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AUDIOLOGICAL EVALUATION Name: Jane Doe Date of Birth: Date of Evaluation: 7/12/07 Audiologist: BACKGROUND: Jane was seen for an audiological evaluation as part of an intake evaluation. Jane has had several audiological evaluations in the past, however they were inconclusive or incomplete. A report from 5/30/07 stated that using play audiometry there were no responses observed in the left ear. The responses in the right ear were boderline normal levels for 1000-4000Hz. It was also reported that Jane pointed to pictures at a level of 25dB in her right ear. Jane had a history of middle ear pathologies. Jane has cri-du-chat syndrome. Jane communicated through vocalizations, gestures and some sign language for this evaluation. RESULTS: PTA: For best ear 37dB SDT: For best ear- id colors 20dB TYMPANOMETRY: WNL OTOSCOPY: RE: drum did not appear “healthy” LE: Unremarkable HEARING AID INFO: None INTERPETATIONS: Warbled tone test results utilizing Visual Reinforcement Audiometry (VRA) in the sound field suggests a mild sloping to moderate hearing loss for at least the better ear. Since Jane would not accept headphones, ear specific information was not obtained. Jane was able to correctly identify colors from a closed set of 5 at a level of 20dB. Tympanometry results were within normal limits, which suggests normal functioning middle ear systems. Jane did push away the probe after the tones for acoustic reflex were presented. Otoscopic examination was unremarkable for the left ear; the right eardrum did not appear “healthy”. Jane’s mom stated that she would take Jane to the doctor. At the end of the evaluation Jane covered her ears when a fake dog barked and moved, this sound was at a level of about 65dB. These 2 incidences and the fear of the headphones may indicate some hypersensitivity to sound. RECOMMENDATIONS: Exposure to communication partners, both peers and adults, who can use a similar communication system, will be important. Jane may benefit from a program with children and staff who can sign which will allow access for peer interaction and maximize incidental learning through spontaneous communication. Jane needs to be accustomed to earphones, recommended to her mom that she use headphones at home. Continued testing to obtain ear specific information. Medical referral for right ear, mom stated she would take Jane to the doctor. NYS Licensed Audiologist