DVBCWAU3 ;ALB/JAM AUDIO WKS TEXT - 1 ; 12 FEB 1998
;;2.7;AMIE;**64**;FEB 2,2004
;
TXT ;
;;Handbook of Standard Procedures and Best Practices for Audiology
;;Compensation and Pension Exams is available online. At:
;;<http://vbaw.vba.domain.ext/bl/21/rating/Medical/docs/cphandbook.pdf>
;;( This is a PDF file. You need Acrobat Reader
;;<http://www.adobe.com/products/acrobat/readstep2.html>
;;to open pdf files. It is a free download. )
;;
;;
;;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, 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
;;Stenger 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.
;;
;;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.
;;
;;
;; Generally, both puretone thresholds and speech discrimination are used to
;;evaluate hearing loss. Where, because of language difficulties or other
;;problems, only puretone thresholds should be used to evaluate hearing loss,
;;the examiner should certify that the evaluation of hearing loss should be
;;based on puretone thresholds average only. The examiner should include the
;;rationale for this statement(e.g. language difficulties, etc.).
;;
;;
;;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, Stenger 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
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWAU3 6247 printed Nov 22, 2024@16:59:49 Page 2
DVBCWAU3 ;ALB/JAM AUDIO WKS TEXT - 1 ; 12 FEB 1998
+1 ;;2.7;AMIE;**64**;FEB 2,2004
+2 ;
TXT ;
+1 ;;Handbook of Standard Procedures and Best Practices for Audiology
+2 ;;Compensation and Pension Exams is available online. At:
+3 ;;<http://vbaw.vba.domain.ext/bl/21/rating/Medical/docs/cphandbook.pdf>
+4 ;;( This is a PDF file. You need Acrobat Reader
+5 ;;<http://www.adobe.com/products/acrobat/readstep2.html>
+6 ;;to open pdf files. It is a free download. )
+7 ;;
+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 ;;
+35 ;;A. Review of Medical Records: Indicate whether the C-file was reviewed.
+36 ;;
+37 ;;B. Medical History (Subjective Complaints):
+38 ;; Comment on:
+39 ;; 1. Chief complaint.
+40 ;; 2. Situation of greatest difficulty.
+41 ;; 3. Pertinent service history.
+42 ;; 4. History of military, occupational, and recreational noise
+43 ;; exposure.
+44 ;; 5. Tinnitus - If present, state:
+45 ;; a. Date and circumstances of onset.
+46 ;; b. Whether it is unilateral or bilateral.
+47 ;; c. Whether it is recurrent (indicate frequency and
+48 ;; duration).
+49 ;; d. The most likely etiology of the tinnitus, and
+50 ;; specifically, if hearing loss is present, whether the
+51 ;; tinnitus is due to the same etiology (or causative
+52 ;; factor) as the hearing loss.
+53 ;;
+54 ;;C. Physical Examination (Objective Findings):
+55 ;; 1. Measure puretone thresholds in decibels at the indicated
+56 ;; frequencies (air conduction):
+57 ;;
+58 ;; = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = =
+59 ;; A* B C D E ** A* B C D E **
+60 ;; 500|1000|2000|3000|4000|average 500|1000|2000|3000|4000|average
+61 ;; | | | | | | | | | |
+62 ;;
+63 ;; * The puretone threshold at 500 Hz is not used in determining the
+64 ;; evaluation but is used in determining whether or not a ratable
+65 ;; hearing loss exists.
+66 ;; ** The average of B, C, D, and E.
+67 ;;
+68 ;;
+69 ;; 2. Speech Recognition Score:
+70 ;; Maryland CNC word list _____% right ear _____% left ear.
+71 ;;
+72 ;;
+73 ;; Generally, both puretone thresholds and speech discrimination are used to
+74 ;;evaluate hearing loss. Where, because of language difficulties or other
+75 ;;problems, only puretone thresholds should be used to evaluate hearing loss,
+76 ;;the examiner should certify that the evaluation of hearing loss should be
+77 ;;based on puretone thresholds average only. The examiner should include the
+78 ;;rationale for this statement(e.g. language difficulties, etc.).
+79 ;;
+80 ;;
+81 ;;D. Diagnostic and Clinical Tests:
+82 ;; 1. Report middle ear status, confirm type of loss, and indicate
+83 ;; need for medical follow-up. In cases where there is poor
+84 ;; inter-test reliability and/or positive Stenger test results,
+85 ;; obtain and report estimates of hearing thresholds using a
+86 ;; combination of behavioral testing, Stenger interference levels,
+87 ;; and electrophysiological tests.
+88 ;;
+89 ;;
+90 ;; 2. Include results of all diagnostic and clinical tests conducted
+91 ;; in the examination report.
+92 ;;
+93 ;;
+94 ;;E. Diagnosis:
+95 ;; 1. Summary of audiologic test results. Indicate type and degree
+96 ;; of hearing loss for the frequency range from 500 to 4000 Hz.
+97 ;; For type of loss, indicate whether it is normal, conductive,
+98 ;; sensorineural, central, or mixed. For degree, indicate whether
+99 ;; it is mild (26-40 HL), moderate (41-54 HL), moderately severe
+100 ;; (55-69 HL), severe (70-89 HL), or profound (90+ HL).
+101 ;; [For VA purposes, impaired hearing is considered to be a
+102 ;; disability when the auditory threshold in any of the frequencies
+103 ;; 500, 1000, 2000, 3000, and 4000 Hz is 40 dB HL or greater; or
+104 ;; when the auditory thresholds for at least three of these
+105 ;; frequencies are 26 dB HL or greater; or when speech recognition
+106 ;; scores are less than 94%]
+107 ;;
+108 ;;
+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 which, if treated, might cause a change in hearing
+112 ;; threshold levels.
+113 ;;
+114 ;;
+115 ;;Signature: Date:
+116 ;;END
