example cases

8/12/2019 Example Cases

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EXAMPLE CASES

The following pages contain typical audiograms and other audiologic data that are from 12 representative

patients. Accompanying each example case is a narrative that explains the audiological findings and the

treatment plans that were formulated for the respective patients.

Case #1. This is a 23-year old male with no complaints of hearing loss, dizziness, or tinnitus, and no

history of otologic disease. The results of his audiological evaluation are shown on the accompanyingaudiogram.

ure-tone air-conduction thresholds for the left ear are shown with !s on the left graph and thresholds for

the right ear are shown with "s on the right graph. Air-conduction thresholds for #oth ears were -$ to 1%-d& '( from 2$%-)%%% 'z, which are within normal limits. &one-conduction thresholds were not o#tained

#ecause the air-conduction thresholds were normal. The two-fre*uency pure-tone average +$%% and 1%%%

'z for the left ear was 3-d& '( and the three-fre*uency pure-tone average +$%%, 1%%%, and 2%%% 'z was

3-d& '(. imilarly, for the right ear, the two-fre*uency average was -3-d& '( and the three-fre*uencyaverage was -2-d& '(. The speech-recognition thresholds +T for the left and right ears were 3-d& '(

and /-d& '(, respectively, which are within the 0-d& range of agreement with the two- and three-

fre*uency pure-tone averages, indicating good inter-test relia#ility. Transient-evoed otoacoustic emissions

were present at least 3-d& a#ove the level of the noise floor across the fre*uency range. This finding was in

agreement with pure-tone findings, indicating normal cochlear function in #oth ears.

ord-recognition performance at conversational level +$%-d& '( was 04 for the left ear and 24 forthe right ear. 5uring the speech test, 2% d& of effective masing was applied to the opposite ear to mas the

1% d& of cross hearing expected from the $%-d& '( air-conducted speech signal. The word-recognition

performance at a high level +%-d& '( with 0% d& of masing in the opposite ear also was good in #oth

ears, indicating that the a#ility of the auditory system to transmit signals at high levels was intact. The most

comforta#le listening level +67(, /$-d& '( and $%-d& '( respectively in the right and left ears, was

normal. The uncomforta#le listening level +8((, %-d& '( in #oth ears, also was normal. Tympanograms

in #oth ears were normal, meaning that a single pea of maximum admittance occurred at atmospheric pressure in the acoustic susceptance and the acoustic conductance measures. Acoustic reflex thresholds areshown on the lower portion of the pure-tone graphs. The reflex thresholds are plotted for the stimulus ear.

Thus, for contralateral measures, the activator signal and the pro#e +recording device are in opposite ears9

the contralateral thresholds are plotted with dots on the graph for the stimulus ear. :or ipsilateral measures,

the stimulus and pro#e are in the same ear9 the ipsilateral thresholds are plotted with carets on the graph for

the stimulus ear. All of the reflex thresholds were normal +)$- to 1%%-d& '( and no contralateral reflex

adaptation was measured at $%% 'z and 1%%% 'z. ;n summary, all test results were consistent with normal

hearing.



Case #2. This case is a /$-year old female who complained of a progressive, unilateral hearing loss. he

reported difficulty hearing people on her right side, localizing sounds, and understanding conversations in

noisy environments. The patient denied a history of ear infection, #ut reported a family history of hearing

loss. u#se*uent to audiometric testing, surgical findings confirmed otosclerosis in the right ear. The pure-

tone air-conduction thresholds were normal in the left ear. The T of -d& '( agreed with the pure-toneaverages. ord-recognition performance at 0%-d& '( and at %-d& '( was good.

The pure-tone air-conduction thresholds in the right ear demonstrated a moderate, flat hearing loss.

&ecause symmetrical hearing is imperative in localizing sounds and in understanding speech in noise, a

unilateral hearing loss of this degree accounts for the communicative difficulties of the patient.

The mased #one-conduction thresholds in the right ear +#racets were normal except at 2%%% 'z. The

hearing loss, therefore, is predominantly conductive. The decrease in #one-conduction sensitivity at 2%%%

'z, the 7arhart notch, has #een attri#uted to a change in the resonance properties of the ossicular chain

#ecause of the #ony growth around the stapes footplate. The 7arhart notch generally is a#sent following a

stapedectomy. This post-surgical finding indicates that #one-conduction testing does not #ypass completelythe middle-ear transmission system.

ord-recognition performance in the right ear at a slightly a#ove normal conversational level +0%-d& '(

was poor. This result is expected #ecause the words were only 1% d& a#ove the air-conduction thresholds at

$%%-2%%% 'z. hen the presentation level of the words was increased to <%-d& '(, word-recognition

performance improved to good. This /)4 improvement in performance for a 1% d& increase in signal level

is consistent with the slope of the psychometric function in normal listeners and in listeners with

conductive hearing losses. ord-recognition performance was 1%%4 at %-d& '(. The level of the signal

reaching the cochlea is attenuated #y the magnitude of the air-#one gap. This attenuation, a#out 3% d& in

this case, is responsi#le for the elevated 67( in the right ear.Tympanograms for #oth ears were normal +1&1=9 tympanometric shape generally is not altered #y

stapedial fixation. Acoustic reflexes were present only when the stimulus and the pro#e were in the normal,

left ear +ipsilateral. Acoustic reflexes were a#sent when the pro#e was in the ear with the conductive pathology +right ipsi and left contra. &ecause the stapes is fixed, contraction of the stapedial muscle does

not move the stapes, and therefore, the acoustic admittance does not change. The acoustic reflexes also

were a#sent when the stimulus was presented to the right, conductive ear, #ecause the level of the tone at

the limits of the e*uipment is not high enough to overcome the conductive component. The audiological

results are consistent with a unilateral conductive hearing loss in the right ear.



Case #3. This case is a /-year old male with a history of ear infections #ilaterally since infancy. The results

of the audiological evaluation are shown on the audiogram.

8nmased pure-tone air-conduction thresholds showed a moderate, flat hearing loss #ilaterally. 8nmased pure-tone #one-conduction thresholds were normal. This case presents a masing dilemma. Although air-

conduction and #one-conduction thresholds in #oth ears must #e mased to prevent a cross-over response

from the opposite ear, over-masing occurs #efore sufficient masing can #e delivered to the non-test ear.

;t is not possi#le, therefore, to test the two ears independently. >?ote@ the masing dilemma presented in

this case potentially could have #een avoided with the use of insert earphones.;n the a#sence of sufficient masing in the non-test ear, the only conclusion that can #e drawn from the

pure-tone thresholds is that there is a maximum conductive hearing loss in at least one ear +either the right

ear, the left ear, or #oth ears. True air-conduction thresholds in the other ear could #e anywhere #etween amoderate hearing loss and the output limits of the audiometer. imilarly, true #one-conduction thresholds

could range from normal to no response at the output limits of the e*uipment.The speech-recognition thresholds agreed with the pure-tone averages. ord-recognition performance was

good at %-d& '(. Again, sufficient masing cannot #e presented to the non-test ear9 therefore, it cannot #e

determined which ear responded to the stimuli.

:lat tympanograms with normal ear-canal volumes were o#tained from #oth ears. This pattern is consistent

with a middle-ear cavity completely filled with fluid. 7ontralateral and ipsilateral acoustic reflexes were

a#sent. These findings support the presence of a #ilateral conductive hearing loss, #ut do not preclude the

presence of a mixed hearing loss in one ear or even a BdeadB ear. 6idline audiometric e#ers at all

fre*uencies, however, support symmetrical #one-conduction thresholds.ith the degree of hearing loss shown on the audiogram, this child will have difficulty hearing normal

conversational speech. Although a conductive hearing loss generally can #e improved with medical or

surgical treatment, a hearing aid must #e considered for patients with long-standing hearing losses. ;f a

hearing loss persists for a long time, then the childCs speech and language development could #e affected

adversely.

6yringotomies were performed on #oth ears of this child. Thic fluid was found in #oth middle-ear

cavities. Two months following the surgery, pure-tone sensitivity had returned to normal in #oth ears.



Case #4. This case is a $)-year old male whose chief complaint was #ilateral tinnitus, worse in the left ear.

The patient reported some difficulty understanding conversational speech, however denied having

significant hearing pro#lems. The patient reported that he has #een a heavy e*uipment operator for over 3%

years. ith the exception of diet- controlled dia#etes, the medical history was negative.

ure-tone air-conduction thresholds were within normal limits from 2$%-1%%% 'z in the left ear and 2$%-

2%%% 'z in the right ear. :or #oth ears, the thresholds indicated a steeply sloping moderate-to-severe

hearing loss in the high fre*uencies through 0%%% 'z. ?o response was o#tained at )%%% 'z in either ear.

The unmased #one-conduction thresholds were e*uivalent to the air-conduction thresholds in the right ear,

indicating a hearing loss of pro#a#le cochlear origin. The Ts were in good agreement with the pure-tone

averages in #oth ears. ord-recognition performance was good at $%-d& '( and %-d& '( in the right ear

and was fair at $%-d& '( improving to good at %-d& '( in the left ear. The poorer air-conductionthreshold at 2%%% 'z in the left ear can account for the slightly poorer word-recognition performance in

comparison with the right ear. Drrors in the words presented to the left ear occurred primarily for phonemescontaining high-fre*uency energy such as f, th, v, s, and t. The most comforta#le loudness levels suggest

that the patient preferred to listen to speech at slightly louder than normal levels. Tympanograms were

normal for #oth ears. Acoustic reflexes were present at normal levels with no reflex adaptation at $%% 'z

and 1%%% 'z.

All of the audiological test results were consistent with a high-fre*uency sensory hearing loss, pro#a#ly

associated with noise exposure over a long period of time. The following recommendations were made forthis patient@

1. The patient was counseled regarding the effects of excessive noise exposure and the use of ear protection

to prevent further deterioration of his hearing.

2. The patient was counseled regarding the implications of tinnitus in an attempt to alleviate the patientCs

concern for its severity.

3. A trial use of #inaural in-the-ear hearing aids was recommended. The hearing aids should improve the

patientCs a#ility to understand speech and may mas the tinnitus.



Case #5. This case is a 33-year old female who presented with a recent history of fluctuating hearing loss

in the right ear, vertigo accompanied with vomiting, a constant #uzzing tinnitus in the right ear, and a

sensation of fullness in the right ear. The patient also reported severe earaches and ear infections when she

was a child. There was a 1% year history of hearing loss. "n the day of the audiological evaluation, the patient reported that her hearing in the right ear was relatively poor.

7onsider first the audiological results from the left ear. The pure-tone air-conduction thresholds +2$%-)%%%

'z were within normal limits9 #one-conduction thresholds were not o#tained #ecause the air-conduction

thresholds were normal. Transient-evoed otoacoustic emissions were present at least 3 d& a#ove the level

of the noise floor for all fre*uencies. The T and the pure-tone averages were in good agreement. The

patient had good word- recognition performance at a normal conversational level +$%-d& '( and at a high

level +%-d& '(. The tympanogram was within normal limits. The contralateral and ipsilateral acoustic-

reflex thresholds were present at normal levels9 no reflex adaptation was measured. These audiological test

results indicated that the left ear of the patient is normal.;n contrast, the audiological results from the right ear indicated a moderate hearing deficit. The air-

conduction and the #one-conduction pure-tone thresholds, which are essentially e*uivalent, indicated a

moderate low- to mid-fre*uency +2$%-1%%% 'z hearing loss with a mild high-fre*uency +2%%%-)%%% 'z

hearing loss. Transient-evoed otoacoustic emissions were present only in the higher fre*uencies,

consistent with the degree of pure-tone loss. The T and the pure-tone averages were in good agreement.

The tenger at 1%%% 'z was negative and the e#er lateralized to the left ear +the ear with the #etter

cochlea. At <%-d& '( and at %-d& '(, word-recognition performance was fair. The most-comforta#le

listening level +67(, although elevated with reference to the 67( in the left ear, was only 2< d& a#ove

the speech-recognition threshold. The $-d& '( uncomforta#le listening level +8(( indicated a tolerance pro#lem for high level stimuli. The tympanogram was normal and acoustic-reflex thresholds were present

at normal hearing levels9 no reflex adaptation was measured at $%% 'z and 1%%% 'z.

The audiological results o#tained on the right ear indicate a moderate-to-mild sensorineural hearing loss.

The medical diagnosis in this case was early 6EniFreCs disease. A hearing aid for the right ear was notconsidered at the time of the evaluation, #ut will #e considered following the medical treatment. The

patient +1 was scheduled to have a follow-up evaluation in three months, and +2 was instructed to return if

her hearing changed #efore the scheduled return appointment.



Case #6. This case is a /<-year old male who reported a sudden hearing loss in the right ear that wasnoticed upon awaening in the morning. The patient also reported nausea, dise*uili#rium, roaring tinnitus

and a feeling of fullness in the right ear. 'e had no previous history of decreased hearing.

The pure-tone air-conduction thresholds in the left ear were normal from 2$%-1%%% 'z with a mild-to-moderate hearing loss from 2%%%-)%%% 'z. Transient-evoed otoacoustic emissions were present at $%%-

1%%% 'z only, consistent with the degree of pure-tone hearing loss. The T agreed with the pure-tone

averages. ord-recognition performance was good at normal conversational levels and at high levels. Thetympanogram is normal. ;psilateral and contralateral acoustic reflex thresholds are present at normal levels.

The pure-tone air-conduction thresholds in the right ear demonstrated a moderate-to-severe hearing loss at

all fre*uencies. The #one-conduction thresholds were e*uivalent to the air-conduction thresholds.

Transient-evoed otoacoustic emissions were a#sent across all fre*uencies. The tenger at 1%%% 'z was

negative. Additionally, the T agreed with the pure-tone averages. The results of the tenger, otoacousticemission results, and the agreement #etween the T and the pure-tone averages suggest that there is an

organic hearing loss in the right ear, i.e., it is not a functional loss. The word-recognition performance

assessed at %-d& '( was poor even though the words were presented 2$ d& a#ove the speech-recognition

threshold. The tympanogram was normal. The acoustic-reflex thresholds with stimulation to the right ear

were present #ut are depressed #y 1%-2% d& in comparison with the reflex thresholds in the left ear.

;n summary, the left ear demonstrated a mild high-fre*uency sensorineural hearing loss. The test results

from the right ear suggested a moderate-to-severe hearing loss of cochlear origin. The patient was referred

for an A& to rule out retrocochlear involvement in the right ear, and results were within normal limits.:or follow-up, he was tested weely over a two month interval, during which time his hearing improved #y

a#out 3% d& in the right ear. >?ote@ etiology in cases lie this one, which usually are difficult to esta#lish,may include viral, vascular, or auto- immune pro#lems.



Case #7. This case is a 1%<-year old man who served in orld ar ;. The veteranCs chief complaint wasthat he could hear people taling #ut had difficulty understanding what they were saying. 'e further stated

that men were easier to understand than were women. 'e reported that he could use the telephone with his

right ear #ut not with his left ear. The veteran reported a history of /% years of noise exposure in the

shipyards, #ut no other positive history. The patient indicated that he had tried hearing aids 1$ years ago

#ut that the hearing aids did not help.

The results of the audiological evaluation for the right ear indicated normal hearing at 2$%-$%% 'z with a

sloping moderate-to-profound loss from 1%%%-)%%% 'z. The #one-conduction thresholds +unmased were

interwoven with the air-conduction thresholds. The pure-tone thresholds for the left ear were similar in

configuration to the thresholds for the right ear, #ut with 1%-2% d& more hearing loss. The threshold at 2$%'z was normal in the left ear with a mild-to-severe loss at $%%-2%%% 'z. ?o responses were o#tained at the

output limits of the audiometer at 3%%%-)%%% 'z9 hence, there was a profound hearing loss. The mased

#one-conduction thresholds agreed with the air-conduction thresholds.

The Ts and the word-recognition performance of #oth ears were similar. The Ts were in fair

agreement with the pure-tone averages, especially considering the precipitous drop in the pure-tone

sensitivity in the mid to high fre*uencies. ord-recognition performance was poor, even at high levels.

The 67(s were elevated /% d& a#ove the Ts and the 8((s were lower than normal 8((s. Giewed

from a different perspective, the 67(-8(( relations indicate that the patient had only a 1$ d& range in

which to listen comforta#ly to speech. The tympanograms were #oth normal. "nly contralateral acousticreflex thresholds were present in #oth ears at 2$% 'z and $%% 'z. ;psilateral reflexes, which are usually

measured at $%%-2%%% 'z, were not measura#le9 this a#sence was attri#uted to the output limits of the

reflex-activator signals in the ipsilateral test mode +%-d& '( at $%% 'z9 11%-d& '( at 1%%% 'z9 and 1%%-

d& '( at 2%%% 'z.

The results of the audiological evaluation for #oth ears indicated normal hearing in the low-fre*uency range

with a mild-to-profound hearing loss in the mid- to high-fre*uency range. The results are consistent with a

sensorineural hearing loss in #oth ears, typical of pres#ycusis, and are consistent with the patientCs age and



history of noise exposure. u#se*uent to the audiological evaluation, the patient was fit with #inaural

hearing aids and enrolled in aural reha#ilitation classes.

Case #8. This case is a 3$-ear old female who reported decreased hearing and tinnitus in her left ear for the

past $ months. he also complained of feeling lightheaded for the past ) months. 'er history was otherwise

unremara#le, and the tympanic mem#ranes looed normal on otologic exam.

:or the right ear, hearing sensitivity was normal and understanding for speech was excellent. All diagnostic

tests using speech and tone signals were also consistent with normal function. :or the left ear, the

audiogram illustrated a hearing loss that #egan at 2%%% 'z and gradually worsened to severe levels #y )%%%

'z. There was no conductive component #y either #one-conduction evaluation or tympanometry. peech

understanding was poor and did not improve at high levels.Although otoacoustic emissions, an indicator of hair cell function, were present, acoustic reflexes were

a#sent when the left ear was stimulated. These two results indicated good cochlear function, #utinterruption of the pathways that mediate the acoustic reflex. This suggested that the auditory #ranch of

7?G;;; might #e damaged. :urther clues that this could #e true were found@ tone decay was excessive and

loudness growth in this ear on loudness #alancing procedures showed no recruitment.

Auditory #rainstem responses +A& were o#tained from each ear. The right ear findings showed a normal

pattern of electric potentials with normal latencies. &rainstem potentials in the left ear were a#normal or

missing. ince waves ; and ;; of the A& arise from the peripheral and central portions of 7?G;;;, the

a#normal result supported the suspicion of 7?G;;; damage as derived from earlier tests.

All results pointed to a 7?G;;;Hextra-axial +peripheral #rainstem lesion. An 6; with contrast revealedthe presence of a space-occupying mass in the internal auditory meatus on the left.



Case #9. This case is a 2-year old male who reported a severe hearing loss in the left ear following a

wor-related head inIury +#low to head. 'e had no complaints a#out the right ear. The history was

negative for otologic pro#lems or prior hearing loss. D?T exam of his eardrums was unremara#le. 'e did

report significant noise exposure during a 2-year army stint and in his Io# as a construction worer. The

patient repeatedly expressed hearing pro#lems during the interview, despite having no complaints of

hearing loss in the right ear.

esults of the standard hearing evaluation are shown on the audiograms. There was a notch of mild hearingloss centered at /%%% 'z in the right ear, with normal hearing at higher and lower fre*uencies. peech

understanding was excellent. The tympanogram was normal and acoustic reflexes were triggered at normal

stimulus levels and did not show decay over time. "toacoustic emissions were present at expected levels.

The results were consistent with the patientCs history of noise exposure.

:or the left ear, thresholds for #oth air-conduction and #one-conduction tones were near or #eyond the

e*uipment limits, suggesting a profound hearing loss. ince these thresholds were o#tained with nomasing to the right ear, they were physiologically unliely. hen using standard earphones, pure-tone

signals may cross the head to the other ear at levels as low as /% d&. &one-conduction signals cross thehead to the #etter cochlea with virtually no attenuation #etween ears. This patient, therefore, should have

heard the signals delivered to the left ear at far #etter levels than he volunteered due to cross hearing #y the

right ear.

The patient recognized parts of speech signals at <% d& '(, which is #elow his admitted pure-tone

sensitivity in the speech fre*uency range, and had excellent speech understanding at levels lower than any

admitted pure-tone threshold. This is impossi#le. ;n addition, acoustic reflexes were elicited via the left ear



at normal levels, indicating an intact 7?G;;;-low #rainstem-7?G;; reflex pathway. "toacoustic emissions

were elicited normally, suggesting good cochlear function.

A pure-tone tenger test was then administered. +ee discussion of the tenger in the section on diagnostic

procedures. The tenger procedure estimated pure-tone thresholds in the left ear very much lie those

found for the right ear. ;n addition, the patient preferred speech Bmost comforta#leB +67( on theaudiogram at <%-d& '(, a level e*ual to his speech-recognition level and #elow any voluntary pure-tone

threshold. :inally, an auditory #rainstem response was measured to clic stimuli for #oth ears. Theresponses had normal latencies and morphology, and were virtually identical for the two ears.

;n summary, #oth #ehavioral and o#Iective tests suggest that the severe- profound hearing loss in the left

ear is not real. The #est estimate of true hearing in the left ear is that it has pure-tone sensitivity much lie

that found in the right ear. =iven the findings, the patient was counseled on the importance of using hearing

protection at wor and given information a#out ear protectors that would #e useful.

Case #10. This case is a 0)-year old male who complained of a gradual decrease in his hearing for several

years, a fact that was testified to at length #y his wife. 'e reported occasional tinnitus. 'e had some noise

exposure in the armed services, #ut little since that time. There was no other relevant otologic or hearing

history, and the examination of his ears was remara#le only for their size. Tympanic mem#ranes were

normal.

The left ear had normal hearing in the low fre*uencies, with a mild hearing loss at 2%%%-)%%% 'z. There

was no conductive component to the hearing loss, tympanograms were normal and acoustic reflexes were

elicited at normal levels. peech understanding was fair at conversational levels and excellent at higher

levels. An auditory #rainstem response was measured using a 2%%%-'z tone #urst as the stimulus and was

consistent with the measured hearing loss.ure-tone tests gave similar results in the low fre*uencies in the right ear. At 1%%% 'z and higher

fre*uencies, however, there appeared to #e a mild-moderate hearing loss with a conductive component that

increased in size as the test fre*uency increased. ince conductive components that are limited to high

fre*uencies are often caused #y ear canals that close owing to pressure from the earphone cushion, the air-

conduction testing was repeated using insert earphones. These devices fit in the ear canal and do not put

pressure on the pinna of the ear. Thresholds o#tained using this new approach were similar to thresholds in

the left ear, i.e., the conductive component disappeared.

Test results o#tained with insert earphones for the right ear mirrored those in the left ear. All diagnostic procedures pointed to cochlear damage. The overall picture of a gradual onset of symmetrical hearing loss

in each ear, worse in the higher fre*uencies, is consistent with the pres#ycusis +age-related hearing loss

typical for males in industrial societies. The patient was counseled a#out the possi#le #enefits of

amplification devices lie hearing aids, counsel that he accepted and his wife em#raced. A hearing aid

evaluation was scheduled to investigate this avenue of reha#ilitation.



Case #11. This case is a /-year old male whose chief complaints are hearing loss and understanding

conversational speech, especially in the presence of #acground noise.

The patient complains of mild periodic tinnitus. 'e has no complaints of dizziness or vertigo. 'e reports

difficulty understanding the speech of women and children, however, he feels this is due to the speaers

mum#ling. 'e also reports difficulty hearing on the telephone. 'istory of military noise exposure is positive, including exposure to artillery. 7ivilian noise exposure includes recreational hunting and

attending concerts +the veteran stated that he wears hearing protection. The medical history was negative.

ure-tone air-conduction thresholds were within normal limits 2$%-2%%% 'z, falling to a moderately-severe

high-fre*uency hearing loss, #ilaterally. The unmased #one-conduction thresholds were e*uivalent to the

air- conduction thresholds. ord-recognition performance was good #ilaterally at $%-d& '( and )%-d&'(. Tympanometry indicated normal 220 'z tympanograms. ;psilateral and contralateral acoustic reflexes

were present. eflex decay at 1%%% 'z was negative #ilaterally.

All of the audiological test results are consistent with a high- fre*uency sensorineural hearing loss, mostliely associated with noise exposure. 5eep canal impressions were made and completely-in-the-canal

+7;7s hearing aids were ordered.

ound field testing with the 7;7s +plotted on the audiogram as BAB indicated the patient received

appropriate gain in the high fre*uencies +3%%% to /%%% 'z, which would not #e o#tained with the larger in-

the-ear hearing aids. &inaural word-recognition testing was good. Testing with high input levels indicated

the hearing aids were never uncomforta#ly loud. The patient was counseled on the use and care of hearing



aids. A two-wee follow-up appointment will #e scheduled to assess the patients #enefit from the hearing

aids, which included functional gain of the hearing aids assessed under earphones.

Case #12. This case is a <0-year old male with a long-standing history of sensorineural hearing loss. The

onset of the hearing loss was $% years ago.

The patient complains of constant #ilateral tinnitus9 he considers the tinnitus severe. 'e has no complaints

of dizziness or vertigo. 'e reports difficulty hearing and understanding in all listening situations and relies

on speechreading in all situations. The veteran has used #ehind-the-ear hearing aids with little success and

can not use any telephone, including those e*uipped with amplifiers. The patient is in good medicalcondition.The results of the audiological evaluation indicated a severe +2$% to 1%%% 'z to profound +no response for

2%%% to )%%% 'z hearing loss, #ilaterally. This configuration is nown as a corner audiogram. ?oresponses were o#tained for #one-conduction stimuli at the limits of the audiometer. Tympanometry

indicated normal middle-ear function and acoustic reflexes were a#sent at all fre*uencies.

peech detection thresholds were o#tained at )$-d& '( for the right ear and %-d& '( for the left ear.

These results were in good agreement with the two-fre*uency +$%% and 1%%% 'z pure-tone averages.

ord-recognition a#ility was poor +A5--/49 A--%4 at the limits of the audiometer.



The patient was fit with a power #ody aid. ound field testing +plotted on the audiogram as BAB indicated

the patient was only receiving an average gain of 3% d& across fre*uencies. ord-recognition a#ility did

not su#stantially improve. Testing at high levels indicted the hearing aids were never uncomforta#ly loud.

The patient was also given the following assistive devices@

1. Text Telephone. A teletype device that allows him to communicate with others who have a similardevice or use the relay system.

2. moe detector. A standard smoe detector e*uipped with a transmitter which signals the receiver placednear the listener. The receiver is e*uipped with a stro#e light to alert the individual to the fire.

3. Alerting system. A signaling system was set up to alert him when the phone rings, someone rings the

door #ell, or when someone opens the front door. The system is plugged into a lamp. The lamp flashes once

for the phone, twice for the door#ell, and three times for the door opening.

The patient is currently under consideration for a cochlear implant. 'e does receive minimal #enefit from

amplification9 however, he still cannot use the telephone and his word-recognition a#ility did not improvewith amplification.

example cases

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