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We take your safety seriously. All of our staff have been vaccinated to ensure we are reducing the risk of transmitting COVID to you. We are practicing social distancing in our waiting rooms or you may wait in your car after you have checked in if you would prefer. Who can attend the appointment? One Parent or Legal Guardian must accompany all patients less than 18 years old. At this time, no siblings may attend an appointment for a child, and only one parent may be with the child in the exam room. We ask that in most situations, adults attend the appointment by themselves. We encourage family members to join on the phone or via video calls, such as Apple FaceTime. For serious conditions, like head and neck cancer and certain other things, we invite one family member to attend each visit. The goal is to keep you safe AND make sure you’re cared for. We’ll be flexible when we can; we ask that you do the same. All rooms are thoroughly sanitized after each visit. Staff and patients will both wear a mask as much as practical during the visit. For certain procedures, enhanced PPE is worn to reduce transmission.
At this time we require a referral for new patients to be seen. If you're having trouble getting a referral, please call our office and we may be able to help facilitate that. Find our contact information here.
One Parent or Legal Guardian must accompany all patients less than 18 years old.
What to expect during your first visit:
If your child is being seen for ear/hearing problems, often we will review any recent audiograms (hearing tests), and we may arrange additional testing. Examination can range from a handheld otoscope to a telescope or microscope for better visualization. A test for middle ear fluid or pressure can be performed if a question remains about what’s going on behind the eardrum.
If your child is being seen for breathing, feeding, or swallowing difficulty, we will often use a small, flexible endoscope. The scope is sized for the nasal cavity of a newborn and is quite small. This scope is passed through the nose (to prevent gagging that would occur if the scope were passed through the mouth). In young children, we use a topical numbing gel on the scope to limit discomfort. In older children, we additionally use some numbing spray. The duration of the scope examination is only 30-60 seconds. Ideally, your child will not have eaten or had anything to drink 1 hour prior to the clinic visit. The exam is recorded on a video tower and the results are replayed and discussed immediately following the scope.
Each child is unique. Each interaction with a child and their parents is an opportunity for us to partner in care, and our goal is to answer any questions or concerns that may exist. This can sometimes take longer than what was allotted for that visit. Unfortunately, this sometimes means that a wait to be seen can develop. We do our best to minimize that wait and to make it easier. Our lobby and exam rooms are equipped with various forms of distraction/entertainment to help keep patients entertained during this wait time.
At your Videostroboscopy appointment, the Speech-Language Pathologist (SLP) will ask you more about your voice concerns, obtain measurements of your voice function, and use a small endoscopic camera to take a video of your vocal folds in motion. At the end of the appointment, you will review the video and the testing with the SLP and discuss what can be done to improve your voice problem. There is no special preparation for this procedure. Please print your voice history form and bring it with you to your appointment. If you need the form, you can find it here - (English) (Spanish).
At your FEES appointment, the Speech-Language Pathologist (SLP) will ask you more about your swallowing concerns, look at the structure and function of muscles involved in eating and drinking, and use a small endoscopic camera to take a video of your throat while you eat and drink. At the end of the appointment, you will review the video with the SLP and discuss what can be done to improve your swallowing issue. There is no special preparation for this procedure. Please print your swallowing history form and bring it with you to your appointment. If you need the form, you can find it here - (English) (Spanish).
The Au.D. is the designator for the professional doctorate in the discipline of audiology. Completion of the degree typically requires four years of full-time study beyond the bachelor's degree. Audiologists are the primary healthcare professionals who evaluate, diagnose, treat, and manage hearing loss, tinnitus, and balance disorders in individuals of all ages from infants to teens to the elderly.
All audiologists at Greenville ENT are Doctors of Audiology.
An audiometric exam takes place in a sound treated booth. The patient has soft inserts placed into each ear canal and is asked to give a response to hearing tones as well as speech stimuli. The result is to identify the type and amount of hearing loss, if any, and the patient’s ability to discriminate speech accurately.
Prior to the hearing evaluation, the audiologist will look in each ear canal to be sure there is not a wax impaction that would interfere with accuracy of testing. Additional assessment of middle ear function is also included in the evaluation, to identify or rule out the presence of middle ear fluid, perforations in the ear drums, or excessive middle ear pressure. The results are displayed on an audiogram, which is a graph showing how different frequency stimuli can be perceived.
The results will be reviewed with you by the audiologist immediately afterward. The test usually takes 20-30 minutes and is painless.
By the time a child is about 5 years old, he or she can generally perform the required tasks to assess hearing like any adult. But for younger children, the tasks need to be more age appropriate, and often involve turning the response task into a game. For toddlers 7 months to nearly 3 years of age, Visual Reinforcement Audiometry (VRA) testing is utilized.
VRA takes place in the sound booth with a parent/guardian and the child seated in the center of the booth.
This type of testing is also referred to as sound field testing. Speakers located to the right and left of the patient will present sounds. We then light up and/or animate a small toy that is hidden at the top of each speaker to condition the child to associate the toy with the sound. After a few practice responses, softer sounds are presented. Every time the child correctly turns towards the side where the sound originated, the toys light-up as a reward.
Results from this test approach can indicate the child’s hearing sensitivity in at least one ear, since the stimuli is presented in the sound booth and not directly presented to each ear separately (via inserts or headphones). Sometimes we only get partial results on the first try and may need to repeat testing on a second day. Try to schedule these appointments during the best time of day for your child. For children aged about 3 to 5, looking for an animated bunny or kitten no longer holds their attention.
The next step is to use Conditioned Play Audiometry (CPA).
For this test approach we may attempt using soft ear inserts or headphones to be worn during testing, to obtain ear-specific measurements. However, CPA can be performed in the sound field if the child is not comfortable with anything on or in the ears. To reinforce responses to the sounds, the child will be coached to respond by, for example, throwing a block in a bucket, or putting a peg in a peg board in response to hearing auditory stimulation. The sounds will be presented at softer and softer levels until the child no longer responds to the stimulus. The results will indicate hearing sensitivity. As with VRA testing, test results may be incomplete on the first try and a second attempt may need to be scheduled. For patients of all ages, middle ear assessment is also performed to identify or rule out the presence of middle ear fluid or other middle ear pathology.
Testing for infants is called an Auditory Brainstem Response evaluation. This test is harmless and painless. The testing is completed by an audiologist and can be done in the office for children 6 months and younger. Older children may need sedation to complete this testing. The testing will take place in a quiet room where small surface electrodes are placed on the forehead and behind each ear. Once the child is asleep, earphones are placed in the child's ears and sounds are presented to the ears. Auditory nerve responses in the form of waveforms are recorded, from which we can estimate hearing sensitivity. As the stimulus gets softer, the auditory nerve response gets weaker. The softest presentation level where the waveform is still present is estimated to be a hearing threshold for that tone.
You typically will have results the same day testing is done. The audiologist will explain the findings and answer any questions you may have. It is important that we establish how a child is hearing as early as possible to ensure they have adequate access to sound in order to develop speech and language. There are specific instructions that will be provided prior to your baby’s appointment. Please read over these instructions carefully the night before testing.
Hearing loss often occurs so gradually that an individual may not be aware of a problem. It is not uncommon for hearing loss to be first detected by a family member, who is having to speak louder or repeat themselves. You may notice some early signs of hearing loss like turning the TV or radio volume louder than other family members prefer, difficulty understanding speech in background noise or at a distance, have more difficulty hearing children and women than men, ringing in the ears when no external sound is present, difficulty hearing people with "low voices" or who "mumble." It is important to remember that hearing sensitivity is not an “all or nothing” condition.
We hear on a spectrum of low, mid, and high-pitched sounds, like a piano keyboard. Most hearing loss tends to occur in the higher frequencies, where speech clarity is involved, leaving the lower frequencies within normal limits. Many people report they hear people talking just fine, but struggle to understand speech if the person is not facing them. People do mumble, but if everyone mumbles, including TV and movie actors, you may have a high-frequency hearing loss.
Hearing aid use is only one part of a total communication improvement plan. Amplification is the backbone of that plan but getting the most benefit from them requires the programming knowledge, counseling skills, and expertise that only a licensed audiologist can provide. An audiologist will help you assess listening needs specific to your lifestyle and choose the type and style of hearing device as well as streaming accessories that best suit your needs.
Advances in technology now provide those with hearing impairment many choices to hear better in different social and occupational listening environments, over the phone, or watching TV. A well thought out communication plan includes more than just hearing better. Amplification pricing has remained stable over many years. The overall cost includes our professional services for verification measures to ensure best fit programming, follow up counseling sessions to ensure that you are comfortable with operation, daily use and care of your devices and accessories, manufacturer warranty, in-house repairs, and cleaning check-ups for the life of your instruments. Looked at over the average 5 to 7-year lifespan of your hearing aids, that makes use of amplification very affordable.
A cochlear implant is an electronic substitute for the inner ear. This technology is reserved for patients who have sensorineural hearing loss affecting the inner ear and hearing nerve that is so severe that even very powerful hearing aids are no longer beneficial. Placement of the implant requires a permanent surgical procedure. An implant under the scalp just behind the ear is used along with an external device that communicates with and provides power to the internal device.
A bone anchored hearing device, or more properly called an auditory osseointegrated implant, is for hearing losses which are primarily conductive. In this case, the user’s problem is in the middle ear, and may involve chronic ear drainage, which prevents the insertion of a hearing aid into the ear canal. The most commonly used AOI is a titanium post placed in the skull behind and just above the ear to which a hearing device is attached.
VNG testing helps determine if the portion of the inner ear responsible for balance is dysfunctional. It also can identify if a change is occurring in the area or areas of the brain that aid in stabilizing our sense of balance when we are in motion or when things around us are in motion. The patient wears goggles containing infrared cameras to track the movement of the eyes in response to various visual stimuli presented on a screen.
Additionally, the cameras record eye movement when there are no visual stimuli to focus on, to see if any spontaneous eye movements arise when the head or body is in different positions. The patient will either be sitting, lying flat on an exam table, or reclined on an exam table throughout the test. The final part of the testing utilizes warm and cool air presented in one ear at a time, for the duration of one minute. This allows us to stimulate one ear without stimulating the other. The resulting eye movements will be recorded for a minute after the air stimulus has ceased.
Ringing in the ear, or tinnitus, is a widespread condition that affects an estimated 50 million Americans. Some people describe it as a hissing, roaring, whooshing or buzzing sound instead of ringing. It may be sporadic or constant and is a symptom of an underlying condition rather than a disease itself. There are many factors that can cause tinnitus. Tinnitus can’t be cured, but there are treatments that make it less of a distraction. The approach taken depends on the underlying condition responsible for the ringing in your ears.
Sometimes, simple steps like removing built-up earwax or switching to a new medication can markedly decrease symptoms. Others benefit from noise suppression therapy or masking techniques designed to cover up the ringing noise. White noise machines, fans, air conditioners and humidifiers are all popular, easy to use options. Tinnitus retraining devices, which rely on patterned tones, are a newer technique that has proven beneficial to many patients.
Your doctor may recommend that your child wear earplugs in the water after having ear tubes placed. There are several types of swim plugs available, ranging from wax plugs that can be purchased over the counter at a pharmacy to custom made swim plugs. In our office, we offer Doc's Pro Plugs, which are semi-fitted, non-invasive, and inexpensive. This type of plug works great in the bathtub, or for younger children who may not be as active in the water.
We also offer custom swim plugs, which are considered the gold standard for water activities. This type of plug is created from a waterproof floating silicone and is designed to have a snug fit in the ear to keep all water out of the ear canal. To make a custom plug, your audiologist will take an impression of the ear to get the best fit. There is typically a 2 to 4-week turnaround to receive custom swim plugs.
The providers at Greenville ENT take your Head and Neck Cancer surveillance very seriously. The decision to perform an endoscopic examination of your nose, throat, and voice box is made on an individual basis. It is critical to examine the surfaces of those areas to check for cancer recurrence or development of complications. We do everything possible to ensure this is as comfortable as possible.
In November 2020, a law came into effect mandating that electronic reports of tests be available to patients as soon as they are finalized. When you are waiting to hear if it’s cancer, that can be scary. We want to decide together with you if you’d like to hear the news electronically via our portal, over the phone, or in person.
Every patient’s head and neck cancer diagnosis is unique. Some people need more than one type of treatment to cure it. You might be referred to see other cancer specialists. Please see our Head and Neck Cancer Page for more details.
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