DVBCWAU5 ;BPOIFO/RLC AUDIO WKS TEXT - 1 ; 26 DEC 2006
;;2.7;AMIE;**118**;FEB 2,2004;Build 3
;
TXT ;
;; The Handbook of Standard Procedures and Best Practices for Audiology
;; Compensation and Pension Exams is available online. ( This is a PDF file.
;; You need Acrobat Reader 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. Pertinent family and social history; history of ear disease,
;; head or ear trauma, etc.
;; 6. Tinnitus - If present, state:
;;
;; a. Date and circumstances of onset.
;; b. Whether it is unilateral or bilateral.
;; c. Whether it is persistent or recurrent.
;;
;; 7. Describe effects on occupational functioning and activities
;; of daily living.
;;
;;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. Puretone thresholds should not exceed 105
;; decibels or the tolerance level.
;; ** The average of B, C, D, and E.
;;
;; 2. Speech Recognition Score: Maryland CNC word list
;;
;; _____% right ear _____% left ear.
;;
;; 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.
;;
;; Thresholds should not exceed 100 decibels or the tolerance level.
;;
;;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 that, if treated, might cause a change in hearing
;; threshold levels.
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWAU5 6094 printed Apr 09, 2024@20:58 Page 2
DVBCWAU5 ;BPOIFO/RLC AUDIO WKS TEXT - 1 ; 26 DEC 2006
+1 ;;2.7;AMIE;**118**;FEB 2,2004;Build 3
+2 ;
TXT ;
+1 ;; The Handbook of Standard Procedures and Best Practices for Audiology
+2 ;; Compensation and Pension Exams is available online. ( This is a PDF file.
+3 ;; You need Acrobat Reader to open pdf files. It is a free download. )
+4 ;;
+5 ;;Narrative: An examination of hearing impairment must be conducted by a
+6 ;;state-licensed audiologist and must include a controlled speech
+7 ;;discrimination test (specifically, the Maryland CNC recording) and a
+8 ;;pure tone audiometry test in a sound isolated booth that meets American
+9 ;;National Standards Institute standards (ANSI S3.1.1991) for ambient noise.
+10 ;;Measurements will be reported at the frequencies of 500, 1000, 2000, 3000,
+11 ;;and 4000 Hz. The examination will include the following tests: Pure tone
+12 ;;audiometry by air conduction at 250, 500, 1000, 2000, 3000, 4000, and
+13 ;;8000 Hz, and by bone conduction at 250, 500, 1000, 2000, 3000, and
+14 ;;4000 Hz, spondee thresholds, speech recognition using the recorded
+15 ;;Maryland CNC Test, tympanometry and acoustic reflex tests, and, when
+16 ;;necessary, Stenger tests. Bone conduction thresholds are measured
+17 ;;when the air conduction thresholds are poorer than 15 dB HL. A modified
+18 ;;Hughson-Westlake procedure will be used with appropriate masking. A
+19 ;;Stenger must be administered whenever pure tone air conduction
+20 ;;thresholds at 500, 1000, 2000, 3000, and 4000 Hz differ by 20 dB or more
+21 ;;between the two ears. Maximum speech recognition will be reported with
+22 ;;the 50 word VA approved recording of the Maryland CNC test. When speech
+23 ;;recognition is 92% or less, a performance intensity function will be
+24 ;;obtained with a starting presentation level of 40dB re SRT. If necessary,
+25 ;;the starting level will be adjusted upward to obtain a level at least 5 dB
+26 ;;above the threshold at 2000 Hz. The examination will be conducted without
+27 ;;the use of hearing aids. Both ears must be examined for hearing
+28 ;;impairment even if hearing loss in only one ear is at issue.
+29 ;;
+30 ;;A. Review of Medical Records: Indicate whether the C-file was reviewed.
+31 ;;
+32 ;;B. Medical History (Subjective Complaints):
+33 ;;
+34 ;; Comment on:
+35 ;;
+36 ;; 1. Chief complaint.
+37 ;; 2. Situation of greatest difficulty.
+38 ;; 3. Pertinent service history.
+39 ;; 4. History of military, occupational, and recreational noise
+40 ;; exposure.
+41 ;; 5. Pertinent family and social history; history of ear disease,
+42 ;; head or ear trauma, etc.
+43 ;; 6. Tinnitus - If present, state:
+44 ;;
+45 ;; a. Date and circumstances of onset.
+46 ;; b. Whether it is unilateral or bilateral.
+47 ;; c. Whether it is persistent or recurrent.
+48 ;;
+49 ;; 7. Describe effects on occupational functioning and activities
+50 ;; of daily living.
+51 ;;
+52 ;;C. Physical Examination (Objective Findings):
+53 ;;
+54 ;; 1. Measure puretone thresholds in decibels at the indicated
+55 ;; frequencies (air conduction):
+56 ;;
+57 ;; = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = =
+58 ;; A* B C D E ** A* B C D E **
+59 ;; 500|1000|2000|3000|4000|average 500|1000|2000|3000|4000|average
+60 ;; | | | | | | | | | |
+61 ;;
+62 ;; * The puretone threshold at 500 Hz is not used in determining the
+63 ;; evaluation but is used in determining whether or not a ratable
+64 ;; hearing loss exists. Puretone thresholds should not exceed 105
+65 ;; decibels or the tolerance level.
+66 ;; ** The average of B, C, D, and E.
+67 ;;
+68 ;; 2. Speech Recognition Score: Maryland CNC word list
+69 ;;
+70 ;; _____% right ear _____% left ear.
+71 ;;
+72 ;; When only puretone results should be used to evaluate hearing loss,
+73 ;; the examiner, who must be a state-licensed audiologist, should certify
+74 ;; that language difficulties or other problems (specify what the problems
+75 ;; are) make the combined use of puretone average and speech
+76 ;; discrimination inappropriate.
+77 ;;
+78 ;; Thresholds should not exceed 100 decibels or the tolerance level.
+79 ;;
+80 ;;D. Diagnostic and Clinical Tests:
+81 ;;
+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 ;; 2. Include results of all diagnostic and clinical tests conducted
+89 ;; in the examination report.
+90 ;;
+91 ;;E. Diagnosis:
+92 ;;
+93 ;; 1. Summary of audiologic test results. Indicate type and degree
+94 ;; of hearing loss for the frequency range from 500 to 4000 Hz.
+95 ;; For type of loss, indicate whether it is normal, conductive,
+96 ;; sensorineural, central, or mixed. For degree, indicate whether
+97 ;; it is mild (26-40 HL), moderate (41-54 HL), moderately severe
+98 ;; (55-69 HL), severe (70-89 HL), or profound (90+ HL).
+99 ;; [For VA purposes, impaired hearing is considered to be a
+100 ;; disability when the auditory threshold in any of the frequencies
+101 ;; 500, 1000, 2000, 3000, and 4000 Hz is 40 dB HL or greater; or
+102 ;; when the auditory thresholds for at least three of these
+103 ;; frequencies are 26 dB HL or greater; or when speech recognition
+104 ;; scores are less than 94%]
+105 ;; 2. Note whether, based on audiologic results, medical follow-up
+106 ;; is needed for an ear or hearing problem, and whether there is
+107 ;; a problem that, if treated, might cause a change in hearing
+108 ;; threshold levels.
+109 ;;
+110 ;;
+111 ;;Signature: Date:
+112 ;;END
