| 1 | DVBCWAU5 ;BPOIFO/RLC AUDIO WKS TEXT - 1 ; 26 DEC 2006
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| 2 | ;;2.7;AMIE;**118**;FEB 2,2004;Build 3
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| 3 | ;
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| 4 | TXT ;
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| 5 | ;; The Handbook of Standard Procedures and Best Practices for Audiology
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| 6 | ;; Compensation and Pension Exams is available online. ( This is a PDF file.
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| 7 | ;; You need Acrobat Reader to open pdf files. It is a free download. )
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| 8 | ;;
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| 9 | ;;Narrative: An examination of hearing impairment must be conducted by a
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| 10 | ;;state-licensed audiologist and must include a controlled speech
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| 11 | ;;discrimination test (specifically, the Maryland CNC recording) and a
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| 12 | ;;pure tone audiometry test in a sound isolated booth that meets American
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| 13 | ;;National Standards Institute standards (ANSI S3.1.1991) for ambient noise.
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| 14 | ;;Measurements will be reported at the frequencies of 500, 1000, 2000, 3000,
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| 15 | ;;and 4000 Hz. The examination will include the following tests: Pure tone
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| 16 | ;;audiometry by air conduction at 250, 500, 1000, 2000, 3000, 4000, and
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| 17 | ;;8000 Hz, and by bone conduction at 250, 500, 1000, 2000, 3000, and
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| 18 | ;;4000 Hz, spondee thresholds, speech recognition using the recorded
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| 19 | ;;Maryland CNC Test, tympanometry and acoustic reflex tests, and, when
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| 20 | ;;necessary, Stenger tests. Bone conduction thresholds are measured
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| 21 | ;;when the air conduction thresholds are poorer than 15 dB HL. A modified
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| 22 | ;;Hughson-Westlake procedure will be used with appropriate masking. A
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| 23 | ;;Stenger must be administered whenever pure tone air conduction
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| 24 | ;;thresholds at 500, 1000, 2000, 3000, and 4000 Hz differ by 20 dB or more
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| 25 | ;;between the two ears. Maximum speech recognition will be reported with
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| 26 | ;;the 50 word VA approved recording of the Maryland CNC test. When speech
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| 27 | ;;recognition is 92% or less, a performance intensity function will be
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| 28 | ;;obtained with a starting presentation level of 40dB re SRT. If necessary,
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| 29 | ;;the starting level will be adjusted upward to obtain a level at least 5 dB
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| 30 | ;;above the threshold at 2000 Hz. The examination will be conducted without
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| 31 | ;;the use of hearing aids. Both ears must be examined for hearing
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| 32 | ;;impairment even if hearing loss in only one ear is at issue.
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| 33 | ;;
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| 34 | ;;A. Review of Medical Records: Indicate whether the C-file was reviewed.
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| 35 | ;;
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| 36 | ;;B. Medical History (Subjective Complaints):
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| 37 | ;;
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| 38 | ;; Comment on:
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| 39 | ;;
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| 40 | ;; 1. Chief complaint.
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| 41 | ;; 2. Situation of greatest difficulty.
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| 42 | ;; 3. Pertinent service history.
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| 43 | ;; 4. History of military, occupational, and recreational noise
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| 44 | ;; exposure.
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| 45 | ;; 5. Pertinent family and social history; history of ear disease,
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| 46 | ;; head or ear trauma, etc.
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| 47 | ;; 6. Tinnitus - If present, state:
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| 48 | ;;
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| 49 | ;; a. Date and circumstances of onset.
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| 50 | ;; b. Whether it is unilateral or bilateral.
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| 51 | ;; c. Whether it is persistent or recurrent.
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| 52 | ;;
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| 53 | ;; 7. Describe effects on occupational functioning and activities
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| 54 | ;; of daily living.
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| 55 | ;;
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| 56 | ;;C. Physical Examination (Objective Findings):
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| 57 | ;;
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| 58 | ;; 1. Measure puretone thresholds in decibels at the indicated
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| 59 | ;; frequencies (air conduction):
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| 60 | ;;
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| 61 | ;; = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = =
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| 62 | ;; A* B C D E ** A* B C D E **
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| 63 | ;; 500|1000|2000|3000|4000|average 500|1000|2000|3000|4000|average
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| 64 | ;; | | | | | | | | | |
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| 65 | ;;
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| 66 | ;; * The puretone threshold at 500 Hz is not used in determining the
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| 67 | ;; evaluation but is used in determining whether or not a ratable
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| 68 | ;; hearing loss exists. Puretone thresholds should not exceed 105
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| 69 | ;; decibels or the tolerance level.
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| 70 | ;; ** The average of B, C, D, and E.
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| 71 | ;;
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| 72 | ;; 2. Speech Recognition Score: Maryland CNC word list
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| 73 | ;;
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| 74 | ;; _____% right ear _____% left ear.
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| 75 | ;;
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| 76 | ;; When only puretone results should be used to evaluate hearing loss,
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| 77 | ;; the examiner, who must be a state-licensed audiologist, should certify
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| 78 | ;; that language difficulties or other problems (specify what the problems
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| 79 | ;; are) make the combined use of puretone average and speech
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| 80 | ;; discrimination inappropriate.
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| 81 | ;;
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| 82 | ;; Thresholds should not exceed 100 decibels or the tolerance level.
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| 83 | ;;
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| 84 | ;;D. Diagnostic and Clinical Tests:
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| 85 | ;;
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| 86 | ;; 1. Report middle ear status, confirm type of loss, and indicate
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| 87 | ;; need for medical follow-up. In cases where there is poor
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| 88 | ;; inter-test reliability and/or positive Stenger test results,
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| 89 | ;; obtain and report estimates of hearing thresholds using a
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| 90 | ;; combination of behavioral testing, Stenger interference levels,
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| 91 | ;; and electrophysiological tests.
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| 92 | ;; 2. Include results of all diagnostic and clinical tests conducted
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| 93 | ;; in the examination report.
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| 94 | ;;
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| 95 | ;;E. Diagnosis:
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| 96 | ;;
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| 97 | ;; 1. Summary of audiologic test results. Indicate type and degree
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| 98 | ;; of hearing loss for the frequency range from 500 to 4000 Hz.
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| 99 | ;; For type of loss, indicate whether it is normal, conductive,
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| 100 | ;; sensorineural, central, or mixed. For degree, indicate whether
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| 101 | ;; it is mild (26-40 HL), moderate (41-54 HL), moderately severe
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| 102 | ;; (55-69 HL), severe (70-89 HL), or profound (90+ HL).
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| 103 | ;; [For VA purposes, impaired hearing is considered to be a
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| 104 | ;; disability when the auditory threshold in any of the frequencies
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| 105 | ;; 500, 1000, 2000, 3000, and 4000 Hz is 40 dB HL or greater; or
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| 106 | ;; when the auditory thresholds for at least three of these
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| 107 | ;; frequencies are 26 dB HL or greater; or when speech recognition
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| 108 | ;; scores are less than 94%]
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| 109 | ;; 2. Note whether, based on audiologic results, medical follow-up
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| 110 | ;; is needed for an ear or hearing problem, and whether there is
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| 111 | ;; a problem that, if treated, might cause a change in hearing
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| 112 | ;; threshold levels.
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| 113 | ;;
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| 114 | ;;
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| 115 | ;;Signature: Date:
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| 116 | ;;END
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