______Are Often the First Health Professionals to Evaluate Patients Who Complain of Hearing

Chapter 10 Case History, Integrating Audiometric Results, and Clinical Decision Analysis

Case History

·  ______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.

·  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 ______%.