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Chapter 10
Case History, Integrating Audiometric Results, and Clinical Decision
Analysis
Case History
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_________________are often the first health professionals to evaluate patients
who complain of hearing loss
 ____________ history plays a critical role in audiologic interpretation and
decisions about the next step in the process
 Preliminary questions should be designed to discover the patient’s “___________
complaint.”
 The _____________examination should establish whether the outer ears are
___________________normal, the amount of ______________, and whether
___________________canals might be anticipated
 General questions before _________________ testing might include: Reason for
visit? Which is the ___________ear? Onset of hearing loss, _________or sudden?
Associated pain? Tinnitus? One Ear? Both ears? Previous diagnosis and
treatment? ____________history of hearing loss? Dizziness and ____________?
 Questionnaires have proved valuable with certain complaints such as _________.
 The ____________course of the disease is often helpful in determining the type
of problem the patient is experiencing.
o Vertigo lasting seconds is more likely to reflect ____________
______________ positional vertigo
o Vertigo lasting minutes is consistent with _________ or vertebrobasilar
insufficiency
o Vertigo lasting hours suggests ___________ syndrome.
o Vertigo lasting days raises the question of ______________neuritis or
infarction of the _____________.
 The astute clinician combines the ____________ account of the patients’
symptoms with the conventional audiologic findings to determine the need for
additional audiologic or ______________testing
 Recommending hearing aids or assistive listening devices are based in part on the
patient’s description of _________________difficulties as well as test results.
 Even when the basic audiologic assessment fails to explain a given complaint, the
history and further _____________should help to determine if further testing is
warranted.
Basic Audiologic Assessment
 The basic audiologic assessment is used to assess or monitor the status of the
_____________auditory system (the outer, middle, and inner ears)
 The ____________ audiogram remains the foundation of the basic audiologic
assessment
 The hearing-threshold test provides documentation of the degree of
___________loss, the slope of the ___________, and the ____________between
ears as well as establishing a __________for other audiologic tests.
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The speech reception threshold may be used to validate the
_______________thresholds as well as provide a baseline for suprathreshold
speech tests.
The monosyllabic-word-recognition scores provide insight into
____________auditory communication ability.
A case history and audiometric results, along with the clinician’s
______________interaction with the patient, provide a clearer picture of the level
of social functioning.
Word-recognition scores have limited ____________value
o Word-recognition tests are given to assess speech understanding
o The suspicion of a retrocochlear hearing loss is strengthened if a score is
________% or less, but scores up to _________% do not preclude a
retrocochlear site of lesion
o Word-recognition scores do provide a valuable _______________ for
assessing changes in an individual’s speech understanding with
progressive hearing loss
Bone-conduction measures are a good measure of ___________ear sensitivity
preceding middle ear surgery.
Upon completion of the basic audiologic assessment, the audiologist reviews the
________findings with patient
A _____________referral may be warranted if the patient complains of ear pain
or discomfort, ear drainage, conductive hearing loss, sudden hearing loss, rapidly
progressive or fluctuating hearing loss, acute or chronic dizziness, or unexplained
unilateral tinnitus.
One measurement tool used by audiologists to assess the auditory nerve and
central auditory nervous system to establish the site of auditory disorder is the
___________reflex.
Case Illustrations

Objective audiologic measures include auditory evoked ____________, evoked
__________, and acoustic reflex
Two Patients With Multiple Sclerosis (MS)

In each of the cases of sudden unilateral hearing loss in patients with MS, the
integration of ______________auditory tests helped to separate the site of
dysfunction within the auditory system.
A Cochlear Implant Candidate

This case highlights the importance of the ___________history
Clinical Decision Analysis and the Assessment of Cochlear Versus Retrocochlear
Auditory Disorders

The ABR has been shown to be the most sensitive of all auditory tests available in
identifying ________nerve lesions
o Factors other than eighth nerve lesions lead to ____________ABR
findings
o MRI-G is considered “the _________standard” for detection of eight
nerve tumors (NIH, 1991).
Background
Measures of Test Performance
 Clinical Decision Analysis is a systematic approach to making clinical decisions
under conditions of ______________.
Disease Prevalence and Test Efficiency
 Prevalence is defined as the ___________of the test population that has the
disease at the time of testing
 Test efficiency is defined as the ___________of being correct with a positive test
result or the probability of being correct with a negative test result.
 Actual prevalence rates of eight nerve tumors have been estimated to be from less
than _____% to more than ________%.