Audiological measures in cases of vestibular schwannoma play an important role in detecting such cases and monitoring auditory and vestibular changes in relation to intervention. The audiologist also plays an important role in providing counseling and appropriate devices for any resultant hearing loss.
LS is a 63-year-old woman originally seen in an otolaryngology outpatient clinic with a primary report of aural fullness in the left ear. Because she had an audiological examination from another institution within the past year and had no report of hearing difficulties, LS was automatically scheduled only for an otology appointment rather than combined audiology and otology appointments. The audiogram from the other institution (Fig. 12.1) reported normal hearing by air conduction with a four-frequency (500, 1000, 2000, and 3000 Hz) pure-tone average (PTA) of 8 dB HL for the right ear and 11 dB HL for the left ear. There were no otoscopy results, tympanograms, bone conduction results, or acoustic reflex thresholds (ARTs) reported. Speech recognition thresholds (SRTs) were 10 dB HL bilaterally, within normal limits and consistent with the PTAs. Word recognition scores (WRSs) in quiet were 100% at 55 dB HL bilaterally. The only remarkable finding was the slightly elevated thresholds at two nonadjacent frequencies (4000 Hz and 8000 Hz) in the left ear compared with the right ear. The slight asymmetry (15 dB) at 250 Hz may not normally be of concern because this finding is easily consistent with a very mild temporary conductive component associated with common upper respiratory infections, allergies, excess cerumen, and the complaint of aural fullness. Otoscopy results, bone conduction thresholds, ARTs, and tympanograms would have contributed to understanding this minor threshold elevation but were not provided. The type of earphone used would also have been beneficial because a minor elevation of air conduction threshold at this lower frequency is consistent with a slight acoustic leak commonly seen with supra-aural earphones, but not with insert earphones. The slight asymmetry (15 dB) at 4000 Hz also may not be of concern because a slightly elevated air conduction threshold at 4000 Hz is consistent with noise exposure, but no noise exposure was provided.