NU-6 ½ lists

• Describe the type and severity of the loss in each ear.

Note that in the right ear, testing at a higher intensity caused the word recognition score to decrease; in the left ear it increased.  A decrease in word recognition as intensity is increased is termed “rollover”.

• What is the formal, traditional way to calculate rollover?  Is this rollover a significant diagnostic finding.

Word recognition scores can and do vary by chance from test to retest. Thorton & Raffin published papers on “the binomial distribution” of speech scores, discussing the degree of change in word recognition that may occur just because of test retest variability.

• Are the changes in word recognition scores within the range of expected test-retest variability or is it more than what is expected by chance?  The left ear score increased as the signal level increased; is that increase more than the size change that can happen by chance?  The right ear score decreased as intensity increased; is that change more than what might happen by chance if the right ear had been retested at 50 dB HL?

• Calculate the three frequency average in the right ear. Research what scores are “disproportionately low” for this degree of impairment. A classic reference is Dubno, et al (1995), “Confidence limits for maximum word recognition scores”, Journal of Speech and Hearing Disorders, 38, 490-502.  Is the 40% score in the right ear unusually low? What about the 64% score. What do low word recognition scores signify?

• Given the evidence that is obtained just from the audiometry, what is your suspicion about the site of lesion in the right ear?