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Download Congenital Hearing Impairment
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Congenital hearing impairment Name: Date of Birth: MRN Number: Family Number: Phenotype Present Phenotype Description Unknown Yes No Bilateral sensorineural hearing impairment Mid-frequency hearing loss Progressive hearing impairment High-frequency hearing impairment Mild hearing impairment Moderate hearing impairment Aplasia of the vestibular nerve Unilateral deafness Vestibular hypofunction Morphological abnormality of the semicircular canal Abnormality of the middle ear ossicles Low-frequency hearing loss Adult onset sensorineural hearing impairment Childhood onset sensorineural hearing impairment Severe sensorineural hearing impairment Vertigo Congenital sensorineural hearing impairment Sensorineural hearing impairment Enlarged vestibular aqueduct Abnormality of the cochlear nerve Hypoplasia of the vestibular nerve Morphological abnormality of the vestibule of the inner ear Abnormality of cochlea Profound sensorineural hearing impairment ADDITIONAL PHENOTYPING Phenotype Description Phenotype Present Unknown Yes No
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