B.N. is a 44 year old female.  Her sister has hearing loss.  Her husband says that she has had longstanding hearing loss.  The HHI, likely completed by her husband, gives a “yes” answer to each question – thus a score of 40/40.

Fifteen months before being seen at NSU’s Clinic for Hearing and Balance she fell down the stairs, hitting her head on a marble floor.  She delayed going to the hospital until her speech became garbled 20 hours after the fall.  She was diagnosed with left hemorrhagic stroke and Wernicke’s aphasia. She was hospitalized for six days, during which time she had a craniotomy to relieve pressure on her brain.

She suffered right sided muscle weakness and expressive aphasia.  She is now 15 months post injury and has had 14 months of intensive speech therapy. Her writing, reading and speaking have improved, but there are still residual deficits. Word recognition testing could not be completed. Speech detection thresholds were 30 dB HL right and 25 dB HL left.  Her audiometric results are shown below. The strike through of the reflexes indicates the reflex is absent at the level shown.

• Read the imaging reports on the next page of this post, and determine whether you think the absent reflexes can be explained from the areas of the brain damaged in the fall.

Case donated by Erica Friedland, AuD, Nova Southeastern University