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OTONEURO MONACO

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FAQ – Frequently asked questions about hearing and balance

At Otoneuro Monaco, we specialise in diagnosing hearing, balance and vision disorders. Our patients often ask us the same questions about the tests we carry out, what they are for and which symptoms should prompt a visit.
We have therefore gathered here simple, precise answers to the most frequently asked questions. This FAQ will help you better understand the tests offered at our centre and know when to seek advice.

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The OTONEURO MONACO centre

What is Otoneuro Monaco?

Otoneuro Monaco is a specialist medical centre for the diagnosis and treatment of hearing disorders (hearing loss, tinnitus) and vestibular disorders (vertigo, balance problems) in adults and children. It offers an innovative approach combining medical expertise, advanced technology and clinical research, which is unique in Europe in the private sector.

Who makes up the Otoneuro Monaco medical team?

The team includes ENT doctors specialising in otoneurology, audiologists (holding a Master’s degree or an inter-university diploma in audiology) and specialist assistants.
The centre is headed by Dr Pierre LAVAGNA, former Head of the ENT Department at the Princess Grace Hospital Centre (CHPG) in Monaco and a specialist in otoneurology.

How do I book an appointment?

Appointments can be booked by phone (+377 99 92 32 70), via Doctolib or using the contact form on our website. 🔗Book an appointment. Available to patients from Monaco, the Alpes-Maritimes, Liguria and beyond.

Fees and payment

What fees does Otoneuro Monaco charge?

Our fees are given before each procedure. They can be viewed on our Doctolib page or obtained from our reception team.

Are medical tests at Otoneuro Monaco reimbursed?

Most of the tests, diagnostic procedures and treatments we offer are reimbursed. Some specialised or innovative procedures may have to be paid for by the patient or covered by their top-up health insurance. Our assistants will let you know when you book your appointment. Find out more about our fees

Conditions treated

Which hearing conditions are treated at Otoneuro Monaco?

We treat all forms of hearing loss, whether congenital, acquired, sudden, occupational or age-related (presbycusis). We also treat chronic tinnitus (buzzing, ringing), hyperacusis, difficulty hearing in noise and hidden hearing loss.

Which balance problems or types of vertigo are treated at Otoneuro Monaco?

Otoneuro treats benign paroxysmal positional vertigo (BPPV), Ménière’s disease, vestibular neuritis, vertigo in children, chronic vestibulopathies and balance disorders related to ageing or injury.

Otoneuro also treats motion sickness (car sickness, seasickness, mal de débarquement, etc.) and cybersickness.

Hearing loss in children

When should my child's hearing be checked?

At birth: hearing screening is routinely offered before leaving the maternity unit (with the parents’ consent).

At the age of 6: a compulsory health check is carried out (at school or by a doctor), including screening for sensory disorders; a hearing test is performed if necessary.

At any age after that: have your child’s hearing checked in the event of delayed speech, difficulties at school, recurrent ear infections, a family history of hearing loss, suspected difficulty hearing in noisy surroundings, or any concern raised by parents or teachers.

What signs should alert me to possible hearing loss in my child?

If you notice several of these signs in your child, a hearing test should be carried out:

  • They do not react to sounds or to their name being called.
  • They speak very little or poorly, or their language skills regress.
  • They have difficulty understanding at school.
  • They turn up the volume on the television.
  • They seem distracted or restless in a group.
How is a newborn's hearing tested?

The newborn hearing test is quick and painless. It relies on otoacoustic emissions (a tiny probe in the ear) or auditory evoked potentials (measuring brain activity in response to sounds).

From what age can a child be tested in the same way as an adult?

From the age of 5 to 6, most children can complete a standard pure-tone audiogram, although some can do so earlier, depending on their maturity.

What are objective hearing tests used for in children?

Objective hearing tests assess hearing without requiring the child’s active participation. They are essential for babies and young children and always complement the hearing assessment.

Can my child be tested at Otoneuro Monaco from birth?

Yes. We have all the necessary equipment, as well as audiologists and doctors experienced in caring for children’s hearing from birth. We also work with hearing aid specialists experienced in paediatrics and, if necessary, with surgical teams for middle-ear conditions or cochlear implants.

What are the main causes of hearing loss in children?
  • Genetic causes.
  • Infections during pregnancy or birth.
  • Chronic glue ear (otitis media with effusion).
  • Acoustic trauma (rare in children).
  • Unknown causes in some cases.
In which family or perinatal circumstances is a hearing assessment essential?
  • A family history of hearing loss.
  • A complicated pregnancy (premature birth, foetal distress, infections).
  • Ototoxic medicines given to the mother or the baby.
  • A stay in a neonatal unit.
Why is it essential to detect severe hearing loss in children as early as possible?

It is important to detect hearing loss in children quickly because hearing is fundamental to the development of language and cognitive skills. The earlier treatment begins (hearing aids or cochlear implantation), the better the results.

When does a child with hearing loss need hearing aids?

As soon as hearing loss interferes with the development of speech, language and communication, hearing aids should be offered as early as possible.

How is glue ear (otitis media with effusion) treated in children?

Glue ear may clear up on its own in children, but medical treatment (nasal washes, corticosteroids, monitoring) or surgery may be needed.

What is a grommet (ventilation tube)?

A grommet is a small tube inserted into the eardrum to ventilate the middle ear and prevent fluid from building up.

Can my child go swimming with grommets?

In most cases, children can swim with grommets, but with care. Protection (earplugs, headbands) is sometimes recommended, depending on the type of grommet and the doctor’s advice.

What is hidden hearing loss in children?

Hidden hearing loss is when a child has hearing difficulties despite a normal audiogram, often revealed by difficulty understanding speech in noise. Specialist tests, carried out at Otoneuro Monaco, are needed to detect it.

What is auditory processing disorder (APD)?

It is a difficulty analysing and understanding sounds, especially in noise, even though basic hearing is normal.

How is APD treated in children?

Treatment combines suitable hearing aids, speech and language therapy, auditory remediation (adapting the home and school environment, etc.) and sometimes specialist educational support.

Hearing loss in adults

What are the first signs of hearing loss in someone exposed to noise?

The first signs of hearing loss are often a loss in the high frequencies, difficulty understanding speech in noisy surroundings, needing people to repeat themselves and hearing tinnitus or ringing after exposure. The person may still hear low-pitched sounds, which masks the problem and can delay diagnosis.

How does noise damage hearing?

Noise damages the sensory cells of the inner ear, but also the auditory pathways (synapses, auditory nerve). Prolonged or intense exposure leads to their irreversible destruction.
The damage may be gradual (occupational hearing loss) or sudden (acoustic trauma, explosion).

How can noise-induced hearing loss be prevented?
  • Avoid or reduce prolonged exposure to noise.
  • Wear suitable hearing protection (earplugs, ear defenders).
  • Take regular breaks when exposed to noise.
  • Have your hearing checked regularly if you are exposed to occupational noise or play music intensively.
What is simple chronic otitis media?

It is a persistent perforation of the eardrum, often following repeated ear infections. It causes variable hearing loss and sometimes discharge from the ear.

What is a cholesteatoma?

A cholesteatoma is an abnormal growth of skin in the middle ear, which gradually destroys the ossicles and bony structures and can spread to neighbouring areas (cochlea, facial nerve, meninges, brain, etc.).

Why is a cholesteatoma potentially dangerous?

A cholesteatoma can cause serious complications: destruction of the middle ear, severe hearing loss, facial paralysis and intracranial infections (meningitis, brain abscess).

When is surgery needed for chronic otitis media?

Surgery is needed when there is troublesome hearing loss, recurrent infections or a risk of progression, as with a cholesteatoma.

What is otosclerosis?

Otosclerosis is a hereditary condition that causes the stapes, one of the ossicles of the middle ear, to become gradually fixed, most often resulting in conductive (mechanical) hearing loss.

What are the risks of otosclerosis surgery?

Possible complications of otosclerosis surgery include total hearing loss in the operated ear (rare, around 1%), vertigo, tinnitus, a perforated eardrum and dysgeusia (altered taste).

What are the main conditions that cause sensorineural hearing loss?
  • Presbycusis (natural ageing).
  • Acoustic trauma.
  • Inner-ear disorders (Ménière’s disease, labyrinthitis).
  • Auditory neuropathies (genetic, chronic noise exposure, toxic substances, etc.).
  • Genetic disorders.
  • Tumours of the auditory nerve (acoustic neuroma).
  • Central causes (stroke, multiple sclerosis).
What is cochlear synaptopathy?

Cochlear synaptopathy is damage to the synapses connecting the sensory cells of the inner ear to the fibres of the auditory nerve. It causes hearing difficulties, particularly in noise, even though the audiogram may be normal.
It is one of the mechanisms behind hidden hearing loss.

What is auditory neuropathy?

Auditory neuropathy is a disorder affecting the transmission of the signal along the auditory nerve. It causes fluctuating sound perception and severely impaired understanding, especially in noise.

What is central auditory impairment?

It is hearing loss caused by damage to the auditory pathways in the brain (brainstem, auditory cortex).
It can cause difficulty understanding speech that is out of proportion to the audiogram, sometimes associated with other neurological signs.

What is presbycusis?

Presbycusis is the gradual loss of hearing associated with ageing, mainly affecting the high frequencies and making it difficult to understand speech in noise.

How is presbycusis treated?

There is no cure for presbycusis.

Early fitting of hearing aids, combined with auditory rehabilitation and sometimes lip-reading, helps to preserve communication and reduce the risk of cognitive decline.

Which medicines can cause hearing loss?

The medicines that can cause hearing loss are:

  • Certain antibiotics (aminoglycosides).
  • Anti-cancer drugs (cisplatin).
  • High doses of diuretics.
  • Antimalarial drugs.
Why should hearing be monitored during chemotherapy?

Because chemotherapy treatments can damage the inner ear. Regular monitoring allows any damage to be detected early and the treatment to be adjusted (stopping, reducing or spacing out doses, or changing the drug).

Why is hearing loss in one ear, or asymmetric hearing loss, a particular cause for concern?

Because any hearing problem affecting one ear only (hearing loss, tinnitus, asymmetric loss) may be a sign of a tumour of the auditory nerve (acoustic neuroma) or another inner-ear condition. A full otoneurological assessment and, in most cases, an MRI scan are essential.

How does a cochlear implant work?

It is an electronic device that bypasses the damaged cells of the cochlea.
An internal implant directly stimulates the auditory nerve and is connected to an external processor that picks up and encodes sounds.

Is a cochlear implant reimbursed?

Since 2021, the French national health insurance system (Assurance Maladie) has reimbursed cochlear implants for severe to profound single-sided deafness with disabling tinnitus, following the opinion of an expert centre and after a CROS or bone-anchored solution has failed.
The disabling nature of the tinnitus must be documented using a validated questionnaire (e.g. THI, VAS).

Hearing aids

Why do I need to see a hearing specialist before getting hearing aids?

Because hearing loss may have medical causes that need treating (earwax, acute or chronic otitis media, otosclerosis, an inner-ear condition, acoustic neuroma).
Only a specialist can make a reliable diagnosis.
If necessary, the ENT specialist then refers the patient to a hearing aid audiologist, ensuring that the fitting is based on sound and safe foundations.

What is the difference between a '100% Santé' hearing aid and a premium hearing aid?

‘100% Santé’ hearing aids (the fully reimbursed range under the French scheme) effectively correct basic hearing loss and are fully reimbursed.

Premium hearing aids offer greater comfort in noise, better sound quality and advanced features: Bluetooth connectivity, rechargeable batteries, smart noise reduction, directional microphones, etc.

The choice between these two options depends above all on the patient’s type of hearing loss, but also on their lifestyle, communication needs and priorities.

What is the best hearing aid?

There is no single best hearing aid for everyone.
The choice depends on:

  • the type and degree of hearing loss,
  • the patient’s tolerance of amplified sounds,
  • their everyday needs (family, work, leisure),
  • and the results of the trials.

The initial assessment and the fitting period are what make it possible to identify the most suitable hearing aid.

How are hearing aids fitted?

Following a medical prescription, the hearing aid audiologist carries out several sessions of gradual adjustments, with trials in different everyday situations. The settings are fine-tuned at each visit, in liaison with Otoneuro Monaco when necessary.

Is Otoneuro Monaco involved in the follow-up of hearing aids?

Yes. Otoneuro Monaco carries out hearing measurements, including with hearing aids (free-field testing, speech-in-noise intelligibility, hearing aid gain measurements), to monitor changes in hearing and measure the effectiveness of the aids, in coordination with our partner hearing aid audiologists.

When should a patient who wears hearing aids consider a cochlear implant?

When understanding remains insufficient despite well-fitted hearing aids, particularly in noise. In this case, an assessment at an expert centre such as Otoneuro Monaco is essential.

Tinnitus

What is tinnitus?

Tinnitus is the perception of a noise with no external sound source: whistling, buzzing, crackling, pulsing, etc. It may be heard in one ear, in both ears or even ‘in the head’. It is a common symptom, affecting around 15% of the population.

What are the main causes of tinnitus?

Tinnitus may be linked to:

  • hearing loss (presbycusis, sudden hearing loss, noise-induced hearing loss, Ménière’s disease, otosclerosis, etc.),
  • acute or chronic noise exposure,
  • certain middle- or inner-ear conditions,
  • head or neck injury,
  • a vascular or neurological cause (rarer).

In almost 80% of cases, it is associated with hearing impairment, even if mild.

Is tinnitus a disease?

No, tinnitus is a symptom. It is not a disease in itself, but it may reveal an ENT, neurological or metabolic condition. A full assessment is therefore needed to look for a cause and offer the best possible care.

Why should I see a doctor about tinnitus?

Because tinnitus may be harmless, but it can also reveal a disorder of the ear or the nervous system. An ENT and audiological assessment is essential, sometimes including imaging (MRI, CT scan) and vestibular tests if other symptoms are present.

Why is tinnitus in one ear a particular cause for concern?

Tinnitus on one side only, especially when accompanied by hearing loss, may be a sign of localised damage to the inner ear or the auditory nerve (e.g. acoustic neuroma). In this case, an MRI scan of the auditory system is always recommended.

What does Otoneuro Monaco offer for tinnitus assessment?

For tinnitus, Otoneuro offers:

  • a very comprehensive hearing assessment (pure-tone and speech audiometry, high-frequency audiometry), together with a careful, targeted clinical examination (ears, dental bite, neck, listening to the heart and neck vessels, etc.),
  • an objective assessment of the inner ear and the auditory nervous system when necessary (evoked potentials, vestibular tests, imaging in liaison with our neuroradiologists),
  • a multidisciplinary approach (otoneurologists, audiologists, specialist psychologists, dentists, osteopaths),
  • access to advanced imaging (3T MRI, high-resolution CT) through our partnership with the CIMM.
Is there a treatment for tinnitus?

There is no ‘miracle pill’ for tinnitus, but many approaches can significantly reduce its impact:

  • correcting hearing loss with suitable hearing aids,
  • sound therapies (e.g. Lenire®, available at Otoneuro Monaco),
  • rehabilitation techniques (audiological rehabilitation, speech and language therapy, management of associated hyperacusis),
  • psychological support and cognitive behavioural therapy,
  • targeted medication.
Can tinnitus go away on its own?

Yes, especially when it follows recent acoustic trauma or an ear infection. However, when it persists for more than a few months, it tends to become chronic. In this case, treatment aims to improve tolerance and quality of life.

Hyperacusis

What is hyperacusis?

Hyperacusis is an oversensitivity to everyday sounds. Normal noises (conversation, washing-up, traffic) become unbearable or even painful. It is often associated with tinnitus, hearing loss or anxiety disorders.

What causes hyperacusis?
  • inner-ear damage,
  • dysfunction of the brain’s central hearing regulation system,
  • the after-effects of acoustic trauma,
  • anxiety or depression,
  • inner-ear disorders (Ménière’s disease, acoustic neuroma, etc.).
How is hyperacusis treated?

Treatment for hyperacusis may include:

  • gradual sound therapy (habituation to sounds),
  • psychological support and cognitive therapies,
  • audiological rehabilitation and speech and language therapy,
  • in some cases, the fitting of specific hearing aids with sound generators.
Can hyperacusis be cured?

In many cases, hyperacusis can improve significantly with appropriate care. The outlook depends on the underlying cause and on how quickly treatment is started.

Vertigo and balance

What is BPPV (benign paroxysmal positional vertigo)?

It is the most common cause of vertigo. It occurs when small crystals in the inner ear (otoliths) become displaced into a semicircular canal. This displacement triggers brief but intense vertigo during certain head movements.

How is BPPV treated?

BPPV is treated with otolith repositioning manoeuvres. The doctor or physiotherapist performs precise head movements to put the crystals back in place.

Can BPPV come back?

BPPV can recur, sometimes several months or years later. However, each episode can be treated effectively.

What is Ménière's disease?

Ménière’s disease is a chronic inner-ear condition characterised by attacks of vertigo, fluctuating hearing loss, tinnitus and a feeling of fullness or pressure in the ear.

How is Ménière's disease treated?

Treatment for Ménière’s disease is gradual and involves:

  • lifestyle and dietary measures (reducing salt, caffeine and stress),
  • medication,
  • transtympanic injections (corticosteroids, gentamicin),
  • vestibular rehabilitation,
  • surgery in certain resistant cases.
What does Otoneuro Monaco offer for the management of Ménière's disease?

To treat Ménière’s disease, Otoneuro Monaco offers:

  • an accurate diagnostic assessment (advanced vestibular tests, audiometry, specialist imaging in collaboration with the Monaco Medical Imaging Centre),
  • multidisciplinary care (otoneurologist, vestibular therapist, psychologist),
  • access to all treatment options, from oral medication to transtympanic injections and from rehabilitation to surgery,
  • psychological support if needed (as the condition can be disabling and cause anxiety).
Can Ménière's disease be cured?

There is no definitive cure for Ménière’s disease, but treatment often keeps the symptoms under control over the long term.

Are cortisone injections effective for Ménière's disease?

Studies show:

  • A marked reduction in the frequency and severity of vertigo attacks in a significant proportion of patients.
  • Variable effectiveness on tinnitus and fluctuating hearing.
  • A better safety profile than gentamicin, although sometimes slightly less effective.
What are the risks or drawbacks of transtympanic cortisone injections?
  • Mild pain at the time of the injection.
  • Rarely, an ear infection or a persistent perforation of the eardrum.
  • An effect that is sometimes temporary, requiring several courses of injections.
What is vestibular neuritis?

An acute inflammation of the vestibular nerve, probably of viral origin, causing intense, prolonged rotational vertigo without any effect on hearing.

How is vestibular neuritis treated?

Medication in the acute phase (anti-vertigo drugs, corticosteroids, anti-sickness drugs), a full assessment to rule out other causes, and early vestibular rehabilitation to speed up central compensation.

What is PPPD (persistent postural-perceptual dizziness)?

PPPD is a chronic balance disorder characterised by a persistent feeling of unsteadiness, often triggered by an initial vestibular episode or by stress.

What causes PPPD?

It results from an interaction between vestibular vulnerability, psychological factors (anxiety, hypervigilance) and poor sensory adaptation.

How is PPPD treated?

PPPD is treated with specific vestibular rehabilitation, psychotherapy (CBT, anxiety management) and sometimes medication.

How can multiple sclerosis cause vertigo?

Multiple sclerosis can affect the central vestibular pathways, disrupting the control of balance and eye movements.

Why is Otoneuro Monaco at the forefront of rehabilitation for vertigo and balance disorders?

Because Otoneuro Monaco combines:

  • A comprehensive, well-reasoned assessment (VNG/VHIT, saccadometry, DVA/GST, otolith tests, stabilometry) to document your symptoms precisely and guide you towards a personalised rehabilitation programme.
  • Benchmark equipment: a TRV chair for BPPV and a virtual reality stabilometry platform (Virtualis) for balance disorders.
  • A dedicated team (expert audiologists, otoneurological medical supervision) and objective monitoring of progress (scores, stabilometry measurements, symptoms).
  • Close collaboration with the best vestibular physiotherapists in the region.
How many sessions are needed to treat BPPV on a TRV chair?

In over 80% of cases, 1 or 2 sessions are enough. Recurrences are possible, and a few extra sessions are sometimes needed for complex forms.

How will I feel after a BPPV session?

A light-headed or unsteady feeling may sometimes persist for a few days; if it continues or if the vertigo comes back, please contact us again.

What does balance rehabilitation involve?

The programmes are based directly on the assessment and are continually adjusted by the doctor in charge according to your progress: VR postural work, gaze stabilisation, habituation to visual stimuli, strengthening of balance strategies, and retraining of walking and confidence. We often start with blocks of 5 to 10 sessions, with regular reassessment.

What does the Virtualis VR platform bring to balance rehabilitation?
  • Immersion and graded scenarios (supermarket, footbridge, pavement, etc.) to work on visual orientation, desensitisation to stimulus-rich environments and postural confidence.
  • Targeted exercises: gaze stabilisation (VOR), smooth pursuit/saccades, optokinetic stimulation, optic flow, cognitive-postural dual tasks, etc.
  • Real-time biofeedback and objective measurements (sway area/speed, limits of stability) to fine-tune the programme.
Can my motion sickness be cured at Otoneuro Monaco?

Yes, Otoneuro helps to treat motion sickness through specific rehabilitation programmes (VR/habituation, gaze stabilisation). Read our dedicated article (in French).

Can a fear of heights be treated with rehabilitation?

Yes, a fear of heights can be overcome through graded exposure in virtual reality combined with CBT (cognitive behavioural therapy) and breathing/attention techniques, with safe, step-by-step progression.

Audiometry

Why have an audiometry test?

Audiometry provides an accurate assessment of your hearing and helps to understand the source of your difficulty: trouble hearing (sensitivity) or trouble understanding (intelligibility). It guides you towards care suited to your hearing loss.

What does a hearing assessment at Otoneuro Monaco involve?

The hearing assessment begins with a consultation and an otoscopy under the microscope. Depending on your situation, we test with headphones or in the free field, with or without hearing aids, in quiet and in noise.
The tests are carried out in ISO-standard soundproof booths with regularly calibrated equipment, by qualified audiologists under medical supervision.

Why test speech 'in noise'?

Many people hear ‘well’ in quiet surroundings but struggle in noisy environments. Speech-in-noise tests detect these early difficulties, which are sometimes present while the audiogram is still normal. In France, they have been mandatory since 2019 before hearing aids can be prescribed, and they are part of our assessments.

Tympanometry

Why carry out a tympanometry test?

To assess how the middle ear (eardrum and chain of ossicles) is working and, depending on the methods used, to obtain information about the inner ear as well. It is a key test in many situations (a blocked-ear sensation, ear infections, Eustachian tube dysfunction, suspected endolymphatic hydrops, tinnitus assessment, vertigo, etc.).

What happens during a tympanometry test?

A small probe is placed so that it seals the outer ear canal. It contains:

  • a loudspeaker that emits a reference sound;
  • a microphone that picks up the sound reflected by the eardrum and the chain of ossicles;
  • a pressure channel that gently varies the pressure in the outer ear canal.

You remain seated; the test is quick and painless.

Is tympanometry painful?

No, tympanometry is not painful. At most you will feel slight, brief pressure. If you have ear pain (acute ear infection) or a large perforation of the eardrum, we will adapt or postpone the test.

How long does tympanometry take?

Generally 1 to 2 minutes for both ears, depending on the protocol.

Auditory brainstem response (ABR)

Why carry out ABR testing (auditory evoked potentials)?

To record the electrical response of the auditory nerve and the auditory pathways of the brainstem to sound stimulation. ABR testing helps to:

  • screen for hearing loss in newborns and infants;
  • look for retrocochlear damage (e.g. acoustic neuroma/vestibular schwannoma);
  • investigate auditory neuropathies and situations where pure-tone and speech audiometry results do not match (ABR is then combined with otoacoustic emissions).
What exactly does ABR testing measure?

Using electrodes placed on the forehead, the mastoids (behind the ears) and sometimes the scalp, it records the small waves generated by the auditory system after a brief sound (clicks or tone bursts) delivered to the ear through headphones or a foam insert. In routine practice, early auditory evoked potentials (ABR) are mainly used, focusing on the responses of the auditory nerve and the brainstem.

How should I prepare for ABR testing?

Come with clean hair (avoid gels and hairspray), relaxed, and bring your previous test results and a list of your medication. Hearing aids are removed during the test.

How are ABR results interpreted?

The specialist analyses whether the waves are present or absent, and their latencies and intervals. An objective threshold can also be estimated. The results are explained to you and correlated with your other tests (audiometry, OAE, tympanometry, imaging if needed) to reach an accurate diagnosis and appropriate care.

Otoacoustic emissions (OAE)

Why carry out OAE (otoacoustic emissions) testing?

To assess the function of the outer hair cells (OHC) of the cochlea, whose role is to amplify sound vibrations. OAE testing is an objective test (requiring no active response from the patient) and an excellent early screening tool for inner-ear damage, particularly when monitoring exposure to noise or to substances that are toxic to the inner ear.

What happens during an OAE test?

A small earpiece placed in the ear contains a loudspeaker (sound stimulus) and a microphone (response returned by the ear). The ear must be sealed (the earpiece must fit snugly). The test is quick, quiet and painless.

What types of OAE are used?
  • TEOAE (transient-evoked otoacoustic emissions): very useful for screening, particularly in young children.
  • DPOAE (distortion product otoacoustic emissions): used to explore a wide range of frequencies (screening, objective frequency-specific monitoring of thresholds).
Is OAE testing painful?

No. OAE testing is non-invasive and painless. It can be carried out from birth.

Electrocochleography (ECochG)

What is electrocochleography?

It is an objective test that records the electrical response of the inner ear (cochlea) and the auditory nerve when sounds are presented. It helps us to understand how sound is converted into a nerve signal.

What happens during an electrocochleography test?

Small electrodes are placed on the skin (forehead/behind the ear) and a thin electrode is placed in the ear canal (sometimes in contact with the eardrum, depending on the indication). Sounds are delivered to the ear through an earpiece or headphones, and the device records the strength and timing of the response. You sit or lie down quietly.

Is electrocochleography painful?

The ear-canal method is well tolerated (you will simply feel the earpiece in place). The eardrum-contact method, reserved for certain indications, is carried out under local anaesthetic and may cause minimal, temporary discomfort. If you have an ear infection, discharge from the ear or a perforated eardrum, the test will be adapted or postponed.

When is ECochG performed?
  • Hearing loss assessment: to pinpoint more precisely where the hearing impairment lies (cochlea or auditory nerve).
  • Suspected Ménière’s disease/endolymphatic hydrops: as supporting evidence, among other diagnostic findings.
  • Cochlear implant plan: it helps to assess feasibility and to optimise the settings.
  • To complement other objective tests (ABR) when results do not match pure-tone/speech audiometry.
Can ECochG be performed on children?

In children, ECochG is mainly reserved for the assessment prior to cochlear implantation. It is carried out by the team that will perform the implantation.

Videonystagmography (VNG)

What is VNG (videonystagmography)?

VNG (videonystagmography) uses an infrared camera connected to a computer to record eye movements (nystagmus) in order to analyse how the balance system is working (the balance sensors of the inner ear, the vestibular nerve and the central nervous system).

What is nystagmus?

Nystagmus is an eye reflex that is triggered when the head turns, alternating between a slow movement and a rapid jerk. The eyes move slowly in the opposite direction to the head movement to keep the image stable on the retina, then make a small, rapid jerk back to the centre when the eye reaches the limit of its movement.

Is nystagmus normal or abnormal?

When the head or body moves, nystagmus occurs to stabilise vision (a normal reflex). Without movement, nystagmus is always abnormal and points to damage to the vestibular sensors, the vestibular nerve or the central nervous system.

Video Head Impulse Test (VHIT)

What is the VHIT (Video Head Impulse Test)?

The VHIT (Video Head Impulse Test) checks whether the motion sensors in your inner ear are working properly during very rapid movements. You wear lightweight goggles fitted with a small camera, which observes your eyes while small, rapid movements are made with your head. The aim is to make sure that your eyes keep the image stable when your head moves.

What is a VHIT used for?
  • To confirm or rule out an inner-ear problem responsible for dizziness or unsteadiness.
  • To determine whether the left ear, the right ear or both are affected.
  • To monitor progress (recovery/compensation) and guide vestibular rehabilitation.
Does the VHIT replace VNG or otolith tests?

Not at all. The VHIT mainly explores high frequencies (the rapid movements of everyday life).

How long does the Video Head Impulse Test take?

The VHIT takes around 15 to 25 minutes.

Otolithic evoked potentials (VEMP / OEP)

What are OEPs / VEMPs?

VEMPs are objective tests that assess sensors in the inner ear called otoliths. The saccule (which senses vertical acceleration) is tested with cVEMP, measuring a small response in a neck muscle. The utricle (which senses horizontal acceleration and gravity) is tested with oVEMP, recording a response around the eyes.

Are OEPs / VEMPs painful or risky?

No. The sounds may seem loud, but they cannot damage the inner ear. Slight neck fatigue (cVEMP) may occur and passes quickly. If you have a significant neck condition, ear pain, an ear infection or a perforated eardrum, we will adapt the method (bone conduction) or postpone the test.

Video-oculography / saccadometry

What is video-oculography (VOG) / saccadometry?

It is a non-invasive test that records your eye movements (smooth pursuit, saccades, anti-saccades) very precisely using high-definition cameras. Software then analyses the speed, accuracy and timing of these movements.

What happens during a video-oculography (VOG) / saccadometry test?

You look at a target on a screen that moves according to different protocols:

  • Smooth pursuit (the target glides): we measure the gain (do your eyes follow the target without delay or saccades?).
  • Saccades (the target jumps): we measure the latency (reaction time), speed and amplitude (accurate, too short or too long).
  • Anti-saccades (you are asked to look in the opposite direction to the target’s movement): we analyse the same parameters and the percentage of directional errors.

Stabilometry

What is stabilometry?

It is an objective analysis of your balance while standing on a computerised platform that measures your body’s tiny oscillations (centre of pressure). It assesses how your brain combines information from your vision, your inner ear (vestibule) and your proprioception (neck, trunk, limbs) to prevent you from falling.

Why have stabilometry at Otoneuro Monaco?

We use state-of-the-art equipment: the Motion VR (Virtualis), which combines a posturography platform with virtual reality (VR).

This allows us to:

  • precisely quantify your stability (sway area, sway speed, limits of stability),
  • simulate real-life situations (a shop, a footbridge, a pavement, a crowd, etc.) in complete safety,
  • offer tailor-made rehabilitation with biofeedback and progressive VR scenarios.
What happens during a stabilometry test?

You stand on the platform, wearing shoes or socks. Your responses are recorded under different conditions (eyes open/closed, with or without visual disturbances (VR), on a fixed or moving surface). The test is painless and takes 20 to 40 minutes, depending on the protocol.