DVBCWAU7        ;BPOIFO/RLC AUDIO WKS TEXT - 1 ; 26 DEC 2006
 ;;2.7;AMIE;**128**;FEB 2,2004;Build 5
 ;
TXT ;
 ;;   The Handbook of Standard Procedures and Best Practices for Audiology
 ;;   Compensation and Pension Exams is available online. ( This is a PDF file.
 ;;   You need Acrobat Reader to open pdf files. It is a free download. )
 ;;
 ;;Narrative:  An examination of hearing impairment must be conducted by a
 ;;state-licensed audiologist and must include a controlled speech
 ;;discrimination test (specifically, the Maryland CNC recording) and a
 ;;pure tone audiometry test in a sound isolated booth that meets American
 ;;National Standards Institute standards (ANSI S3.1.1991) for ambient noise.
 ;;Measurements will be reported at the frequencies of 500, 1000, 2000, 3000,
 ;;and 4000 Hz.  The examination will include the following tests: Pure tone
 ;;audiometry by air conduction at 250, 500, 1000, 2000, 3000, 4000, and
 ;;8000 Hz, and by bone conduction at 250, 500, 1000, 2000, 3000, and
 ;;4000 Hz, spondee thresholds, speech recognition using the recorded
 ;;Maryland CNC Test, tympanometry and acoustic reflex tests, and, when
 ;;necessary, Stenger tests.  Bone conduction thresholds are measured 
 ;;when the air conduction thresholds are poorer than 15 dB HL.  A modified
 ;;Hughson-Westlake procedure will be used with appropriate masking.  A
 ;;Stenger must be administered whenever pure tone air conduction
 ;;thresholds at 500, 1000, 2000, 3000, and 4000 Hz differ by 20 dB or more
 ;;between the two ears.  Maximum speech recognition will be reported with
 ;;the 50 word VA approved recording of the Maryland CNC test.  When speech
 ;;recognition is 92% or less, a performance intensity function will be
 ;;obtained with a starting presentation level of 40dB re SRT.  If necessary,
 ;;the starting level will be adjusted upward to obtain a level at least 5 dB
 ;;above the threshold at 2000 Hz.  The examination will be conducted without
 ;;the use of hearing aids.  Both ears must be examined for hearing 
 ;;impairment even if hearing loss in only one ear is at issue.
 ;;
 ;;A.  Review of Medical Records: Indicate whether the C-file was reviewed.
 ;;
 ;;B.  Medical History (Subjective Complaints):
 ;;
 ;;      Comment on:
 ;;
 ;;        1.  Chief complaint.
 ;;        2.  Situation of greatest difficulty.
 ;;        3.  Pertinent service history.
 ;;        4.  History of military, occupational, and recreational noise
 ;;            exposure.
 ;;        5.  Pertinent family and social history; history of ear disease,
 ;;            head or ear trauma, etc.
 ;;        6.  Tinnitus - Is there a current complaint of tinnitus? (yes/no)
 ;;            If yes, indicate the following:
 ;;
 ;;              a.  Date and circumstances of onset.
 ;;              b.  Whether it is unilateral or bilateral.
 ;;              c.  Whether it is constant or recurrent.
 ;;              d.  If recurrent (intermittent), indicate the frequency and
 ;;                  duration of tinnitus episodes.
 ;;
 ;;              INSTRUCTIONS:
 ;;              -------------
 ;;
 ;;              a.  Refer to 2507 for claimed disabilities.
 ;;
 ;;              b.  It veteran has filed a claim for tinnitus and there is a
 ;;                  current complaint of tinnitus, answer the questions above.
 ;;
 ;;              c.  If tinnitus is claimed and the veteran denies complaints
 ;;                  of tinnitus, answer no to the above question and do not
 ;;                  answer subsequent questions.
 ;;
 ;;              d.  If tinnitus is not claimed but the veteran reports a
 ;;                  complaint of tinnitus, then note the presence of tinnitus
 ;;                  and answer subsequent questions.
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    1.  Measure puretone thresholds in decibels at the indicated
 ;;        frequencies (air conduction):
 ;;
 ;;    = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = = 
 ;;    A*    B    C    D    E    **       A*   B    C   D    E     **
 ;;    500|1000|2000|3000|4000|average   500|1000|2000|3000|4000|average
 ;;       |    |    |    |    |             |    |    |    |    |
 ;;  
 ;;    *  The puretone threshold at 500 Hz is not used in determining the
 ;;       evaluation but is used in determining whether or not a ratable 
 ;;       hearing loss exists.  Puretone thresholds should not exceed 105
 ;;       decibels or the tolerance level.
 ;;    ** The average of B, C, D, and E.
 ;;
 ;;    2.  Speech Recognition Score: Maryland CNC word list
 ;;
 ;;                         _____% right ear _____% left ear.
 ;;
 ;;    When only puretone results should be used to evaluate hearing loss, 
 ;;    the examiner, who must be a state-licensed audiologist, should certify
 ;;    that language difficulties or other problems (specify what the problems
 ;;    are) make the combined use of puretone average and speech
 ;;    discrimination inappropriate.
 ;;
 ;;    Thresholds should not exceed 100 decibels or the tolerance level.
 ;;
 ;;D.  Diagnostic and Clinical Tests:
 ;;
 ;;    1.  Report middle ear status, confirm type of loss, and indicate
 ;;        need for medical follow-up.  In cases where there is poor
 ;;        inter-test reliability and/or positive Stenger test results,
 ;;        obtain and report estimates of hearing thresholds using a
 ;;        combination of behavioral testing, Stenger interference levels,
 ;;        and electrophysiological tests.
 ;;    2.  Include results of all diagnostic and clinical tests conducted
 ;;        in the examination report.
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;    1.  Summary of audiologic test results.  Indicate type and degree 
 ;;        of hearing loss for the frequency range from 500 to 4000 Hz.
 ;;        For type of loss, indicate whether it is normal, conductive,
 ;;        sensorineural, central, or mixed.  For degree, indicate whether
 ;;        it is mild (26-40 HL), moderate (41-54 HL), moderately severe 
 ;;        (55-69 HL), severe (70-89 HL), or profound (90+ HL).
 ;;
 ;;    [For VA purposes, impaired hearing is considered to be a disability
 ;;    when the auditory threshold in any of the frequencies 500, 1000, 2000,
 ;;    3000, and 4000 Hz is 40 dB HL or greater; or when the auditory thresholds
 ;;    for at least three of these frequencies are 26 dB HL or greater; or when
 ;;    speech recognition scores are less than 94%]
 ;;
 ;;    2.  Note whether, based on audiologic results, medical follow-up
 ;;        is needed for an ear or hearing problem, and whether there is
 ;;        a problem that, if treated, might cause a change in hearing 
 ;;        threshold levels.
 ;;
 ;;    3.  If there is a current complaint of tinnitus, indicate whether or not
 ;;        tinnitus is as likely as not a symptom associated with hearing loss,
 ;;        if hearing loss is present.  If tinnitus is associated with
 ;;        conditions other than hearing loss indicate that the complaint of
 ;;        tinnitus requires referral to another provider (appropriate provider
 ;;        to be determined by C&P Director) for determination of etiology.
 ;;
 ;;
 ;;
 ;;Signature:                                        Date:
 ;;END