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Interesting Case

Paul D Dybala dybala at utdallas.edu
Mon Oct 6 15:24:54 EST 1997

He shouldn't have acoustic reflexes or emissions
at all if they have +110 dB Hearing Loss.

Also think about the fact that that you can have up to a 40 dB loss and
present emissions, you can also have absent emissions and normal hearing!
It could be possible that he has a mild to moderate HF loss
and this person is exaggerating but all of the information
just does not add up.

Plus, you and I know that you CANNOT get all the
speech information you need from lipreading.

Get this guy worked up with some electophysiological
testing especially ABR and MLR.  Do the ABR with
clicks and 500 and 4000 Hz tone bursts.

Also, did you use an ascending approach from 0 dB in 2 dB steps
for speech and then for tones to throw off any loudness judgements?

It is true that his claims are not unreasonable of 
having a hearing loss,  but you
are not unreasonable in saying my tests are not agreeing
with each other and I cannot get a definitive answer.
Then bring him back in and do everything over again
plus the electrophys stuff.

What is your gut feeling on this person?

Earsense (earsense at aol.com) wrote:
> I had an interesting case recently and would appreciate any advice regarding
> it.  A patient of mine had a car accident about 2 months ago and had been 
> receiving physical therapy. The patient claimed 2 weeks ago that the physical
> therapist twisted their neck during a therapy session, and the following 
> day  woke up with no hearing in both ears. This incident happened about 2 weeks
>  ago, and the patient is claiming total hearing loss in both ears, with 
> a "static" like noise in both ears. The patient denied significant
>  imbalance/dizziness problems. Other case history information was unremarkable.
> The patient claims essentially normal hearing and no otologic problems
> before the incident.The patient claims they now communicate via lip reading
>  only.The patient responded very well to questions during case history
>  questions
> and test instructions, however  did not respond at all when attempts to prevent
> lip reading occurred.

> The audiologic evaluation took place two weeks following the incident. The
>  patient
> did not respond to pure tone or speech stimuli for either ear at equipment
> limits ( >110 dbHL). No responses at all. Tympanometry revealed type A
>  tympanograms for both ears. Acoustic reflex thresholds were between 90-95 dB
> at 500Hz-2000 Hz for ipsilateral stimulation for the left ear, and were largely
> absent for ipsilateral stimulation for the right ear. Contralateral acoustic
>  reflexes
> were essentially absent, or elevated (105-110 dB) for both ears. 

> DPOAE testing revealed cochlear emissions present 500 Hz-2000 for the left ear,
> and absent above 2000 Hz. Cochlear emissions were essentially absent for the 
> right ear. 

> What do you think about this case study?. How would you interpret it? AR and 
> OAE results suggest hearing thresholds better than 40 dBHL 500Hz-2000Hz
> for the left ear, and possibly a moderately severe to profound snhl for the
>  right ear.
> Behavioral results are not in good agreement with physiologic findings on the 
> left ear.

> The patient appears remarkably adept at lip reading, considering they suffered
> a sudden total loss of hearing in both ears (just two weeks ago).
> Any suggestions regarding interpretation? Further testing? (possible ABR or
>  not?)
> Counseling? Legal Ramifications?
> I would appreciate any advice/help on this case.

> P.S. I read in the Hearing Journal months ago about cervical manipulation and 
> sudden hearing loss. I guess the cervical artery has a branch called the
>  veterbral
> basilar artery- which supplies the inner ear. So I guess the patient's claims
>  are
> not completely out of the range of possibilities. Correct me if I'm wrong.

Thank you for your support,
Paul Dybala
dybala at utdallas.edu

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