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Auditory Neuropathy Spectrum Disorder Name: Date of Birth: MRN Number: Family Number: Phenotype Present Phenotype Description Abnormality of the vestibulocochlear nerve Sensorineural hearing impairment High-frequency hearing impairment Mid-frequency hearing loss Low-frequency hearing loss Conductive hearing impairment Abnormality of the auditory canal Abnormality of the internal auditory canal Abnormality of the middle ear ossicles Abnormality of the middle ear ossicles Aplasia/Hypoplasia of the middle ear Morphological abnormality of the vestibule of the inner ear Abnormality of cochlea Abnormality of the cochlear nerve Hypoplasia of the vestibular nerve Aplasia of the vestibular nerve Morphological abnormality of the semicircular canal Persistent stapedial artery Vestibular dysfunction Abnormal speech discrimination Tinnitus Hyperacusis Otitis media Cholesteatoma Neoplasm of the middle ear Abnormality of the outer ear Abnormal location of ears Abnormality of periauricular region Abnormality of the earlobe Abnormality of the antihelix Abnormality of the helix Crumpled ear Cryptotia Cupped ear Macrotia Microtia Anotia Unknown Yes No Auditory Neuropathy Spectrum Disorder Cont. Phenotype Present Phenotype Description Polyotia Protruding ear Calcification of the auricular cartilage Cystic lesions of the pinnae Telangiectasia of the ear Asymmetry of the ears Unknown Yes No ADDITIONAL PHENOTYPING Phenotype Description Phenotype Present Unknown Yes No
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