Audiological report

Patient Information

Name: Arthur Pendelton (NHI: ZXY4829)

Date of Birth: 14/05/1956

Date of Assessment: 24/10/2023

Referral Information

Referred by: Sarah Jenkins, Vestibular Physiotherapist

Reason for Referral: The patient was referred for a comprehensive audiological evaluation following a presentation of episodic vertigo and bilateral hearing difficulty noted during vestibular rehabilitation.

Case History

Medical History: The patient has a history of hypertension managed with cilazapril 2.5 mg PO daily and hyperlipidaemia managed with atorvastatin 20 mg PO daily, with no history of head trauma or ototoxic medication use.

Hearing History: The patient reports a gradual, symmetrical decline in hearing sensitivity over the past five years, characterized by significant difficulty understanding speech in background noise.

Family History: The patient's father experienced presbycusis in his late sixties, though there is no known family history of congenital or early-onset sensorineural hearing loss.

Noise Exposure: The patient worked as a carpenter for thirty-five years with inconsistent use of hearing protection around heavy machinery and power tools.

Tinnitus: The patient experiences a constant, high-pitched, non-pulsatile ringing bilaterally that is most noticeable in quiet environments but does not significantly disturb sleep.

Vertigo/Dizziness: The patient reports brief episodes of rotatory vertigo triggered by rolling over in bed, which are currently being successfully managed by his physiotherapist with canalith repositioning manoeuvres for right posterior canal BPPV.

Audiological Assessment

Otoscopy: Bilateral external auditory canals were clear of cerumen and debris, with intact, pearly grey tympanic membranes and visible landmarks bilaterally.

Tympanometry: Type A tympanograms were obtained bilaterally, indicating normal middle ear pressure and compliance with ear canal volumes of 1.2 mL on the right and 1.3 mL on the left.

Pure Tone Audiometry: Pure tone testing revealed normal hearing sensitivity from 250 Hz to 1,000 Hz, sloping to a moderate-to-severe sensorineural hearing loss from 2,000 Hz to 8,000 Hz bilaterally, with a pronounced notch at 4,000 Hz and no significant air-bone gaps.

Speech Audiometry: Speech reception thresholds were 25 dB HL bilaterally, and word recognition scores were 88% at 65 dB HL in the right ear and 84% at 65 dB HL in the left ear.

Otoacoustic Emissions: Distortion product otoacoustic emissions were present from 1,000 Hz to 1,500 Hz and absent from 2,000 Hz to 8,000 Hz bilaterally, consistent with outer hair cell dysfunction in the basal cochlear regions.

Auditory Brainstem Response: Auditory brainstem response testing was not clinically indicated as the pure tone findings were symmetrical and speech discrimination scores showed no evidence of retrocochlear pathology.

Summary and Impression

Summary of Findings: Assessment results demonstrate normal middle ear function with a bilateral, symmetrical, mild-to-severe high-frequency sensorineural hearing loss and good speech discrimination ability in quiet.

Impression: The audiological profile is consistent with bilateral noise-induced sensorineural hearing loss compounded by age-related presbycusis, which is unrelated to his concurrent benign paroxysmal positional vertigo.

Recommendations

Further Testing: No further diagnostic audiological or medical imaging investigations are required at this stage given the symmetrical nature of the loss.

Management Plan: Binaural receiver-in-canal hearing aids with tinnitus sound generator features were recommended to improve high-frequency audibility, and an application for ACC funding for noise-induced hearing loss has been initiated.

Follow-Up: The patient is scheduled to return in three weeks for a hearing aid fitting and orientation, with an annual audiological review recommended thereafter.

Clinician Information

Clinician Name: Liam O'Connor, MNZAS

Clinician Title: Senior Audiologist

Clinic Name: Auckland Hearing and Balance Centre

Contact Information: 142 Broadway, Newmarket, Auckland 1023, Phone: (09) 555-0192, Email: l.oconnor@ahbc.co.nz