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1DVBCWAU1 ;ALB/JAM AUDIO WKS TEXT - 1 ; 12 FEB 1998
2 ;;2.7;AMIE;**26**;Apr 10, 1995
3 ;
4TXT ;
5 ;;Narrative: An examination of hearing impairment must be conducted by a
6 ;;state-licensed audiologist and must include a controlled speech
7 ;;discrimination test (specifically, the Maryland CNC recording) and a
8 ;;pure tone audiometry test in a sound isolated booth that meets American
9 ;;National Standards Institute standards (ANSI S3.1.1991) for ambient noise.
10 ;;Measurements will be reported at the frequencies of 500, 1000, 2000, 3000,
11 ;;and 4000 Hz. The examination will include the following tests: Pure tone
12 ;;audiometry by air conduction at 250, 500, 1000, 2000, 3000, 4000 Hz,
13 ;;and 8000 Hz, and by bone conduction at 250, 500, 1000, 2000, 3000, and
14 ;;4000 Hz, spondee thresholds, speech recognition using the recorded
15 ;;Maryland CNC Test, tympanometry and acoustic reflex tests, and, when
16 ;;necessary, Stenger tests. Bone conduction thresholds are measured
17 ;;when the air conduction thresholds are poorer than 15 dB HL. A modified
18 ;;Hughson-Westlake procedure will be used with appropriate masking. A
19 ;;Strenger must be administered whenever pure tone air conduction
20 ;;thresholds at 500, 1000, 2000, 3000, and 4000 Hz differ by 20 dB or more
21 ;;between the two ears. Maximum speech recognition will be reported with
22 ;;the 50 word VA approved recording of the Maryland CNC test. When speech
23 ;;recognition is 92% or less, a performance intensity function will be
24 ;;obtained with a starting presentation level of 40dB re SRT. If necessary,
25 ;;the starting level will be adjusted upward to obtain a level at least 5 dB
26 ;;above the threshold at 2000 Hz. The examination will be conducted without
27 ;;the use of hearing aids. Both ears must be examined for hearing
28 ;;impairment even if hearing loss in only one ear is at issue.
29 ;;
30 ;;
31 ;;A. Review of Medical Records: Indicate whether the C-file was reviewed.
32 ;;
33 ;;B. Medical History (Subjective Complaints):
34 ;; Comment on:
35 ;; 1. Chief complaint.
36 ;; 2. Situation of greatest difficulty.
37 ;; 3. Pertinent service history.
38 ;; 4. History of military, occupational, and recreational noise
39 ;; exposure.
40 ;; 5. Tinnitus - If present, state:
41 ;; a. Date and circumstances of onset.
42 ;; b. Whether it is unilateral or bilateral.
43 ;; c. Whether it is recurrent (indicate frequency and
44 ;; duration).
45 ;; d. The most likely etiology of the tinnitus, and
46 ;; specifically, if hearing loss is present, whether the
47 ;; tinnitus is due to the same etiology (or causative
48 ;; factor) as the hearing loss.
49 ;;TOF
50 ;;
51 ;;C. Physical Examination (Objective Findings):
52 ;; 1. Measure puretone thresholds in decibels at the indicated
53 ;; frequencies (air conduction):
54 ;;
55 ;; = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = =
56 ;; A* B C D E ** A* B C D E **
57 ;; 500|1000|2000|3000|4000|average 500|1000|2000|3000|4000|average
58 ;; | | | | | | | | | |
59 ;;
60 ;; * The puretone threshold at 500 Hz is not used in determining the
61 ;; evaluation but is used in determining whether or not a ratable
62 ;; hearing loss exists.
63 ;; ** The average of B, C, D, and E.
64 ;;
65 ;;
66 ;; 2. Speech Recognition Score:
67 ;; Maryland CNC word list _____% right ear _____% left ear.
68 ;;
69 ;;
70 ;; 3. When only puretone results should be used to evaluate hearing
71 ;; loss, the examiner, who must be a state-licensed audiologist,
72 ;; should certify that language difficulties or other problems
73 ;; (specify what the problems are) make the combined use of
74 ;; puretone average and speech discrimination inappropriate.
75 ;;
76 ;;
77 ;;D. Diagnostic and Clinical Tests:
78 ;; 1. Report middle ear status, confirm type of loss, and indicate
79 ;; need for medical follow-up. In cases where there is poor
80 ;; inter-test reliability and/or positive Stenger test results,
81 ;; obtain and report estimates of hearing thresholds using a
82 ;; combination of behavioral testing, Strenger interference levels,
83 ;; and electrophysiological tests.
84 ;;
85 ;;
86 ;; 2. Include results of all diagnostic and clinical tests conducted
87 ;; in the examination report.
88 ;;
89 ;;
90 ;;E. Diagnosis:
91 ;; 1. Summary of audiologic test results. Indicate type and degree
92 ;; of hearing loss for the frequency range from 500 to 4000 Hz.
93 ;; For type of loss, indicate whether it is normal, conductive,
94 ;; sensorineural, central, or mixed. For degree, indicate whether
95 ;; it is mild (26-40 HL), moderate (41-54 HL), moderately severe
96 ;; (55-69 HL), severe (70-89 HL), or profound (90+ HL).
97 ;; [For VA purposes, impaired hearing is considered to be a
98 ;; disability when the auditory threshold in any of the frequencies
99 ;; 500, 1000, 2000, 3000, and 4000 Hz is 40 dB HL or greater; or
100 ;; when the auditory thresholds for at least three of these
101 ;; frequencies are 26 dB HL or greater; or when speech recognition
102 ;; scores are less than 94%]
103 ;;
104 ;;
105 ;; 2. Note whether, based on audiologic results, medical follow-up
106 ;; is needed for an ear or hearing problem, and whether there is
107 ;; a problem which, if treated, might cause a change in hearing
108 ;; threshold levels.
109 ;;
110 ;;
111 ;;Signature: Date:
112 ;;END
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