This assignment discusses the differential diagnosis of a 60 year old male who was referred into Audiology on 12th September 2013. He is complaining of bothersome tinnitus and a gradual hearing loss that seems to have worsened over time. He is also presenting with occasional vertigo and a feeling of imbalance. He is struggling when communicating with his family and in background noise when at work.
The symptom in the referral letter mirror the symptoms that are associated with Presbycusis, age related deafness. This occurs as a result of a deterioration of the auditory system due to the ageing process. This, together with factors such as noise exposure, medical conditions and their treatment, and the use of ototoxic drugs, result in a deterioration of hearing thresholds with age. As seen in Fig 6.17 (Gelfand, 2009). Presbycusis stereotypically presents an audiogram with an essentially symmetrical bilateral high frequency hearing loss.
The patient attended the Audiology Department for a Hearing Assessment on the 8th October 2013. A detailed medical questionnaire was performed. The patient had never had any perforations, infections or any operations on his ears. The patient revealed that he felt his hearing loss was primarily in the left ear, although he did feel his hearing had deteriorated in the right ear too. He also believed that his tinnitus was mainly in his left ear, which he described as a continuous high pitched ringing that he found to be very disturbing. He had never worked in noise or been exposed to loud noises before and although he was on several drugs, none were ototoxic. The Client Orientated Scale of Improvement (COSI) questionnaire revealed ‘general conversation in quiet’ and ‘Hearing on the telephone’ to...
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...previously and the patient is finding it hard to cope with. He was advised to trial the hearing aids bilaterally for another 6 weeks due to the benefits of localisation and a balance in hearing (Noble, 2006). He was also referred for tinnitus counselling. He was advised that Assisted Listening Devices could be another option if the left side does not improve. Speech discrimination can be effective due to the higher signal to noise ratio (Mulvany,2008). He was provided with a Connevans Catalogue to look into this option. The second part of the COSI was filled out. He felt that conversation in background noise was just as difficult but he felt his hearing on the telephone when using his right ear was improving. The next stage of the IMP was filled out:
1. Review booked for 6 weeks’ time
2. Referred for tinnitus counselling
3. More advice on ALD’s in next review
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