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1DVBCWAU3 ;ALB/JAM AUDIO WKS TEXT - 1 ; 12 FEB 1998
2 ;;2.7;AMIE;**64**;FEB 2,2004
3 ;
4TXT ;
5 ;;Handbook of Standard Procedures and Best Practices for Audiology
6 ;;Compensation and Pension Exams is available online. At:
7 ;;<http://vbaw.vba.va.gov/bl/21/rating/Medical/docs/cphandbook.pdf>
8 ;;( This is a PDF file. You need Acrobat Reader
9 ;;<http://www.adobe.com/products/acrobat/readstep2.html>
10 ;;to open pdf files. It is a free download. )
11 ;;
12 ;;
13 ;;Narrative: An examination of hearing impairment must be conducted by a
14 ;;state-licensed audiologist and must include a controlled speech
15 ;;discrimination test (specifically, the Maryland CNC recording) and a
16 ;;pure tone audiometry test in a sound isolated booth that meets American
17 ;;National Standards Institute standards (ANSI S3.1.1991) for ambient noise.
18 ;;Measurements will be reported at the frequencies of 500, 1000, 2000, 3000,
19 ;;and 4000 Hz. The examination will include the following tests: Pure tone
20 ;;audiometry by air conduction at 250, 500, 1000, 2000, 3000, 4000, and
21 ;;8000 Hz, and by bone conduction at 250, 500, 1000, 2000, 3000, and
22 ;;4000 Hz, spondee thresholds, speech recognition using the recorded
23 ;;Maryland CNC Test, tympanometry and acoustic reflex tests, and, when
24 ;;necessary, Stenger tests. Bone conduction thresholds are measured
25 ;;when the air conduction thresholds are poorer than 15 dB HL. A modified
26 ;;Hughson-Westlake procedure will be used with appropriate masking. A
27 ;;Stenger must be administered whenever pure tone air conduction
28 ;;thresholds at 500, 1000, 2000, 3000, and 4000 Hz differ by 20 dB or more
29 ;;between the two ears. Maximum speech recognition will be reported with
30 ;;the 50 word VA approved recording of the Maryland CNC test. When speech
31 ;;recognition is 92% or less, a performance intensity function will be
32 ;;obtained with a starting presentation level of 40dB re SRT. If necessary,
33 ;;the starting level will be adjusted upward to obtain a level at least 5 dB
34 ;;above the threshold at 2000 Hz. The examination will be conducted without
35 ;;the use of hearing aids. Both ears must be examined for hearing
36 ;;impairment even if hearing loss in only one ear is at issue.
37 ;;
38 ;;
39 ;;A. Review of Medical Records: Indicate whether the C-file was reviewed.
40 ;;
41 ;;B. Medical History (Subjective Complaints):
42 ;; Comment on:
43 ;; 1. Chief complaint.
44 ;; 2. Situation of greatest difficulty.
45 ;; 3. Pertinent service history.
46 ;; 4. History of military, occupational, and recreational noise
47 ;; exposure.
48 ;; 5. Tinnitus - If present, state:
49 ;; a. Date and circumstances of onset.
50 ;; b. Whether it is unilateral or bilateral.
51 ;; c. Whether it is recurrent (indicate frequency and
52 ;; duration).
53 ;; d. The most likely etiology of the tinnitus, and
54 ;; specifically, if hearing loss is present, whether the
55 ;; tinnitus is due to the same etiology (or causative
56 ;; factor) as the hearing loss.
57 ;;
58 ;;C. Physical Examination (Objective Findings):
59 ;; 1. Measure puretone thresholds in decibels at the indicated
60 ;; frequencies (air conduction):
61 ;;
62 ;; = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = =
63 ;; A* B C D E ** A* B C D E **
64 ;; 500|1000|2000|3000|4000|average 500|1000|2000|3000|4000|average
65 ;; | | | | | | | | | |
66 ;;
67 ;; * The puretone threshold at 500 Hz is not used in determining the
68 ;; evaluation but is used in determining whether or not a ratable
69 ;; hearing loss exists.
70 ;; ** The average of B, C, D, and E.
71 ;;
72 ;;
73 ;; 2. Speech Recognition Score:
74 ;; Maryland CNC word list _____% right ear _____% left ear.
75 ;;
76 ;;
77 ;; Generally, both puretone thresholds and speech discrimination are used to
78 ;;evaluate hearing loss. Where, because of language difficulties or other
79 ;;problems, only puretone thresholds should be used to evaluate hearing loss,
80 ;;the examiner should certify that the evaluation of hearing loss should be
81 ;;based on puretone thresholds average only. The examiner should include the
82 ;;rationale for this statement(e.g. language difficulties, etc.).
83 ;;
84 ;;
85 ;;D. Diagnostic and Clinical Tests:
86 ;; 1. Report middle ear status, confirm type of loss, and indicate
87 ;; need for medical follow-up. In cases where there is poor
88 ;; inter-test reliability and/or positive Stenger test results,
89 ;; obtain and report estimates of hearing thresholds using a
90 ;; combination of behavioral testing, Stenger interference levels,
91 ;; and electrophysiological tests.
92 ;;
93 ;;
94 ;; 2. Include results of all diagnostic and clinical tests conducted
95 ;; in the examination report.
96 ;;
97 ;;
98 ;;E. Diagnosis:
99 ;; 1. Summary of audiologic test results. Indicate type and degree
100 ;; of hearing loss for the frequency range from 500 to 4000 Hz.
101 ;; For type of loss, indicate whether it is normal, conductive,
102 ;; sensorineural, central, or mixed. For degree, indicate whether
103 ;; it is mild (26-40 HL), moderate (41-54 HL), moderately severe
104 ;; (55-69 HL), severe (70-89 HL), or profound (90+ HL).
105 ;; [For VA purposes, impaired hearing is considered to be a
106 ;; disability when the auditory threshold in any of the frequencies
107 ;; 500, 1000, 2000, 3000, and 4000 Hz is 40 dB HL or greater; or
108 ;; when the auditory thresholds for at least three of these
109 ;; frequencies are 26 dB HL or greater; or when speech recognition
110 ;; scores are less than 94%]
111 ;;
112 ;;
113 ;; 2. Note whether, based on audiologic results, medical follow-up
114 ;; is needed for an ear or hearing problem, and whether there is
115 ;; a problem which, if treated, might cause a change in hearing
116 ;; threshold levels.
117 ;;
118 ;;
119 ;;Signature: Date:
120 ;;END
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