Editor’s note: I am most pleased to have Jim Jerger make a contribution to our Pathways Column. Correctly considered the “father of diagnostic audiology”, Dr. Jerger has seen and reported on many fascinating diagnostic cases. He has always been a champion for the clinical audiologist, supporting the practitioner in many positive ways. Dr. Jerger’s excellent experimental clinical studies have laid the groundwork for many of the diagnostic tests that most audiologists have used and presently do employ in the clinic. I know that Dr. Jerger has always valued the case report as an important contribution to the literature and a valuable teaching tool. In the commentary below a most interesting case profile is presented. It should stir one’s curiosity and thought processes as to why such findings would occur. I would encourage our readers to send me firstname.lastname@example.org comments on this case and to consider sending interesting case studies to our Pathways column to share with our readership.
By Jim Jerger
If you have been involved in Neuro-audiology for any length of time you have had at least one unforgettable experience with a patient. Mine happened many years ago. A young woman had an unusual reason for her visit to the clinic. Her complaint was that she was deaf in her left ear and wanted a hearing aid. How long had she been aware of the problem, we asked? As long as she can remember, she insisted, she has heard nothing in that left ear.
To our surprise pure tone thresholds were within normal limits on both ears. Why, then, did she think she was deaf in one ear? The answer was simple enough. Her PB max score was 98% on the right ear and 0% on the left ear. We explored higher levels on the left ear as well, but she understood no speech at any level. Under further questioning she admitted that she did hear some sounds in that ear, but they made no sense, so she just ignored them. As far as she was concerned that ear was useless to her, therefore “deaf”.
This was one of the earliest cases we had seen showing the combination of normal pure-tone thresholds and a marked deficit in speech understanding, the signature of an auditory processing disorder; in this young woman an almost unbelievable disparity between hearing-something and hearing- something-meaningful. We tried various amplification schemes to get speech on her left side over to the right ear, but without much success.
A few cases like this wetted our appetite to be on the lookout for similar problems. We never saw anything quite as dramatic as this again, but, by keeping an open mind and a test battery philosophy, uncovered many, many more adults with perhaps less dramatic evidence of APD.