Health Science- Intro to Audiology
ASSIGNMENT PART II
Case study 1
Marks – 5 (Answer to the point, explain in few words only wherever required, {less than 50 words})
In the case studies, wherever ipsilateral and contralateral reflexes are mentioned, it has been done only at 1000 Hz (screening)
A 40 year old male was seen for a routine evaluation. He reported being in excellent health. He stated that he has been experiencing a continuous high pitched ringing sound in both the ears that began one month ago. He said that over the last year it appears that his hearing has been declining. He experiences difficulty hearing especially while listening to music. He has been a musician playing the clarinet for the last ten years. He has never been using ear protection devices, his dad had a HL and wore hearing aids. No other significant history.
Questions (Refer picture 1)
1. What is the degree of loss if any?
2. Do you think the tympanometry is correct?
3. What does the RDT reveal? Cochlear or Retrocochlear pathology?
4. What recommendations do you have for this person?
5. If at all OAEs were done, what results do you expect?
Picture 1
Case study 2
Marks – 5
Your patient is a 39-year-old male with a history of sudden hearing loss in the right ear and vertigo. Previous to an incident several months earlier, the patient had not had difficulty with either hearing or balance. The course of symptoms is described as follows: The patient first noted a sensation of fullness in his right ear along with some slight difficulty understanding through that ear over the telephone. On the second day, he noticed a humming noise in that ear followed by a loud roaring sound. He suddenly had the sensation of whirling and was unable to keep his balance; he became ill and vomited several times. He now feels that he has no hearing in his right ear, although the spinning sensation has completely disappeared. Both his parents had difficulty hearing when they became much older. His greatest communication difficulty is in group situations or when people speak softly to him on his right side.
Test Right Ear Left Ear
SRT 70 dB HL 5 dB HL
SRS 34% 100%
ARTs (ipsilateral) 105 dB HL 90 dB HL
ARTs (contralateral) 105 dB HL 90 dB HL
Static compliance 09. cc 0.65 cc
ABR all waves prolonged all waves normal
TEOAE Absent Present
Picture 2
Questions
1. What is the type of loss on the right side?
2. What is the PTA of the left ear?
3. Based on the symptoms, what would be the possible cause for HL in right ear?
4. Is masking done in this patient?
5. Why do you think the DPOAEs were absent in the right side?
Case study 3
Marks – 5
Your patient is a 34-month-old male who is brought to you by his parents. They are not certain whether a hearing loss is present, although the child says “huh” a good deal. The father believes that the child “does not pay attention.” The child has been “slightly behind” his two older, normal siblings (a boy and a girl) in his language development milestones. A pediatrician has treated the child with antibiotics for “ear infections” on a few occasions, but more often for “tonsillitis.” No marked temperature elevations were associated with these episodes, and the child is otherwise healthy. There is no family history of hearing loss, although his father has difficulty understanding speech in groups and has a constant high-pitched tinnitus since serving two years in the artillery. The child tired quickly before all the desired hearing tests could be completed.
Test Right Ear Left Ear
SRT 20 dB HL 25 dB HL
SRS ? ?
ARTs (ipsilateral) Absent Absent
ARTs (contralateral) Absent Absent
Static compliance 0.25 cc 0.20 cc
Picture 3
Questions
1. What is the type of hearing loss?
2. Do you think the HL is symmetrical?
3. What is the type of tympanogram?
4. Do you think you will obtain a good response in OAE on this patient?
5. What would be the probable cause?
Case study 4
Marks – 5
Your patient is a 23-year-old male who was referred by his attorney for routine hearing tests because of a gradual hearing loss in his left ear associated with noise. The patient is a construction worker. There is no history of ear infections, vertigo, or tinnitus, and no reported family members with hearing loss. The patient claims that he is “totally deaf” in the left ear and requests that you write a letter to this effect “To whom it may concern.” He claims that he cannot hear people speak at all when they are on his left side.
Test Right Ear Left Ear
SRT 5 dB HL NR
SRS 100% NR
ARTs (ipsilateral) 95 dB HL 95 dB HL
ARTs (contralateral) 100 dB HL 95 dB HL
Static compliance 0.62 cc 0.66 cc
ABR All waves normal in both ears
TEOAE Present Present
Picture 4
Questions
1. Do you think his left ear thresholds are genuine?
2. What is the probable diagnosis?
3. Which part in the case history helped you to come to this conclusion?
4. Will a patient have ipsilateral and contralateral reflexes with profound degree of loss?
5. What is the sensation that you usually obtain for BC at low frequencies especially 250 and 500 Hz?
Case study 5
Marks – 5
Your patient is an 82-year-old man with a history of gradually progressive hearing loss in both ears over the past fifteen years. He is brought, reluctantly, to the clinic by his daughter-in-law, who complains privately “He does not pay attention.” He claims that sometimes he hears well than at other times and compliments you on the fact that you are easier to understand than most people. He has tried several hearing aids, which were useless to him; he has no desire to purchase any more hearing aids. Because he finds listening in groups difficult, he has ceased attending church, parties, and the theater. He claims that people do not speak clearly and that he understands better when they speak more slowly.
Test Right Ear Left Ear
SRT 50 dB HL 45 dB HL
SRS 62% 58%
ARTs (ipsilateral) 95 dB HL 95 dB HL
ARTs (contralateral) 90 dB HL 100 dB HL
Static compliance 0.92 cc 0.65 cc
Picture 5
Questions
1. What is the type of loss in right ear?
2. What is the PTA of the left ear?
3. Is masking required?
4. Based on his age, what would be the probable cause of HL?
5. Calculate the ABG at 1000 Hz.
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