B. Otolaryngology
1.
Hearing impairment. Hearing ability should be
evaluated in terms of the person's ability to hear
and distinguish speech.
Loss
of hearing can be quantitatively determined by an
audiometer which meets the standards of the American
National Standards Institute (ANSI) for air and bone
conducted stimuli (i.e., ANSI S 3.6-1969 and ANSI
S 3.13-1972, or subsequent comparable revisions) and
performing all hearing measurements in an environment
which meets the ANSI standard for maximal permissible
background sound (ANSI S 3.1-1977).
Speech
discrimination should be determined using a standardized
measure of speech discrimination ability in quiet
at a test presentation level sufficient to ascertain
maximum discrimination ability. The speech discrimination
measure (test) used, and the level at which testing
was done, must be reported.
Hearing
tests should be preceded by an otolaryngologic examination
and should be performed by or under the supervision
of an otolaryngologist or audiologist qualified to
perform such tests.
In
order to establish an independent medical judgment
as to the level of impairment in a claimant alleging
deafness, the following examinations should be reported:
Otolaryngologic examination, pure tone air and bone
audiometry, speech reception threshold (SRT), and
speech discrimination testing. A copy of reports of
medical examination and audiologic evaluations must
be submitted.
Cases
of alleged "deaf mutism" should be documented
by a hearing evaluation. Records obtained from a speech
and hearing rehabilitation center or a special school
for the deaf may be acceptable, but if these reports
are not available, or are found to be inadequate,
a current hearing evaluation should be submitted as
outlined in the preceding paragraph.
2.
Vertigo associated with disturbances of labyrinthine-vestibular
function, including Meniere's disease. These disturbances
of balance are characterized by an hallucination of
motion or loss of position sense and a sensation of
dizziness which may be constant or may occur in paroxysmal
attacks. Nausea, vomiting, ataxia, and incapacitation
are frequently observed, particularly during the acute
attack. It is important to differentiate the report
of rotary vertigo from that of "dizziness"
which is described as lightheadedness, unsteadiness,
confusion, or syncope.
Meniere's
disease is characterized by paroxysmal attacks of
vertigo, tinnitus, and fluctuating hearing loss. Remissions
are unpredictable and irregular, but may be longlasting;
hence, the severity of impairment is best determined
after prolonged observation and serial reexaminations.
The
diagnosis of a vestibular disorder requires a comprehensive
neuro- otolaryngologic examination with a detailed
description of the vertiginous episodes, including
notation of frequency, severity, and duration of the
attacks. Pure tone and speech audiometry with the
appropriate special examinations, such as Bekesy audiometry,
are necessary. Vestibular functions is assessed by
positional and caloric testing, preferably by electronystagmography.
When polytograms, contrast radiography, or other special
tests have been performed, copies of the reports of
these tests should be obtained in addition to reports
of skull and temporal bone X-rays.
3.
Organic loss of speech. Glossectomy or laryngectomy
or cicatricial laryngeal stenosis due to injury or
infection results in loss of voice production by normal
means. In evaluating organic loss of speech (see 2.09),
ability to produce speech by any means includes the
use of mechanical or electronic devices. Impairment
of speech due to neurologic disorders should be evaluated
under 11.00-11.19.
2.01
Category of Impairments, Special Senses and Speech
2.02
Impairment of central visual acuity.
Remaining vision in the better eye after best correction
is 20/200 or less.
2.03
Contraction
of peripheral visual fields in the better eye.
A.
To 10º or less from the point of fixation; or
B.
So the widest diameter subtends an angle no greater
than 20º;
Or
C.
To 20 percent or less visual field efficiency.
2.04
Loss of visual
efficiency. Visual efficiency of better eye after
best correction 20 percent or less. (The percent of
remaining visual efficiency equals the product of
the percent of remaining central visual efficiency
and the percent of remaining visual field efficiency.)
2.05 Complete homonymous
hemianopsia (with or
without macular sparing). Evaluate under 2.04.
2.06 Total
bilateral ophthalmoplegia.
2.07 Disturbance
of labyrinthine-vestibular
function (including Meniere's disease), characterized
by a history of frequent attacks of balance disturbance,
tinnitus, and progressive loss of hearing. With both
A and B:
A. Disturbed function
of vestibular labyrinth demonstrated by caloric or
other vestibular tests; and
B. Hearing loss established
by audiometry.
2.08 Hearing
impairments (hearing not restorable by a hearing aid)
manifested by:
A. Average hearing
threshold sensitivity for air conduction of 90 decibels
or greater and for bone conduction to corresponding
maximal levels, in the better ear, determined by the
simple average of hearing threshold levels at 500,
1000 and 2000 hz. (see 2.00B1); or
B. Speech discrimination
scores of 40 percent or less in the better ear;
2.09 Organic loss of speech
due to any cause
with inability to produce by any means speech which
can be heard, understood, and sustained.
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