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Routine: DVBCWAUB

DVBCWAUB.m

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  1. DVBCWAUB ;BPOIFO/RLC - AUDIO WKS TEXT - 1 ; 2/10/2010
  1.  ;;2.7;AMIE;**150**;Apr 10, 1995;Build 13
  1.  ;
  1. TXT ;
  1.  ;;   The Handbook of Standard Procedures and Best Practices for Audiology
  1.  ;;   Compensation and Pension Exams is available online. ( This is a PDF file.
  1.  ;;   You need Acrobat Reader to open pdf files. It is a free download. )
  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.  The starting
  1.  ;;presentation level will be 40dB re SRT.  If necessary, the starting level
  1.  ;;will be adjusted upward to obtain a level at least 5 dB above the threshold
  1.  ;;at 2000 Hz, if not above the patient's tolerance level.  The examination
  1.  ;;will be conducted without the use of hearing aids.  Both ears must be
  1.  ;;examined for hearing impairment even if hearing loss in only one ear is
  1.  ;;at issue.
  1.  ;;
  1.  ;;   When speech recognition is 92% or less, a performance intensity
  1.  ;;   function must be obtained.
  1.  ;;
  1.  ;;Procedures for Obtaining a Modified Performance-Intensity Function
  1.  ;;   1.  The starting level is 40 dB re: SRT (speech reception threshold).
  1.  ;;   The starting level will be adjusted upward to obtain a level at least
  1.  ;;   5 dB above the threshold at 2000 Hz, if not above the patient's
  1.  ;;   tolerance level.
  1.  ;;   2.  Present 25 words at 6 dB above and 6 dB below the starting level.
  1.  ;;   3.  If recognition performance improves less than 6%, then maximum word
  1.  ;;   recognition performance has been obtained.
  1.  ;;       Example:  starting level=50 dB HL.  Initial performance=80%.
  1.  ;;       Decrease level to 44 dB HL.  Performance decreases to 76%.  Increase
  1.  ;;       level to 56 dB HL.  Performance increases to 84%.  Test level for
  1.  ;;       full list=50 dB HL.
  1.  ;;   4.  If performance improves by 6% or more at the first 6-dB increment,
  1.  ;;   then word recognition is measured using another 25 words at an
  1.  ;;   additional 6-dB increment.
  1.  ;;       Example:  starting level=50 dB HL.  Initial performance=80%.
  1.  ;;       Increase level to 56 dB HL.  Performance improves to 88% (+8%).
  1.  ;;       Increase level to 62 dB HL.  Performance decreases to 84% (-4%).
  1.  ;;       Test level for full list=56 dB HL.
  1.  ;;   5.  A full list (50 words) is then presented at the level of maximum
  1.  ;;   performance.  The word recognition performance at this level is reported
  1.  ;;   as the speech recognition score.  Only the best performance for a full
  1.  ;;   list (50 words) will be reported.
  1.  ;;
  1.  ;;A.  Review of Medical Records: Indicate whether the C-file was reviewed.
  1.  ;;
  1.  ;;B.  Medical History (Subjective Complaints):
  1.  ;;
  1.  ;;      Comment on:
  1.  ;;
  1.  ;;        1.  Chief complaint.
  1.  ;;        2.  Effects of the condition on occupational functioning and daily
  1.  ;;            activities.
  1.  ;;        3.  Pertinent service history.
  1.  ;;        4.  History of military, occupational, and recreational noise
  1.  ;;            exposure.
  1.  ;;        5.  Pertinent family and social history; history of ear disease,
  1.  ;;            head or ear trauma, etc.
  1.  ;;        6.  Tinnitus.
  1.  ;;
  1.  ;;              a.  Is there a claim for tinnitus (verify from examination
  1.  ;;                  request, i.e., 2507)?  (yes/no)
  1.  ;;              b.  Is there a current complaint of tinnitus? (yes/no)  If yes
  1.  ;;                  answer the following questions whether or not the condition
  1.  ;;                  is claimed.
  1.  ;;              c.  Date and circumstances of onset.
  1.  ;;              d.  Whether it is constant or recurrent (intermittent). 
  1.  ;;                  Current complaints only.
  1.  ;;              e.  If there is a claim and no current complaint, the
  1.  ;;                  audiologist must:
  1.  ;;
  1.  ;;                  State when veteran last experienced tinnitus.
  1.  ;;
  1.  ;;                  Describe the tinnitus experienced at that time.
  1.  ;;
  1.  ;;                  Describe intervening course between onset and last episode,
  1.  ;;                  e.g., how frequently in a year does a veteran experience
  1.  ;;                  tinnitus.
  1.  ;;
  1.  ;;C.  Physical Examination (Objective Findings):
  1.  ;;
  1.  ;;    1.  Measure and record 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 calculating the
  1.  ;;       puretone threshold average for evaluation purposes but is used in
  1.  ;;       determining whether or not, for VA purposes, a hearing impairment
  1.  ;;       reaches the level of a disability.  Puretone thresholds should not
  1.  ;;       exceed 105 decibels or the tolerance level.
  1.  ;;    ** The average of B, C, D, and E.
  1.  ;;
  1.  ;;    2.  Speech Recognition Score: Maryland CNC word list
  1.  ;;
  1.  ;;                         _____% right ear _____% left ear.
  1.  ;;
  1.  ;;    When only puretone results should be used to evaluate hearing loss, 
  1.  ;;    the examiner, who must be a state-licensed audiologist, should certify
  1.  ;;    that language difficulties or other problems (specify what the problems
  1.  ;;    are) make the combined use of puretone average and speech
  1.  ;;    discrimination inappropriate.
  1.  ;;
  1.  ;;    Thresholds should not exceed 100 decibels or the tolerance level.
  1.  ;;
  1.  ;;    Pausing:  Examiners should pause when necessary during speech
  1.  ;;    recognition tests, in order to give the veteran sufficient time to
  1.  ;;    respond.  This will ensure that the test results are based on actual
  1.  ;;    hearing loss rather than on the effects of other problems that might
  1.  ;;    slow a veteran's response.  There are a variety of problems that might
  1.  ;;    require pausing, for example, the presence of cognitive impairment.  It
  1.  ;;    is up to the examiner to determine when to use pausing and the length
  1.  ;;    of the pauses.
  1.  ;;
  1.  ;;    Need for a modified performance-intensity function:  The normal speech
  1.  ;;    recognition performance is 94% or better for a full (50 word) list.  If
  1.  ;;    speech recognition is worse than 94% after presentation of a full list,
  1.  ;;    then a modified performance-intensity function must be obtained to
  1.  ;;    determine best performance (see Narrative for description of procedures).
  1.  ;;
  1.  ;;When describing speech recognition performance, use these terms:
  1.  ;;
  1.  ;;     Percent        Correct Description
  1.  ;;     100-94%        Excellent (Normal)
  1.  ;;     92-80%         Good
  1.  ;;     78-70%         Fair
  1.  ;;     Less than 70%  Poor
  1.  ;;
  1.  ;;D.  Diagnostic and Clinical Tests:
  1.  ;;
  1.  ;;    1.  Report middle ear status, confirm type of loss and indicate need
  1.  ;;        for medical follow-up.  In cases where there is poor inter-test
  1.  ;;        reliability and/or positive Stenger test results, obtain and report
  1.  ;;        estimates of hearing thresholds using a combination of behavioral
  1.  ;;        testing, Stenger interference levels, and electrophysiological
  1.  ;;        tests.
  1.  ;;    2.  Include results of all diagnostic and clinical tests conducted
  1.  ;;        in the examination report.
  1.  ;;
  1.  ;;E.  Diagnosis:
  1.  ;;
  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.  ;;
  1.  ;;    [For VA purposes, impaired hearing is considered to be a disability
  1.  ;;    when the auditory threshold in any of the frequencies 500, 1000, 2000,
  1.  ;;    3000, and 4000 Hz is 40 dB HL or greater; or when the auditory thresholds
  1.  ;;    for at least three of these frequencies are 26 dB HL or greater; or when
  1.  ;;    speech recognition scores are less than 94%]
  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 that, if treated, might cause a change in hearing 
  1.  ;;        threshold levels.
  1.  ;;
  1.  ;;    3.  If there is a current complaint of tinnitus, indicate whether or not
  1.  ;;        tinnitus is as likely as not a symptom associated with hearing loss,
  1.  ;;        if hearing loss is present.  If there is no hearing loss present;
  1.  ;;        or the audiologist determines that it is as likely as not that
  1.  ;;        tinnitus is associated with another medical condition; or the
  1.  ;;        etiology of tinnitus cannot be determined on the basis of available
  1.  ;;        information without resorting to speculation, so state.  The VBA
  1.  ;;        regional office will then determine whether further non-audiological
  1.  ;;        examination is needed, based on their review of all evidence of
  1.  ;;        record.
  1.  ;;
  1.  ;;
  1.  ;;
  1.  ;;Signature:                                        Date:
  1.  ;;END