The Audiology and Hearing Center at Concord Otolaryngology is a sister organization with Alliance Audiology LLC and is allied with Concord Otolaryngology. This partnership allows you to come to one office for complete otolaryngology, audiology, and hearing aid services.

Dr. Nicole Bettencourt, Eliza Evans, and Dwight “Ike” Valdez form the Concord and Peterborough office teams with over 80 years of combined experience.    Their expertise in the latest diagnostic procedures assures their patients the highest of audiological care.


Nicole Bettencourt, AuD, CCC-A
Dwight R. Valdez, MA, FAAA
Karen C. Dale, M.S., CCC-A


“The solution to better hearing begins with a thorough hearing evaluation.”

The Audiology and Hearing Center at Concord Otolaryngology provides diagnostic hearing tests for individuals referred by family physicians, internal medicine doctors, pediatricians, ear, nose, and throat specialists, school systems, and industry. If you or your doctor suspects a hearing loss or if you have problems with noises in the ears (tinnitus), dizziness, speech delay, learning difficulties or ear infections he or she will recommend a hearing evaluation.

We have two sound-treated rooms in both our Concord and Peterborough offices and the latest diagnostic equipment to evaluate you or your child’s hearing abilities. A comprehensive audiological evaluation includes:

Case History: We encourage you to bring previous hearing test results to the initial office visit. Our audiologists will ask about relevant background information, such as ear and health history, as well as noise exposure history. We will discuss your concerns and questions regarding your hearing and listening difficulties. This will help us to decide on the best assessment and treatment options for your needs.

Otoscopy: We will look at the outer ear and ear canal to check for any anomalies, such as signs of cerumen (earwax), foreign objects, middle ear fluid or infection, and/or perforation.

Tympanometry: A soft rubber tip is placed in the ear canal. You will hear a low pitched hum and feel a change in air pressure. The movement of the eardrum in response to changes in air pressure is recorded, which provides information about ear canal volume, mobility of the middle ear system, and the possible presence or absence of middle ear fluid.

Acoustic Reflex: The equipment used for Tympanometry is used to measure acoustic reflexes. Acoustic reflex tests measure the ear’s ability to stiffen the eardrum as a protective mechanism from loud sounds. A rubber tip is placed in the ear canal, and a series of loud tones are presented to each ear at different frequencies. This information provides the audiologist with diagnostic information regarding possible problems in the auditory pathway.

Acoustic Reflex Decay: This is a version of the Acoustic Reflex test where the loud tones are presented continuously for 15-20 seconds. The equipment records how long your ear can maintain the reflex. This provides additional information about the auditory pathway.

Pure-tone Audiometry: The screening version of Pure-tone Audiometry is what most people will recall having done by a nurse at school or at the pediatrician’s office. Diagnostic audiometry involves listening through earphones for electronically generated "pure tones" that differ in frequency and intensity. This is done in a soundproof booth so that you can hear the softest possible sounds without disturbance from outside noises.

If a hearing loss is detected then your hearing acuity is measured with a bone conductor placed behind the ear. The bone conductor sends sounds directly to the inner ear, bypassing the middle and outer ear. This information determines the whether your hearing loss is from the inner ear (sensorineural) or the outer/middle ear (conductive) or both (mixed). The results also determine the severity of your hearing loss.

Speech Tests: Two common tests measure your Speech Recognition Thresholds (SRT) and your Word Discrimination abilities. The SRT test assesses the lowest level that you can detect and repeat back two syllable words (e.g. baseball and ice-cream). The Word Discrimination test determines how clearly you can hear single syllable words.

Visual Reinforcement Audiometry: Visual Reinforcement Audiometry (VRA) is a version of the Pure-tone Audiometry. It is a behavioral hearing test for children who are approximately 6 months to 3 years old. Your child sits on your lap in a soundproof room and frequency specific sounds are presented either through speakers or through earphones. When your child hears the sound and turns to look, mechanical toys mounted on walls light up to reinforce the turning behavior. The quietest levels that your child turns to the sounds are recorded. If poor hearing is noted, testing is done through bone conduction to determine if the hearing loss is permanent, or due to conductive problems.

Conditioned Play Audiometry: Conditioned Play Audiometry is a version of the Pure-tone Audiometry test. It is for children age 3 to 5 years. Your child will play a listening game where he or she will drop a block into a bucket when the sound is heard. The softest level that your child responds is recorded. If a hearing loss is detected, bone conduction testing is administered to determine whether the hearing loss conductive or sensorineural.

Otoacoustic Emissions: Otoacoustic emissions (OAEs) are sounds produced by the outer hair cells of the cochlea in the inner ear in response to sounds. These emissions are measured and recorded in the ear canal.

Damaged outer hair cells result in a hearing loss so the OAE sounds will not be produced. Generally, if your hearing is at 30 decibels or better (normal), then OAEs are present and can be measured.

The test procedure is quick and non-invasive. A probe tip is placed in your outer ear canal and a series of clicks made by the OAE test equipment. You do not have to respond to the sounds. Instead the equipment will measure emissions produced by your cochlea in response to the clicks. A “Pass” result indicates that OAEs are present and your hearing levels are at least 30 dB or better.

“The solution to dealing with your tinnitus (noises in the ears) is with a thorough tinnitus evaluation.”

Tinnitus History Questionnaire and Tinnitus Reaction Questionnaire: Detailed information about the onset of your tinnitus, health and medical history, and noise exposure history are obtained through the Tinnitus History Questionnaire. The Tinnitus Reaction Questionnaire provides detailed information about how you perceive the noises in your ears and how it impacts your life. Your audiologist will discuss this information from these questionnaires since they provide valuable and crucial information about you and your tinnitus.

Tinnitus Evaluation: The nature of the noises (tinnitus) in your ears can be evaluated with specialized equipment and tests. A Pure-tone Audiometry test is administered in our soundproof room to measure your ultra-high frequency hearing (above 8000 Hz) through special headphones.

A second test is called Tinnitus Matching. You will be given different sounds to listen and compare to the noises in your ears. The pitch and sound quality of your tinnitus is matched.

Your sensitivity to sounds is evaluated with the Loudness Sensitivity test. You will listen to different narrowband sounds and asked to rate how loud you perceive those sounds as the volume is increased. We will search for the level that is “uncomfortably loud” for you. This information helps the audiologist to determine if you have loudness tolerance problems.

Your ability to hear a broadband noise called “white noise” is evaluated. Just like the Pure-tone Audiometry test you will listen to the “white noise” and indicate the softest level you can hear it. Then you will listen to that noise and indicate when it just barely “covers up” your tinnitus.

Another test is called Residual Inhibition. In this test you will listen to the sound that was previously matched to your tinnitus. All you need to do is sit quietly and listen to that sound for one minute. If your tinnitus disappears that is a good indicator that you will respond to treatment.

Tinnitus Treatment: There are number of treatment methods that your audiologist will discuss with you. The appropriate method will depend on the outcome of the tinnitus questionnaires and the tinnitus evaluation.


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