Specialties

Facial Plastic and Reconstructive Surgery

Facial Plastic and Reconstructive Surgery

The UW Division of Facial Plastic and Reconstructive Surgery provides the full spectrum of patient care from aesthetic to reconstructive surgery and medicine. Partnering with a team of experts that includes dermatologists, aestheticians, physical therapists, anaplastologists, ophthalmologists, and oral surgeons, we provide the latest treatments available in a setting tailored to an individual’s needs, and we do this with care and compassion. Our faculty are board-certified in facial plastic and reconstructive surgery as well as in otolaryngology – head & neck surgery. Or goal is simple: to provide the best possible results for every patient we treat.

Treatment options provided by our specialists

Aesthetic procedures

  • Facelift
  • Browlift
  • Necklift
  • Eyelid surgery
  • Cheek and midface augmentation
  • Otoplasty (cosmetic ear procedures) 
  • Rhinoplasty
  • Skin resurfacing and injectable treatments (fillers and botulinum toxin)

Reconstructive procedures

  • Nasal reconstruction
  • Ear reconstruction
  • Microvascular reconstruction
  • Skin cancer and repair after Mohs surgery
  • Cleft lip and palate repair
  • Craniofacial trauma reconstruction
  • Endoscopic skull base surgery

We have active research and development programs in many aspects of facial plastic surgery. These include NIH-funded studies with collaboration in the Departments of Neurological Surgery, Bioengineering, and Electrical Engineering. Multiple patents and devices have resulted from these projects, as well as new procedures and novel techniques in virtual surgery, preoperative surgical planning, and computer-aided surgery. We greatly appreciate donations to our research program which directly impact patient care at all levels. 

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The following doctors specialize in Facial Plastic and Reconstructive Surgery

General Otolaryngology

General Otolaryngology

General otolaryngology - head and neck surgery (also sometimes referred to as ear, nose and throat) encompasses the broad range of disorders of the ears, nose, sinuses, mouth, throat, face and neck in the adult patient. Since all of these areas are connected to each other, symptoms in one region can often be due to problems in other regions. With this in mind, a global assessment of all of these areas can often be the best place to start.

Treatment options provided by our specialists

Treatments include a full range of medical and surgical therapies for a wide variety of otolaryngologic conditions. On occasion, some disorders may involve collaboration with subspecialists within UW Medicine for more complex diagnostic and therapeutic options.

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The following doctors specialize in General Otolaryngology

Head & Neck Surgery and Oncology

Head & Neck Surgery and Oncology

The UW Department of Otolaryngology - Head and Neck Surgery in collaboration with the Seattle Cancer Care Alliance is the northwest's leader in head and neck cancer care and is ranked as one of the top five cancer centers in the nation.

Studies have shown that the first treatment you receive for cancer is by far the most important. That's why your first choice in a treatment center needs to be the right one. The Department of Otolayryngology - Head and Neck Surgery at the University of Washington partners with the Seattle Cancer Care Alliance (SCCA) to offer patients the full range of disciplines that come together to deliver state-of-the-art integrated care. The Seattle Cancer Care Alliance was founded to incorporate the expertise of all three parent institutions, the Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and UW Medicine, to deliver the best care possible. Patients who begin their treatment at Seattle Cancer Care Alliance often have better outcomes than those who started treatment elsewhere. Not only can you expect the best standard of care available, but patients at SCCA have access to advanced therapies and treatments being explored in many of the clinical trials for head and neck cancers. Research and therapies are truly intertwined to offer patients today the therapies of tomorrow.

Patients at SCCA have access to the advanced care of the Otolaryngology - Head & Neck Surgery Center at University of Washington Medical Center (UWMC) that attracts hundreds of new patients each year and performs complex reconstructions with great results. In 80 percent or more of the cases, the doctors can save a patient's larynx or voice box.

Every year, some 350 new head and neck cancer patients are evaluated at UWMC. A multidisciplinary Head and Neck Tumor Board, which includes head and neck surgeons, reconstructive surgeons, dental surgeons, radiation oncologists, medical oncologists, neuroradiologists, and pathologists, meets weekly to discuss the cases and come up with the best treatment plan for each patient. 

Most head and neck cancers are found in people over age 40. Men are two to three times more likely than women to have head and neck cancer, although rates in women have been rising along with their growing use of tobacco and alcohol. The number of cases related to HPV, the same virus that causes cervical cancer in women, seems also on the rise.

If cancer is limited to the lining of your mouth and throat, it is called carcinoma in situ. When the cancer penetrates the surface lining, it's called invasive squamous cell carcinoma. If it arises from glands below the surface lining, it is called adenocarcinoma, adenoid cystic carcinoma, or mucoepidermoid carcinoma.

Read more about these cancers in the page links below:

While many cancers of the head and neck are curable, treatment depends on where the cancer is, the severity of the disease, and the patient's age and overall health. The primary method of treatment is surgery (removing the cancer cells). Radiation (using high-dose X-rays to kill cancer cells) and chemotherapy (using high-dose anti-cancer medication) are also used.

Surgery

Great advances have been made in surgical procedures so that structures affected by cancer can either be spared from removal or reconstructed well enough that the patient is not disfigured. The larynx, or voice box, can be saved in half the cases in which it would have been removed in the past. When part of the lower or upper jaw needs to be removed, doctors can now refashion a jawbone using bone from the patient's leg, hip, or shoulder blade. The tongue can even be reconstructed with appropriate soft tissue from various parts of the body.

For patients in whom a structure cannot be saved or restored, there are several new ways of helping to improve speech, swallowing, and other functions. Doctors can now restore a patient's vocal ability using a quick implant procedure. Other options for restoring a person's vocals include an electrolarnyx (a device placed against the neck to help form words) and a tracheosophageal puncture (a surgical procedure that restores the patient's ability to deliver air into the throat and eventually allows speech).

Using a simultaneous two-team approach during surgery, oncologic and reconstructive surgeons work alongside one another. Their team efforts, combined with anesthesia and operating room nursing staff, have significantly shortened procedure times. After surgery, the team of nurses, speech pathologists, and social workers work with patients to help them recover and rehabilitate quickly.

Newest Techniques

The newest technique offered is Transoral Robotic-assisted Surgery (TORS) for tumors of the upper aerodigestive tract (tumors of the back of the tongue and throat). UW Medical Center is the only center in the region to offer this specialized surgery. Use of the da Vinci Robot allows patients to return home in only a day or two without experiencing the long-term effects of more invasive techniques, which were once the only surgical option available.

Click the link below to see a video about one of our patients treated with TORS. 
Lydia's Story - Who knew that getting cancer could be a path leading to Carnegie Hall? When Lydia Miner discovered a lump in her throat, she faced a blistering regime of radiation ...

Radiation Therapy

  • Over the last decade there have been tremendous technical advances in head and neck radiotherapy. Intensity modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), and adaptive radiotherapy are a few.
  • IMRT combined with IGRT allows for very precise delivery of radiation therapy to tumors while sparing normal structures. Adaptive radiotherapy is the process of varying the radiation intensity according to changes in tumor dimensions during treatment. The goal is to cure the patient while minimizing side effects.
  • Head and neck radiotherapy is a highly complex and specialized field. SCCA patients are cared for by specialized radiation oncologists with clinical experience specifically in treating head and neck cancers using state-of-the-art technology in a patient-centered approach.
  • For us, every patient is unique, and care is individualized according to his or her specific clinical situation.

Unique to our program are the following: 

  1. Quality assurance components among the head and neck radiation oncologists that ensure a uniform quality of care and technical expertise for all our patients.
  2. Specialized head and neck supportive care including nursing, nutrition, speech pathology, lymphedema care, and specialized dental support with unique devices to minimize radiation toxicity.
  3. Internationally recognized cyclotron (fast neutron therapy) to treat rare salivary gland tumors.
  4. Several clinical trials testing newer strategies in cancer care.
  5. For complicated tumors involving vital structures, we have highly specialized experience with integrated approaches incorporating Gamma Knife radiosurgery.
  6. Proton therapy, an advanced form of radiation treatment and an important alternative to standard X-ray radiation for many types of cancer and some non-cancerous tumors. Learn more about proton therapy for head and neck cancer.

Chemotherapy

The use of systemic therapy in head and neck cancer has expanded in the last few years. Chemotherapy, in combination with radiotherapy, is now the standard of care for patients with locally advanced disease, either as a primary treatment or after surgical resection.

Targeted therapies have improved the efficacy of conventional chemotherapy and in some cases are used alone as a monotherapy. Recently the use of targeted therapy has shown progress, and we have started using agents that specifically target growth receptors on tumor cells, such as cetuximab and erlotinib. Other encouraging new discoveries harnessing the power of the immune system are being tested and developed here at the Seattle Cancer Care Alliance. Please visit the SCCA website for a full list of available trials for head and neck cancer patients.

The highest quality multidisciplinary care uses systemic therapy as an integral part of head and neck cancer care. Every patient requiring systemic therapy at SCCA has the option of receiving the standard of care or participating in innovative clinical studies that explore new approaches to fight their disease.

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The following doctors specialize in Head & Neck Surgery and Oncology

Laryngology

Laryngology

The laryngology team at UW Medicine specializes in the diagnosis, medical and surgical treatment of diseases affecting the throat. This includes all aspects of care related to voice, airway and swallowing disorders. UW Laryngology is unsurpassed in the breadth and depth of clinical practice of contemporary laryngology at the highest level. The multidisciplinary approach to patient care practiced by our three laryngologists and five voice/swallow therapists follows an ideal model of collaborative care. All members are intimately familiar with the complex anatomy and physiology of the larynx, pharynx, trachea and esophagus.

Conditions treated include:

  • Hoarseness affecting your speaking voice
  • Hoarseness affecting your singing voice, for both for professional singers and enthusiasts
  • Vocal cord paralysis/weak vocal cords
  • Aging voice
  • Vocal fold nodules/cysts/polyps
  • Laryngeal cancer - early and advanced
  • Spasmodic dysphonia and other neurological disorders affecting the larynx
  • Laryngeal papilloma/recurrent respiratory papilloma (RRP)
  • Swallowing problems – food getting “stuck” or “going down the wrong way”
  • Aspiration
  • Zenker’s diverticulum affecting swallowing
  • Globus sensation – the feeling of a “lump” in the throat
  • Breathing problems related to your throat or trachea – this includes glottis, subglottic, and tracheal stenosis. 
  • Chronic tracheotomy – evaluation for possible decannulation (getting rid of the tracheotomy)
  • Chronic throat pain
  • Throat clearing, reflux affecting the throat
  • Chronic cough/neurogenic cough
  • Paradoxical vocal fold dysfunction/VCD

Our treatment plans emphasize patient education and preservation or restoration of normal anatomy wherever possible. We place special emphasis on rehabilitation strategies designed to maintain and recover function using state-of-the-art medical and surgical therapies to ensure the most favorable outcomes. 

Treatements include:

  • Treatment of laryngeal cancer – both minimally invasive and open techniques
  • In-office vocal fold surgery including vocal fold augmentation for paralysis, in-office laser for vocal fold growths and tumors, and airway dilation
  • Botox injections for spasmodic dysphonia and other neurological disorders affecting the larynx
  • Office-based and surgical treatment for benign voice disorders such as vocal fold nodules, polyps, and cysts
  • Laser treatment for airway diseases
  • Both endoscopic and open surgery for Zenker’s diverticulum
  • Comprehensive care of vocal fold paralysis – including diagnostic laryngeal EMG, office-based injection, laryngoplasty, traditional framework surgery, and laryngeal reinnervation

We work closely with our UWMC colleagues in speech/language pathology for assessment and treatment planning.  We have a deep relationship with the related areas of the UW Medicine system, including UW Pulmonary Medicine, Gastroenterology, Neurology, and the Center for Esophageal Surgery to provide comprehensive diagnostics and care.  The result is an enhanced, coordinated approach to treatment of the whole patient. 

Research

The University of Washington laryngology program is a productive and well-regarded center for clinical research related to the understanding, diagnosis and treatment of voice, airway and swallowing disorders. There is an ongoing interchange with colleagues in Speech and Hearing Sciences to help advance our shared areas of clinical care and scholarly interest.  

 

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The following doctors specialize in Laryngology

Otology and Neurotology

Otology and Neurotology

The Otology/Neurotology team at UW Medicine specializes in the diagnosis, medical and surgical treatment of diseases of the ear and skull base. All members are intimately familiar with the complex anatomy and physiology of the outer, middle and inner ear, and the central nervous system connections as well as their afflictions.

Conditions treated include:

  • Sudden, chronic and progressive hearing loss
  • Tinnitus
  • Chronic and acute ear infections, ear drum perforations and cholesteatoma
  • Dizziness and vertigo
  • Meniere's disease
  • Positional vertigo
  • Facial nerve paralysis
  • Tumors of the ear and temporal bone including vestibular schwannoma (acoustic neuroma) and meningioma

Our treatment plans emphasize patient education and preservation or restoration of normal anatomy wherever possible. We place special emphasis on rehabilitation strategies designed to maintain and recover function using state-of-the-art medical and surgical therapies to ensure the most favorable outcomes.

We work closely with our UW Medicine colleagues in Audiology, the Dizziness and Balance Center, Rehabilitation Medicine, Neurosurgery and Neurology to provide comprehensive diagnostics and care. The result is an enhanced, coordinated approach to treatment of the whole patient.

Treatment options provided by our specialists:

  • Medical assessment for hearing aid clearance
  • Middle ear surgery for chronic infections, ear drum perforations, skull fractures and cholesteatoma
  • Stapes surgery for otosclerosis
  • Osseointegrated bone conducting devices (BAHA) 
  • Prosthetic ear reconstruction (Vistafix)
  • Cochlear implantation
  • Medical and surgical treatment of dizziness and Meniere’s disease
  • Treatment for superior semicircular canal dehiscence (SSCD)
  • Treatment in the Multidisciplinary Skull Base Tumor Clinic

Research

The University of Washington is a world leader in research related to the understanding, diagnosis and treatment of hearing and balance disorders.  There is an ongoing fertile interplay between advancements in the laboratory and potential clinical applications in treating patients.  In addition to clinical research, our team has particular interests and active basic science research programs in cochlear and vestibular implant design and inner ear regeneration. There are additional opportunities for patients to participate in hearing loss research throughout the University of Washington.  

Links

Virginia Merrill Bloedel Hearing Research Center
American Academy of Otolaryngology - Head and Neck Surgery
Hearing Loss Association of America
American Tinnitus Association
National Institute on Deafness and Other Communication Disorders

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The following doctors specialize in Otology and Neurotology

Pediatric Otolaryngology

Pediatric Otolaryngology

The Division of Pediatric Otolaryngology clinical practice is located at Seattle Children’s Hospital, an affiliate of the University of Washington. We are comprised of nine full time staff MDs, three part time staff MDs, five nurse practioners, and approximately 25 audiologists. We work closely with other departments at Seattle Children’s, including speech pathology and craniofacial anomalies, to deliver comprehensive care to children with special needs.

Our division believes strongly in the Seattle Children’s Hospital mission statement of continually trying to improve the health of children by combining research and teaching with the care of pediatric patients. Being a part of the WWAMI regional network allows us to concentrate experience and develop new expertise in patients with complex or routine medical problems alike.

In addition to providing services for common situations such as large tonsils or ear infections, we have developed specialty programs for integrated care of complex problems. The Childhood Communications Center focuses on children with significant hearing or speech problems. The Vascular Anomalies Center provides care for children with birthmarks or masses such as hemangiomas. We also have specialty clinics for sinus problems, voice issues, swallowing and breathing difficulties, thyroid masses and palate (speech) problems. 

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The following doctors specialize in Pediatric Otolaryngology

Rhinology/Sinus and Skull Base Surgery

Rhinology/Sinus and Skull Base Surgery

The rhinology team at UW. Medicine is a group of ENT surgeons and health care providers with subspecialty training and expertise in the medical and surgical treatment of diseases involving the sinuses, nose, and anterior skull base.  We treat conditions that often have a significant impact on people’s quality of life.  Fixing a persistent sinus infection with medicine or surgery can dramatically improve a person’s comfort, energy level, and ability to function in life activities. Similarly, restoring breathing through the nose can significantly help with sleeping and exercise tolerance

Our approach to the patient involves performing a comprehensive evaluation using state-of-the-art technologies and a team approach with our colleagues in other specialties to determine the proper diagnosis and treatment plan for each individual patient.  Often the initial line of treatment is using medical therapy.  If medication does not work to improve a person’s symptoms, then when we consider surgery.  The ultimate decision is made by the patient.  We pride ourselves on giving the patient the best, most up-to-date information available to make an informed decision.  Being in a university medical center, not only do we know the latest research and newest techniques, but in many cases we are the ones developing those new treatment strategies.  We work closely with our UW Medicine colleagues in allergy, immunology, pulmonary, infectious diseases, and neurosurgery.  The result is an enhanced, coordinated approach to treatment of the whole patient. 

We also treat many serious conditions including CSF leaks and skull base tumors.  This area is called endoscopic skull base surgery and often uses our expertise along with that of neurosurgeons to work together as a team to fix these problems.  In addition, there are several eye conditions that require both rhinologist and a specially trained eye surgeon (ophthalmologist) to work together for ideal treatment.  

Conditions treated include:

  • Sinusitis (including nasal polyps)
  • Nasal congestion (septal deviation and turbinate hypertrophy)
  • CSF leaks (rhinorrhea)
  • Endoscopic skull base tumors and sinus tumors
  • Loss of smell function
  • Epistaxis (bloody nose and hereditary hemorrhagic telangiectasia [HHT])
  • Epiphora (excessive tears draining down the cheeks)

Our team sees patients with a wide spectrum of severity of disease from the most simple sinus and nasal problems to the most advanced sinus and nasal issues involving highly complex issues and tumors of the sinuses and skull base.

Research

We have active research and development programs in many aspects of skull base surgery. These include NIH-funded studies with collaboration in the Departments of Neurological Surgery, Bioengineering, and Electrical Engineering. Multiple patents and devices have resulted from these projects, as well as new procedures and novel techniques in virtual surgery, preoperative surgical planning, and computer-aided surgery.

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The following doctors specialize in Rhinology/Sinus and Skull Base Surgery

Sleep Surgery
Sleep Surgery

Sleep Surgery

Sleep Surgery is the specialty that focuses on surgery for treating snoring and obstructive sleep apnea.  It includes techniques and procedures to evaluate the breathing passages thoroughly and surgeries to enlarge and stabilize the breathing passages.  These surgeries facilitate other non-surgical treatments (eg, CPAP, dental devices) and improve the symptoms and consequences of sleep apnea.

Evaluation

Surgery evaluation techniques enable identification of obstructing tissues and structures contributing to sleep apnea.  Most are non-invasive or minimally invasive and are performed in the clinic.  Examples include:

  • Physical examination
  • Acoustic rhinometry
  • Peak inspiratory flow 
  • Nasal endoscopy 
  • Fiberoptic laryngoscopy 
  • Sleep endoscopy (performed under sedation)

NASAL SURGERY

Nasal surgeries improve tolerance of CPAP, effectiveness of dental devices, daytime nasal breathing, snoring, and mild sleep apnea.  Examples of nasal surgeries include:

  • Septoplasty (corrects internal deformities)
  • Septorhinoplasty (corrects internal and external deformities that compromise breathing)
  • Turbinate reduction (reduces obstructing tissues in the nose)

AIRWAY SURGERY

Airway surgeries to treat snoring and sleep apnea include, for example:

  • Palate stiffening (reduces snoring with implants or radiofrequency)
  • Tonsillectomy, lingual tonsillectomy, and adenoidectomy (remove obstructing tissues)
  • Uvuloplalatopharyngoplasty (prevents collapse of the tissues in the back of the mouth)
  • Partial glossectomy (reduces tongue size)
  • Genioglossus advancement (reduces tongue collapse)
  • Hyoid suspension (lifts and stabilizes the airway from the neck)
  • Epiglottoplasty (stabilizes the voice box cover)
  • Maxillomandibular advancement (moves jaws forward to open and stabilize the throat)
  • Tracheotomy (bypasses the throat for breathing but still allows normal daytime function)
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Individualized treatment plans for obstructive sleep apnea are designed for each patient after careful evaluation and discussion of the options.  Surgery often involves staged procedures to treat all sites of obstruction.

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The following doctors specialize in Sleep Surgery

Vestibular Diagnostics and Audiology

Vestibular Diagnostics and Audiology

Vestibular neurophysiology is the study of vestibular system function, and Audiology is a scientifically based, clinical discipline that involves the study and assessment of hearing and balance disorders.

The vestibular system uses information from motion sensing organs in the inner ear.  It combines this information with additional information from vision and body senses to create a seamless representation of our orientation within the world.  When this system is compromised, patients experience a variety of symptoms including vertigo, imbalance, disorientation, nausea, cognitive impairment, and vision loss due to oscillopsia (uncontrolled visual motion).

The Vestibular Diagnostic Service at the University of Washington Medical Center (UWMC) provides assessment of vestibular disorders.  It utilizes Ph.D. level providers with a specialization in vestibular and oculomotor neurophysiology to perform and interpret complex diagnostic procedures required to provide an accurate diagnosis of vestibular dysfunction.  A second clinical interpretation of each test is provided by physician otologists, producing a fully integrated clinical assessment.

Services offered include:

  • Comprehensive evaluation of balance, gait, and orientation function
  • Diagnosis of diseases of the vestibular end organs, the vestibular nerve, and the skull base

The Vestibular Diagnostic Service is part of the Otolaryngology/Head and Neck Surgery Center at UWMC.  It is also the diagnostic arm of the Dizziness and Balance Center, which was established in 1996 as a conjoint service of the Departments of Otolaryngology Head and Neck Surgery, Neurology, Neurological Surgery, Ophthalmology, Psychiatry and Behavioral Sciences, and Rehabilitation Medicine.   The Dizziness and Balance Center serves as an intake service into the medical center for patients with complaints of dizziness and imbalance and coordinates multidisciplinary care. In addition to providing expert diagnosis and management of patients with vestibular disorders, the Dizziness and Balance Center has a special mandate to contribute to advancing the clinical science of the vestibular system. Although current diagnostic methods are good, there is still a large gap in the sensitivity and specificity of existing test batteries. Developing new tests and treatments, evaluating their effectiveness, and applying them to patient care are a vital part of the Dizziness and Balance Center’s responsibility. This is in keeping with the reputation of the UWMC as one of the premiere teaching and research hospitals in the U.S.

The Dizziness and Balance Center conducts a multidisciplinary monthly conference for case review and coordination of patient care that is attended by representatives from the sponsoring departments, and clinicians in outside practice in the community. This is a working staffing conference in which problem cases are reviewed and joint treatment plans are instituted. The conference also features a mini-lecture program under the aegis of Dr. Phillips for basic education in vestibular disorders and treatment.

The Dizziness and Balance Center faculty and staff under the direction of Dr. James Phillips and Dr. Jay Rubinstein recently began a human safety and efficacy study of a new vestibular prosthesis for the treatment of vestibular loss and vestibular dysfunction.  The device, which is based on a cochlear implant, is designed to provide electrical stimulation to the vestibular end organs that sense rotation, and to replace balance function with the use of an external gyroscope array and microprocessor which sense head motion in 3-dimensions.  

Vestibular Diagnostic Services

Vestibular neurophysiologists use a wide variety of testing procedures to determine someone’s vestibular status. Working in tandem with a trained physician otologist, the vestibular neurophysiologist can determine what parts of the vestibular system are damaged, how balance and orientation are affected by that damage, and what adaptation has taken place in response to these changes.  These three factors are critical to the diagnosis and treatment of a vestibular disorder.  Patients who are referred for diagnostic services from outside the UWMC will receive the same level of professional assessment and care as internal patients, and the tests will be reviewed by both the neurophysiologist and interpreting otologist before they are forwarded to the referring provider.

The Vestibular Diagnostic Service at UWMC provides a range of evaluations that include:

This test places a patient in a wobbling room to assess balance function under conditions where one or more sensory cues to aid in balance and orientation are compromised. The test can also assess the integrity of the functional reflexes that allow one to maintain balance.
This test evaluates the ability of a patient to see clearly when the head is moving. This computerized test can detect functional changes associated with loss of vestibular reflexes that stabilize the eye.
These tests evaluate the ability of a patient to walk normally in situations which challenge balance, such as when turning the head, or changing direction.
These tests evaluate the function of the vestibular system by rotating the patient in various ways in a computer-controlled motorized chair. Rotational tests are especially useful in assessing bilateral loss of vestibular function, function of the utricle, adaptation to vestibular loss, and central processing of vestibular signals.
The static test evaluates the ability of a patient to perceive vertical orientation using only vestibular cues. The dynamic test evaluates the ability of one of the vestibular organs (the utricle) to inform the brain of orientation with respect to gravity.
These tests evaluate the response of the vestibular end organs to changes in sound and pressure. These tests are useful in identifying a defect in the membranes of the inner ear or in the bone surrounding the inner ear.
These potentials measure activation of reflexes that stabilize the eyes and head in response to head motion by activating eye and neck muscles, respectively. Cervical VEMP (cVEMP) looks at changes in neck muscle activity in response to stimulation of the vestibular end organs with loud sounds, taps, vibration, or electrical stimulation. Ocular VEMP (oVEMP) looks at activation of the eye muscles using similar stimuli. These tests are very good at assessing the function of the vestibular organs and pathways that detect linear motion and tilt with respect to gravity.
These tests evaluate eye movements that normally compensate for rapid head motion. They can detect loss of function in individual end organs in the inner ear. The coil test uses a small contact lens in a magnetic field and can detect very subtle changes in the function of these reflexes.
This test evaluates eye movements that result from problems with the vestibular organs of the ear or nerve, as well as evaluating eye movements that result from abnormal central (brain) processing of movement information.

  Treatment options provided by the Dizziness and Balance Center:

  • Physicians in the Department of Neurology can provide medical treatment of balance and orientation issues related to autoimmune disorders, degenerative disease, orthostatic intolerance, stroke, syncope, transient ischemia, traumatic brain injury, and vestibular migraine.
  • Physicians in the department of Neurological Surgery can provide medical and surgical treatment of balance issues related to acoustic neuroma (Vestibular schwanoma), canal dehiscence, central nervous system tumors and stroke.
  • Physicians and optometrists in the Department of Ophthalmology can provide medical and surgical treatment of vision, eye movement and eye alignment issues produced by central vestibular loss.
  • Physicians and Audiologists in the Department of Otolaryngology - Head and Neck Surgery can provide medical and surgical treatment of many vestibular disorders including acoustic neuroma (Vestibular schwanoma), autoimmune vestibular disorders, benign paroxysmal positional vertigo (BPPV), canal dehiscence, Meniere’s disease, migraine associated vertigo, perlymphatic fistula, vestibular labyrinthitis and vestibular neuronitis.  
  • Physicians in the Department of Psychiatry and Behavioral Sciences can provide treatment of behavioral disorders associated with vestibular loss including anxiety disorders, cognitive changes, memory problems, and mood disorders.
  • Physicians and physical therapists in the Department of Rehabilitation Medicine can provide treatment of peripheral and central balance disorders providing evidence based approaches for the restoration of normal activities through strengthening, changes in postural and gait strategies, adaptation of preserved functions, and the substitution of other inputs, such as visual or body senses, for those that are lost. 

Audiologists are graduate-trained healthcare professionals who evaluate, diagnose, and provide nonmedical treatment to those with hearing loss and/or balance disorders. 

Audiology

The Audiology Service at the University of Washington Medical Center (UWMC) Otolaryngology/Head and Neck Surgery Center is dedicated to the identification, assessment, and treatment of individuals with hearing disorders. The audiology professionals employed at UWMC function as independent practitioners who consult with patients referred for hearing evaluations and rehabilitation services. The audiologists work closely with highly trained vestibular (balance) specialists, otolaryngologists (ear, nose, and throat physicians) and otologists/neurotologists (specialty trained ear surgeons) to develop treatment plans for those identified with hearing and/or balance problems. Through active research programs and collaborations the Audiology Service continually investigates new and improved ways to assess hearing and provide state-of-art treatment options.

Audiologists use various testing procedures to determine someone’s hearing status; whether that be within the normal range or not. The audiologist will determine what parts of the auditory system are damaged and how hearing is impacted (low, middle, or high pitches) and to what extent. If it is determined that an individual has a hearing loss recommendations will be provided as to treatment options such as assistive listening devices, hearing aids, auditory implants, counseling, rehabilitative therapy, and/or, appropriate medical referral.

The Audiology Service at UWMC provides a range of evaluations that include:

Patients listen to tones using headphones or earphones and a bone vibrator that sits behind the ear. The tones are presented at different levels and pitches to help the audiologist determine the degree of hearing loss, if any, and what pitches are most affected.
A rubber probe is placed into the ear that allows the audiologist to measure how well the eardrum (tympanic membrane) is moving. This helps determine whether or not the patient has a middle-ear problem (e.g., an ear infection).
Patients listen to words and/or sentences to determine how well speech can be understood. This helps the audiologist understand how communication might be impacted by any hearing loss that might be present.
These tests measure electrical signals generated in the brain in response to sound using electrodes placed on the scalp, earlobes, or through the eardrum. Results can help determine the type and degree of hearing loss, and verify function of the auditory nerve.
A type of hearing test that measures sound generated by the inner ear (cochlea). A small probe is placed in the patient’s ear that contains a speaker and a microphone. A sound is presented from the speaker and the microphone measures an echo that comes back into the ear canal. This test can be used to measure hearing but also to help the audiologist determine function of the cochlea.
The Audiology Service uses otoacoustic emission testing to screen the hearing of newborn babies.
Certain drugs used to treat patients with cancer can be harmful to hearing (ototoxic). Audiometry testing with very high pitches and otoacoustic emission testing are used to monitor the hearing of patients undergoing therapies and to identify ototoxic effects as early as possible so that alternative treatments for the cancer can be explored.
This test involves measuring the function of the facial nerve using electrodes placed on the face and near the ear.
Hearing aid services are available for patients with hearing loss that is not medically treatable.
Auditory implants are surgically placed devices for individuals for whom hearing aids are not adequate to compensate for hearing loss or for whom the use of hearing aids is not possible.
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The following doctors specialize in Vestibular Diagnostics and Audiology