Our Services

Dizziness & Balance

Our practice offer a wide range of diagnostic assessments, working closely with other healthcare professionals, to determine the cause of your dizziness and balance disorder. Our test battery includes videonystagmography (VNG) testing, video head impulse testing (vHIT), as well Vestibular Evoked Myogenic Potential (VEMP) testing. Once we have established the presence and site of the vestibular disorder we work with you to provide a customised exercise-based rehabilitation programme to help reduce symptoms and improve your everyday functioning.

What is a vestibular disorder?

There are three common symptoms that you may experience if you have a vestibular disorder:

Vertigo: Here you may feel like the world is revolving around you or like you are revolving in space. There is a sense of spinning even while you are standing or sitting still.

Dizziness: This is a disturbed sense of your placement in relation to the world around you; a sense of unsteadiness that comes with moving your head. It is often accompanied by giddiness or lightheadedness.

Disequilibrium: Here you may feel a sense of unsteadiness or imbalance that is worsened by movement or environmental influences.

Take this little test:

Have you ever felt…

A sensation of motion, spinning, or falling when moving your head quickly, or changing your position (for example, when getting in and out of bed)? Yes No
Uncomfortable trying to walk in the dark? Yes No
That walking down grocery store aisles or through a mall is disturbing? Yes No
Your feet just won’t go where you want them to? Yes No
A sense of unsteadiness? A feeling that you are not surefooted? Yes No
A fear of falling or stumbling? Yes No
That looking at moving objects like escalators or looking out of the side window of a car makes you queasy? Yes No
Difficulty keeping your balance as you walk on different surfaces, e.g. from tile to carpet? Yes No
That you are drifting or being pulled to one side when walking? Yes No
That no-one really understands how frustrating all this is? Yes No

If you answer ‘Yes’ to two or more of these questions, it’s time to consider a vestibular and equilibrium evaluation. The good news, however, is that in 90% of cases, these balance disorders can be successfully treated once they are properly diagnosed.

Again, if you have two or more of these symptoms, please contact us today. We can help.

Our assessments

Equilibrium carries out a wide range of assessments. Yours may include:

  • Diagnostic hearing assessment
  • Positional and positioning assessment
  • Videonystagmography (VNG)
  • Auditory Brainstem Response (ABR) testing
  • Vestibular Evoked Myogenic Potentials (VEMPS)
  • Video Head-Impulse Test (vHIT)

We pride ourselves in acknowledging the symptoms holistically and, therefore, we work closely with (yet independently of) many other healthcare professionals, including Ear, Nose, and Throat (ENT) specialists and neurologists, as well as physiotherapists.

Our management

At Equilibrium, we offer our dizzy patients customised exercise-based programmes aimed at reducing the associated symptoms that are associated with a vestibular pathology (disease or disorder). This is known as Vestibular Rehabilitation Therapy (VRT).

Why exercise rather than medication? Research has found that, over the long term, medications that suppress vestibular function can cause drowsiness and limit a person’s ability to function fully. VRT is an alternative treatment protocol, involving specific exercises that eliminate or significantly reduce the symptoms of disequilibrium and dizziness, and promote recovery.

Hearing & Hearing Loss

A hearing loss is more than the inability to hear loudly enough. People with a hearing loss experience problems in hearing and localising a sound source. They may also have a discrimination loss – that is, difficulty discriminating words from each other, even if they are fairly loud. They can hear the words, but fail to understand the spoken message.

Causes of hearing loss

The most common type of hearing loss is the natural deterioration of hearing with age. However, in our continuously developing digital era, frequent exposure to loud noises and music can be detrimental to hearing, regardless of age. In addition, hearing loss can occur:

  • as a result of infection during gestation;
  • through infection;
  • after a head injury;
  • if the eardrum is perforated;
  • as a result of untreated diabetes;
  • as a result of untreated hypertension;
  • as a result of some cancer treatments; or
  • as a result of taking certain medications.

Other disturbances in the auditory system can include tinnitus or hyperacusis.

Take this quick hearing quiz:

Would you say that you…

Find that people mumble when they talk? Yes No
Have difficulty hearing on the telephone? Yes No
Have to turn up the volume of the television to hear what’s being said? Yes No
Sometimes miss what’s being said to you? Yes No
Often have to ask people to repeat themselves? Yes No
Misunderstand when people talk and sometimes respond incorrectly? Yes No
Ask others to repeat what they’ve just said? Yes No
Have a buzzing / zinging / roaring sound in your ear/s? Yes No
Have difficulty hearing in crowds / restaurants? Yes No
Have difficulty hearing speech when there is background noise? Yes No
Have more difficulty hearing when women and children are talking? Yes No
Often have to strain to hear conversations? Yes No
Have dizziness / vertigo? Yes No

If you’ve answered ‘Yes’ to three or more questions, please contact us today. We can help.

Untreated hearing loss

Let’s say that you suspect your may have a hearing loss, but you put off having it diagnosed. This could have serious social, emotional, physiological and psychological effects on you:

  1. Feelings of irritability, negativity or anger
  2. Fatigue, tension, stress or depression
  3. Avoidance or withdrawal from social situations
  4. Damaged interpersonal relationships
  5. Reduced alertness and increased risk to personal safety
  6. Impaired memory and ability to learn new tasks
  7. Reduced job performance
  8. Diminished psychological and overall health

The most serious effect is auditory deprivation – a serious condition that occurs when the auditory nerve and other areas of the brain responsible for processing and interpreting sound are deprived of sound, and begin to atrophy or weaken further.

In addition, new studies have shown a significant link between untreated hearing loss and dementia. Even individuals with mild hearing losses are nearly twice as likely to develop dementia compared to those with normal hearing.

Therefore, the key to hearing better for longer is keeping the hearing mechanism active. One way to do this is to use hearing aids – even if the hearing loss is minimal.

Feel free to watch this Youtube video on what a hearing loss sounds like. Or contact us.

Diagnostic Hearing Testing

Equilibrium performs a range of diagnostic hearing assessments, analysing the outer, middle andinner ear, in order to determine the type and degree of hearing loss. Assessments typically include testing such as pure tone audiometry, speech audiometry, impedance audiometry, Eustachian tube function testing. Electrophysiological tests including Auditory Brainstem Response (ABR), diagnostic oto-acoustic emissions (DPOAE), and Electrocochleography (ECochG) testing are also offered at our practice.

Diagnostic hearing tests

Pure Tone Audiometry. This is the key hearing test for identifying an individual’s hearing levels, whereby the patient indicates a response to a sound.

Speech Audiometry. The patient’s performance during this test aids the audiologist in determining the type of hearing loss as well as provides valuable insight into the individual’s levels of comfort to speech and word recognition abilities.

Eustachian Tube Function Testing. A functional and patent Eustachian tube is necessary for ideal middle ear sound mechanics. This test assesses the changes in middle ear pressure under varying circumstances in order to determine Eustachian tube function.

Impedance Audiometry
Tympanometry.  A small probe is inserted into the outer ear canal and measurements representing the functioning of the middle ear are recorded to indicate eardrum perforations, abnormal pressure, fluid build-up and increased/decreased mobility of the eardrum and middle ear structures.

Acoustic Reflexes. Acoustic reflex measurements are carried out to measure the involuntary muscle contraction that occurs in the middle ear in response to loud sounds.

Electrophysiologic tests

These are measures to partially estimate hearing function and to determine which function of the auditory system is at fault. They’re commonly used for children who can’t be tested behaviourally (due to age, developmental delay, or other medical conditions), as well as adults who are unable to participate in a standard test battery (due to cognitive impairment).

Diagnostic Oto-Acoustic Emissions. This test assesses the outer hair cell functioning of the cochlea.

Auditory Brainstem Response (ABR). This test gives the audiologist information about the cochlea and neural pathways for hearing. ABRs are commonly used to test hearing in:

  • ‘At-risk’ infants, like babies who have not passed the OAE assessment, have spent more than five days in NICU, have a low birth weight, or have low APGAR scores
  • Difficult-to-test populations, including children with cerebral palsy, developmentally delayed children or children with medical conditions
  • To confirm hearing loss in medico-legal cases
  • To diagnose auditory disorders, such as auditory neuropathy
  • To conduct intra-operative monitoring; for example, during the removal of tumours on the 8th cranial nerve (vestibulocochlear nerve)

Electrocochleography (ECochG / ECOG) test

This test is used to confirm the diagnosis of Meniere’s disease, as well as during intra-operative monitoring or to assist in the diagnosis of auditory neuropathy disorder.

If you’d like more information on any of our testing, please contact us today. We can help.

Hearing Instruments

With advances in technology, approximately 95% of people with a sensorineural hearing loss can be helped with hearing aids. We are proudly independent of any hearing aid manufacturer or commercial company, and love to work closely with our patients to discuss the various hearing aid solutions that will suit their lifestyle as well as budget.

The hearing aid myths

Hearing loss affects only “old people” and is a sign of ageing.

Did you know that, in fact, 65% of people with hearing loss are younger than 64? It can affect all age groups.

My hearing loss is normal for my age.

Okay. But it happens to be “normal” for overweight people to have high blood pressure. This doesn’t mean they shouldn’t receive treatment for the problem.

If I had a hearing loss, my family doctor would have told me.

Not true! Only 14% of doctors in first-world countries routinely screen for hearing loss. Since most people with hearing impairments hear well in a quiet environment, like a doctor’s office, your doctor may never recognise the extent of your problem. Special training and an understanding of the nature of hearing loss are required to diagnose a hearing problem.

I have one ear that’s ‘down’ a little, but the other one’s okay.

Everything is relative. Nearly all patients who believe that they have one “good” ear actually have two “bad” ears. When one ear is slightly better than the other, we learn to favour that ear for the telephone, group conversations, etc. This can give the illusion that “the better ear” is normal, when it isn’t. Most types of hearing loss affect both ears fairly equally and about 90% of patients are actually in need of hearing aids for both ears.

My hearing loss can’t be treated/fixed.

Many people with hearing loss in one ear, a high-frequency hearing loss or nerve damage have been told they can’t be helped. This may have been true years ago, but with modern technology, 95% of people with a sensorineural hearing loss can be helped.

Selecting hearing aids

Whether it’s just been confirmed that you need a hearing aid or you’ve been wearing hearing aids for many years, our audiologists specialise in helping you to select the most appropriate solution for your needs, in the context of your lifestyle and personal goals.

Equilibrium is proudly independent of any hearing aid manufacturer or commercial company. This enables us to choose any brand of hearing aid available in South Africa and to attend regular and diverse training, to stay on top of industry developments.

We strongly advise every patient to ‘test drive’ a selection of appropriate hearing aids and to accept a hearing aid trial period. This is an important part of making an informed choice. In addition, once you buy your hearing aid, its servicing will always be a priority for us.

Technology and styles

Equilibrium supplies a vast selection of programmable hearing aids that use digital processing and directional microphones for better hearing. Our spectrum of devices includes both entry-level hearing aids and the latest in blue-tooth and wireless technology, which helps us to find the best solution for you as an individual living in the digital era.

There are many styles of hearing instrument, including completely-in-the-canal, in-the-canal, in-the-ear and behind-the-ear. Most hearing aid technology is available in your choice of these styles and our audiologists will help you to determine which will work best for you.

If you’d like more information on hearing aids, please contact us today.

Paediatric Hearing

Hearing loss affects three in every 100 children under the age of 18. Both hearing and speech are essential tools for children to be able to learn, play and develop social skills. Children with undetected and untreated hearing losses may miss a lot of the speech and language around them, resulting in delayed speech or language development, social problems and academic difficulties.

Equilibrium believes in the early identification of hearing loss, to allow for intervention, if needed, at a young age. In fact, all babies can and should have their hearing tested before their six week check-up with the paediatrician.

We offer a wide range of age-appropriate screening and diagnostic evaluation services for newborns, infants, toddlers, school-age children and adolescents, including objective tests which do not require a response from the child, and behavioural measures including Conditioned Play Audiometry.

How do you test a baby’s hearing? Equilibrium uses Oto-Acoustic Emissions (OAE) in our hearing screening. This type of special electrophysiological testing does not require a behavioural response from the baby. During this test, a miniature earphone and microphone are placed in the ear, sounds are played and the ear’s response is measured. 

Babies who’ve been in NICU. If your baby has spent time in NICU, we strongly recommend an additional screening test, called an Auditory Brainstem Response or ABR. During this test, sounds are played into the baby’s ears and electrodes are gently placed on the baby’s head to detect responses. The test measures how the hearing nerve responds to sounds and can identify babies with hearing loss.

Use this little questionnaire to consider some common signs of possible hearing loss.

Does your child…

  • Turn up the volume of the TV excessively high?
  • Respond inappropriately to questions?
  • Not reply when you call him/her?
  • Watch others to imitate what they are doing?
  • Have articulation problems or speech / language delays?
  • Have problems academically?
  • Complain of earaches, ear pain or head noises?
  • Have difficulty understanding what people are saying?
  • Seem to speak differently from other children his or her age?

While these signs don’t necessarily mean that your child has a hearing problem, they could be indicators of one. Children of all age can and should be given an appropriate hearing evaluation on a yearly basis to monitor hearing.

If you have a concern, question or related issue, please contact us today.

Auditory Processing Disorders

When the brain can’t hear…
Would you say that, despite having no hearing loss, your child doesn’t seem able to process the information he or she hears, in the same way as other children?

here’s a chance that your child has Central Auditory Processing Disorder (CAPD), a complex problem affecting school-aged children. In CAPD cases, the child’s ears and brain don’t fully coordinate and so he or she can’t process auditory information normally.

Symptoms of CAPD range from mild to severe and take many different forms. However, if the auditory deficits aren’t identified and managed early, children with CAPD may have speech and language delays and experience significant academic problems.

Take this quick CAPD quiz:

Would you say that your child has…

Difficulty hearing in noisy environments (e.g. the classroom)? Yes No
Difficulty following long conversations? Yes No
Difficulty hearing conversations on the telephone? Yes No
Difficulty learning a foreign language or challenging vocabulary words? Yes No
Difficulty remembering spoken information (i.e. auditory memory deficits)? Yes No
Difficulty taking notes? Yes No
Difficulty maintaining focus on an activity if other sounds are present? Yes No
Difficulty with organisational skills? Yes No
Difficulty following multi-step directions? Yes No
Difficulty in directing, sustaining, or dividing attention? Yes No
Difficulty with reading and/or spelling? Yes No
Difficulty processing nonverbal information (e.g. lack of music appreciation)? Yes No

If you’ve answered ‘Yes’ to one or more questions, please contact us today. We can help.

Tinnitus & Hyperacusis

Do you have constant or occasional sense of ringing, buzzing, whistling, humming, clicking, or hissing in your ears? Or perhaps an increased or over-sensitivity to sound? These conditions are called tinnitus and hyperacusis – and you don’t have to live with them.

Diagnosing tinnitus

Tinnitus is typically caused by hearing loss, noise exposure or medication (over 200 different kinds, including aspirin). There are several ways to treat it:

Hearing aids
Sound therapy with hearing aids exercises the auditory portion of the brain and creates stimulation in areas with hearing loss. There are also hearing aids available that feature tinnitus and relaxation programmes, incorporating peaceful background sounds for tinnitus sufferers.

The use of hearing aids and sound therapy to treat tinnitus must be accompanied by education, counselling and stress management. In some cases, it may be beneficial to include professionals from other disciplines.

If you’d like more information on tinnitus, please contact us today. We can help you.

Unpacking hyperacusis

Often tinnitus is associated with hyperacusis, with an increased or over-sensitivity to sound. This condition is characterised by abnormal discomfort in response to sounds that are tolerable for those with normal hearing.

Although hyperacusis may follow a blow to the head or exposure to loud noise, for many people its onset is baffling because it occurs independently of other identifiable disorders. Having said that, hyperacusis is a recognised symptom of several conditions and is sometimes associated with:

  • noise trauma,
  • head injury,
  • reactions to drugs,
  • viruses,
  • allergic reactions,
  • auto-immune disorders,
  • chronic ear infections,
  • hearing loss,
  • brain injury,
  • post-traumatic stress disorder,
  • migraines,
  • some types of depression,
  • vitamin B6 deficiency,
  • Tay-sach’s Disease,
  • chronic fatigue syndrome,
  • neurological disorders and
  • autism

The first step in managing hyperacusis involves a full audiological work-up by a qualified

Medico-legal Audiology

Equilibrium’s audiologists can perform hearing and vestibular assessments for medico-legal purposes, such as when a client is involved in a motor vehicle accident. Audiograms can also show when an individual is suffering from hearing loss as a result of excessive exposure to workplace noise, known as noise-induced hearing loss (NIHL).