UNIVERSITY of CENTRAL MISSOURI
Welch-Schmidt Center for Communication Disorders
Audiologic Evaluation Report
CLIENT: TGO CLINICIANS:CHE, ASC
DATE OF BIRTH:7-13-50 DATE OF EVALUATION: 2-14-xx
HISTORY:
TGO, a 60 year old female, came to the Welch-Schmidt Center for Communication Disorders for an audiological evaluation following concerns regarding her hearing. TGO’s history indicates frequent ear infections as a child and young adult. TGO also indicated difficulty hearing low tones and low pitch voices, bilaterally. However, she suspected her left ear was slightly worse than her right ear. Previous testing at the Center in 20xx indicated TGO had a mild sensorineural hearing loss with a notched configuration in the upper frequencies in the right and left ears, and in the lower frequencies of the left ear. She also reported significant "noise" exposure from attending concerts.
RESULTS:
Otoscopy revealed normal appearing ear canals and tympanic membranes, with slightly more cerumen in the left ear. Immitance audiometry indicated a normal Jerger type A tympanogram, bilaterally, with an unusual downward slope in the left ear. Pure-tone audiometry revealed hearing within lower frequencies are within normal limits, with a high frequency loss at 4000 Hz in the right ear. The left ear indicated a low frequency loss at 250 and 500 Hz, as well as a high frequency loss at 4000 Hz. Bone conduction thresholds were not obtained. Speech reception thresholds were 10 and 25 dB HL for the right and left ear. Word recognition scores were 88% and 100% for the right and left ears at 40 dB SL re: SRT.
IMPRESSIONS:
Results for the right ear were normal except for a slight high frequency notch at 4000 Hz, probably related to noise exposure. The low frequency loss is present in the left ear at 250 and 500 Hz. A high frequency loss (notch) is also present at 4000 Hz. Results indicate a fairly stable hearing loss.
RECOMMENDATIONS:
1) TGO returns to the clinic for re-evaluation every year or if a change in her hearing is noted.
2) TGO wear hearing protection when prior knowledge of noise exposure will be present.
______
ASC, B.S. Robert de Jonge, PhD, CCC-A
Graduate Student Clinician Clinical Instructor
______
CHE, B.S.
Graduate Student Clinician
(Letterhead)
February 14, 20xx
TGO
123 Anywhere Dr.
Anytown, MO 640xx
Re: TGO
Dear TGO,
Enclosed are the results of the audiologic evaluation performed on February 14, 20xx at the Welch-Schmidt Center for Communication Disorders.
The results of the testing revealed a mild-moderate high frequency hearing loss in the right ear and a mild-moderate low and high frequency hearing loss in the left ear. This loss appears stable.
We recommended:
1) Return to the clinic for re-evaluation annually or if a change in hearing is noted.
2) Wear hearing protection during noise exposure.
Please feel free to contact the clinic at (660) 543-4993 if you have any questions or if we can be of any further assistance.
Sincerely,
______
ASC, B.S. Robert de Jonge, PhD, CCC-A
Graduate Student Clinician Clinical Instructor
______
CHE, B.S.
Graduate Student Clinician