Clinic : Unilateral Hearing Loss

Last week, its my practical exam, and i got Unilateral hearing loss cases

History

• 24/ Male
• alleged of hearing problem on left side
• started after MVA (early last year), doctor diagnosed hearing organ and nerve affected
• have balance problem
• left ear ringing sound, that occurred continuously
• no other significant problem related

Audiological Findings

• Otoscopic Examination: Clear EAC, with intact TM bilaterally
• Tympanometry : Type A bilaterally
• Acoustic Reflex: Tone effect pattern
• PTA : 
• Right : Mild SNHL
• Left : Profound SNHL

Management

• ABR ( SOL) - for Unilateral tinnitus, and Unilateral HL. Even if its above output limit of the ABR, this test can be done to check the consistencies, avoid functional HL.
• Tinnitus therapy : main goal is to achieve habituation. counselling is important
• Balance test: to check on the vestibular system. 
• Communication Strategies : to ensure patient able to be a competent comunicator
• ENT referral: for management ( 1- Unilateral HL --> even if the MVA can be the possible causes, to ruled out retrocochlear loss is important, 2- balance problem
• monitor hearing : since he have only one side hearing, its important to preserve his hearing. 

Issues encounter

1) Masking dilemma - undermasking likely to occur..

2) Change to insert phone, to reduce masking

3) BC start at poorer ear

4) vibrotactile respond - ensure with patient =)

and..... i get to remedial my clinic...

i not yet that competent =)