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