during the following opening times:

Monday – Thursday: 08:30am – 12 noon & 1:30pm – 5:00pm

Friday: 08:30am – 12 noon & 1:30pm – 4:00pm

Saturday: 08:30am – 12 noon^**

** Please note there is no Saturday clinic on Bank holiday weekends or between the Christmas – New Year period. The department is closed on all bank holidays***

•  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.

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?