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Routine: DVBCWAU3

DVBCWAU3.m

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  1. DVBCWAU3        ;ALB/JAM AUDIO WKS TEXT - 1 ; 12 FEB 1998
  1.  ;;2.7;AMIE;**64**;FEB 2,2004
  1.  ;
  1. TXT ;
  1.  ;;Handbook of Standard Procedures and Best Practices for Audiology
  1.  ;;Compensation and Pension Exams is available online. At:
  1.  ;;<http://vbaw.vba.domain.ext/bl/21/rating/Medical/docs/cphandbook.pdf>
  1.  ;;( This is a PDF file. You need Acrobat Reader 
  1.  ;;<http://www.adobe.com/products/acrobat/readstep2.html>
  1.  ;;to open pdf files. It is a free download. )
  1.  ;;
  1.  ;;
  1.  ;;Narrative:  An examination of hearing impairment must be conducted by a
  1.  ;;state-licensed audiologist and must include a controlled speech
  1.  ;;discrimination test (specifically, the Maryland CNC recording) and a
  1.  ;;pure tone audiometry test in a sound isolated booth that meets American
  1.  ;;National Standards Institute standards (ANSI S3.1.1991) for ambient noise.
  1.  ;;Measurements will be reported at the frequencies of 500, 1000, 2000, 3000,
  1.  ;;and 4000 Hz.  The examination will include the following tests: Pure tone
  1.  ;;audiometry by air conduction at 250, 500, 1000, 2000, 3000, 4000, and
  1.  ;;8000 Hz, and by bone conduction at 250, 500, 1000, 2000, 3000, and
  1.  ;;4000 Hz, spondee thresholds, speech recognition using the recorded
  1.  ;;Maryland CNC Test, tympanometry and acoustic reflex tests, and, when
  1.  ;;necessary, Stenger tests.  Bone conduction thresholds are measured 
  1.  ;;when the air conduction thresholds are poorer than 15 dB HL.  A modified
  1.  ;;Hughson-Westlake procedure will be used with appropriate masking.  A
  1.  ;;Stenger must be administered whenever pure tone air conduction
  1.  ;;thresholds at 500, 1000, 2000, 3000, and 4000 Hz differ by 20 dB or more
  1.  ;;between the two ears.  Maximum speech recognition will be reported with
  1.  ;;the 50 word VA approved recording of the Maryland CNC test.  When speech
  1.  ;;recognition is 92% or less, a performance intensity function will be
  1.  ;;obtained with a starting presentation level of 40dB re SRT.  If necessary,
  1.  ;;the starting level will be adjusted upward to obtain a level at least 5 dB
  1.  ;;above the threshold at 2000 Hz.  The examination will be conducted without
  1.  ;;the use of hearing aids.  Both ears must be examined for hearing 
  1.  ;;impairment even if hearing loss in only one ear is at issue.
  1.  ;;
  1.  ;;
  1.  ;;A.  Review of Medical Records: Indicate whether the C-file was reviewed.
  1.  ;;
  1.  ;;B.  Medical History (Subjective Complaints):
  1.  ;;      Comment on:
  1.  ;;        1.  Chief complaint.
  1.  ;;        2.  Situation of greatest difficulty.
  1.  ;;        3.  Pertinent service history.
  1.  ;;        4.  History of military, occupational, and recreational noise
  1.  ;;            exposure.
  1.  ;;        5.  Tinnitus - If present, state:
  1.  ;;              a.  Date and circumstances of onset.
  1.  ;;              b.  Whether it is unilateral or bilateral.
  1.  ;;              c.  Whether it is recurrent (indicate frequency and
  1.  ;;                  duration).
  1.  ;;              d.  The most likely etiology of the tinnitus, and
  1.  ;;                  specifically, if hearing loss is present, whether the
  1.  ;;                  tinnitus is due to the same etiology (or causative
  1.  ;;                  factor) as the hearing loss.
  1.  ;;
  1.  ;;C.  Physical Examination (Objective Findings):
  1.  ;;    1.  Measure puretone thresholds in decibels at the indicated
  1.  ;;        frequencies (air conduction):
  1.  ;;
  1.  ;;    = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = = 
  1.  ;;    A*    B    C    D    E    **       A*   B    C   D    E     **
  1.  ;;    500|1000|2000|3000|4000|average   500|1000|2000|3000|4000|average
  1.  ;;       |    |    |    |    |             |    |    |    |    |
  1.  ;;  
  1.  ;;    *  The puretone threshold at 500 Hz is not used in determining the
  1.  ;;       evaluation but is used in determining whether or not a ratable 
  1.  ;;       hearing loss exists.
  1.  ;;    ** The average of B, C, D, and E.
  1.  ;;
  1.  ;;
  1.  ;;    2.  Speech Recognition Score:
  1.  ;;        Maryland CNC word list  _____% right ear _____% left ear.
  1.  ;;
  1.  ;;
  1.  ;; Generally, both puretone thresholds and speech discrimination are used to
  1.  ;;evaluate hearing loss.  Where, because of language difficulties or other 
  1.  ;;problems, only puretone thresholds should be used to evaluate hearing loss, 
  1.  ;;the examiner should certify that the evaluation of hearing loss should be 
  1.  ;;based on puretone thresholds average only. The examiner should include the
  1.  ;;rationale for this statement(e.g. language difficulties, etc.).
  1.  ;;
  1.  ;;
  1.  ;;D.  Diagnostic and Clinical Tests:
  1.  ;;    1.  Report middle ear status, confirm type of loss, and indicate
  1.  ;;        need for medical follow-up.  In cases where there is poor
  1.  ;;        inter-test reliability and/or positive Stenger test results,
  1.  ;;        obtain and report estimates of hearing thresholds using a
  1.  ;;        combination of behavioral testing, Stenger interference levels,
  1.  ;;        and electrophysiological tests.
  1.  ;;
  1.  ;;
  1.  ;;    2.  Include results of all diagnostic and clinical tests conducted
  1.  ;;        in the examination report.
  1.  ;;
  1.  ;;
  1.  ;;E.  Diagnosis:
  1.  ;;    1.  Summary of audiologic test results.  Indicate type and degree 
  1.  ;;        of hearing loss for the frequency range from 500 to 4000 Hz.
  1.  ;;        For type of loss, indicate whether it is normal, conductive,
  1.  ;;        sensorineural, central, or mixed.  For degree, indicate whether
  1.  ;;        it is mild (26-40 HL), moderate (41-54 HL), moderately severe 
  1.  ;;        (55-69 HL), severe (70-89 HL), or profound (90+ HL).
  1.  ;;        [For VA purposes, impaired hearing is considered to be a 
  1.  ;;        disability when the auditory threshold in any of the frequencies
  1.  ;;        500, 1000, 2000, 3000, and 4000 Hz is 40 dB HL or greater; or 
  1.  ;;        when the auditory thresholds for at least three of these 
  1.  ;;        frequencies are 26 dB HL or greater; or when speech recognition
  1.  ;;        scores are less than 94%]
  1.  ;;
  1.  ;;
  1.  ;;    2.  Note whether, based on audiologic results, medical follow-up
  1.  ;;        is needed for an ear or hearing problem, and whether there is
  1.  ;;        a problem which, if treated, might cause a change in hearing 
  1.  ;;        threshold levels.
  1.  ;;
  1.  ;;
  1.  ;;Signature:                                        Date:
  1.  ;;END