Question
I have a patient who filed a claim for occupational hearing loss in the State
of Washington. The claim was allowed, but because the ENT stated that
there was little benefit from amplification (mild, high-frequency loss),
he has been denied hearing aids. Any suggestions for articles/proof that I might use to follow-up with the state?
Answer
This touches on the age-old question regarding what I call data-free opinions ventured by professional persons. Physicians and audiologists carry a great deal of weight with compensation entities -- especially when the recommendation saves the comp program money. In this day and time, it is unwise and inappropriate to guess whether amplification will be beneficial based simply on pure tone audiometry. In former times (when I was a practicing clinical audiologist) mild hearing impairments were difficult to satisfy with amplification and hearing aid devices were woefully lacking in the adjustments necessary to accommodate the lesser impairments. Historically, noise-induced impairments are among the most difficult to fit. Those problems no longer exist with modern amplification units.
I am firmly convinced that the final arbiter of decisions on the propriety of amplification is the hearing aid evaluation. Without information on patient performance with amplification, we are left to guesswork. While the physician's opinion might be confirmed with further testing, it will never be known whether the patient, in fact, benefits adequately.
My area of study is hearing conservation and the development/evaluation of programs. Thus, I confess to limited current knowledge of the hearing aid literature -- particularly as it relates to mild impairments. I have three suggestions:
- A PhD dissertation by Dennis Earl (U. of Tennessee) discovered that persons with hearing within the "normal" range (no greater than 20 dB HL for any hearing test frequency) could be separated into two groups: "normal-normals" and "abnormal-normals". This separation was first determined by a questionnaire and was then confirmed by testing for release from masking. The importance of this finding is that there are folks who do not perform at all normally, even though they would be considered "within the normal range".
- The work of Dr. Fred Bess and colleagues (Vanderbilt University) has illuminated many of the problems of mild impairment, particularly in children. I invite you to search for his studies, or contact Dr. Bess at the Bill Wilkerson Speech and Hearing Center in Nashville, TN.
- In the January issue of JAAA, on p. 6 begins an article by a group in The Netherlands regarding mild hearing impairment and auditory processing tests. Of importance in this report, in addition to the data they present, is the considerable list of references at the end of the article.
Dr. David M. Lipscomb obtained his Ph.D. at the University of Washington in 1966. He began his career as a clinical audiologist and professor of audiology. Throughout most of his professional life, he has participated as a consultant in a wide range of subjects. In 1987, Dr. Lipscomb left academia and entered full-time consulting. This avenue of professional service has included setting up hearing conservation programs, evaluating such programs, consulting with community and governmental entities, investigating collisions involving acoustical warning signals, and participating in litigation as an expert witness.