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Routine: DVBCWAU1

DVBCWAU1.m

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DVBCWAU1 ;ALB/JAM AUDIO WKS TEXT - 1 ; 12 FEB 1998

 ;;2.7;AMIE;**26**;Apr 10, 1995

 ;

TXT ;

 ;;Narrative:  An examination of hearing impairment must be conducted by a

 ;;state-licensed audiologist and must include a controlled speech

 ;;discrimination test (specifically, the Maryland CNC recording) and a

 ;;pure tone audiometry test in a sound isolated booth that meets American

 ;;National Standards Institute standards (ANSI S3.1.1991) for ambient noise.

 ;;Measurements will be reported at the frequencies of 500, 1000, 2000, 3000,

 ;;and 4000 Hz.  The examination will include the following tests: Pure tone

 ;;audiometry by air conduction at 250, 500, 1000, 2000, 3000, 4000 Hz,

 ;;and 8000 Hz, and by bone conduction at 250, 500, 1000, 2000, 3000, and

 ;;4000 Hz, spondee thresholds, speech recognition using the recorded

 ;;Maryland CNC Test, tympanometry and acoustic reflex tests, and, when

 ;;necessary, Stenger tests.  Bone conduction thresholds are measured 

 ;;when the air conduction thresholds are poorer than 15 dB HL.  A modified

 ;;Hughson-Westlake procedure will be used with appropriate masking.  A

 ;;Strenger must be administered whenever pure tone air conduction

 ;;thresholds at 500, 1000, 2000, 3000, and 4000 Hz differ by 20 dB or more

 ;;between the two ears.  Maximum speech recognition will be reported with

 ;;the 50 word VA approved recording of the Maryland CNC test.  When speech

 ;;recognition is 92% or less, a performance intensity function will be

 ;;obtained with a starting presentation level of 40dB re SRT.  If necessary,

 ;;the starting level will be adjusted upward to obtain a level at least 5 dB

 ;;above the threshold at 2000 Hz.  The examination will be conducted without

 ;;the use of hearing aids.  Both ears must be examined for hearing 

 ;;impairment even if hearing loss in only one ear is at issue.

 ;;

 ;;

 ;;A.  Review of Medical Records: Indicate whether the C-file was reviewed.

 ;;

 ;;B.  Medical History (Subjective Complaints):

 ;;      Comment on:

 ;;        1.  Chief complaint.

 ;;        2.  Situation of greatest difficulty.

 ;;        3.  Pertinent service history.

 ;;        4.  History of military, occupational, and recreational noise

 ;;            exposure.

 ;;        5.  Tinnitus - If present, state:

 ;;              a.  Date and circumstances of onset.

 ;;              b.  Whether it is unilateral or bilateral.

 ;;              c.  Whether it is recurrent (indicate frequency and

 ;;                  duration).

 ;;              d.  The most likely etiology of the tinnitus, and

 ;;                  specifically, if hearing loss is present, whether the

 ;;                  tinnitus is due to the same etiology (or causative

 ;;                  factor) as the hearing loss.

 ;;TOF

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;    1.  Measure puretone thresholds in decibels at the indicated

 ;;        frequencies (air conduction):

 ;;

 ;;    = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = = 

 ;;    A*    B    C    D    E    **       A*   B    C   D    E     **

 ;;    500|1000|2000|3000|4000|average   500|1000|2000|3000|4000|average

 ;;       |    |    |    |    |             |    |    |    |    |

 ;;  

 ;;    *  The puretone threshold at 500 Hz is not used in determining the

 ;;       evaluation but is used in determining whether or not a ratable 

 ;;       hearing loss exists.

 ;;    ** The average of B, C, D, and E.

 ;;

 ;;

 ;;    2.  Speech Recognition Score:

 ;;        Maryland CNC word list  _____% right ear _____% left ear.

 ;;

 ;;

 ;;    3.  When only puretone results should be used to evaluate hearing

 ;;        loss, the examiner, who must be a state-licensed audiologist,

 ;;        should certify that language difficulties or other problems

 ;;        (specify what the problems are) make the combined use of

 ;;        puretone average and speech discrimination inappropriate.

 ;;

 ;;

 ;;D.  Diagnostic and Clinical Tests:

 ;;    1.  Report middle ear status, confirm type of loss, and indicate

 ;;        need for medical follow-up.  In cases where there is poor

 ;;        inter-test reliability and/or positive Stenger test results,

 ;;        obtain and report estimates of hearing thresholds using a

 ;;        combination of behavioral testing, Strenger interference levels,

 ;;        and electrophysiological tests.

 ;;

 ;;

 ;;    2.  Include results of all diagnostic and clinical tests conducted

 ;;        in the examination report.

 ;;

 ;;

 ;;E.  Diagnosis:

 ;;    1.  Summary of audiologic test results.  Indicate type and degree 

 ;;        of hearing loss for the frequency range from 500 to 4000 Hz.

 ;;        For type of loss, indicate whether it is normal, conductive,

 ;;        sensorineural, central, or mixed.  For degree, indicate whether

 ;;        it is mild (26-40 HL), moderate (41-54 HL), moderately severe 

 ;;        (55-69 HL), severe (70-89 HL), or profound (90+ HL).

 ;;        [For VA purposes, impaired hearing is considered to be a 

 ;;        disability when the auditory threshold in any of the frequencies

 ;;        500, 1000, 2000, 3000, and 4000 Hz is 40 dB HL or greater; or 

 ;;        when the auditory thresholds for at least three of these 

 ;;        frequencies are 26 dB HL or greater; or when speech recognition

 ;;        scores are less than 94%]

 ;;

 ;;

 ;;    2.  Note whether, based on audiologic results, medical follow-up

 ;;        is needed for an ear or hearing problem, and whether there is

 ;;        a problem which, if treated, might cause a change in hearing 

 ;;        threshold levels.

 ;;

 ;;

 ;;Signature:                                        Date:

 ;;END