plied to measures obtained in very specific test conditions. Moreover, the criteria vary somewhat for claimants who wear a hearing aid or cochlear implant compared with claimants who are unaided. For claimants who do not wear a hearing aid or cochlear implant, the criterion for hearing disability is a PTA in the profound range (≥ 90 dB HL) or speech recognition performance less than or equal to 40 percent correct in quiet. For those claimants who wear a hearing aid or cochlear implant, the criterion for hearing disability is aided speech recognition performance less than 40 percent correct in quiet under specified test conditions.

These changes to the protocol are expected to yield an improvement in validity and can be supported by two generic examples:

  1. Under the current medical listings, many persons with severe hearing loss who are not cochlear implant users are denied eligibility because their PTA 512 is better than 90 dB HL and their speech recognition score, measured at unrealistically high presentation levels, is higher than 40 percent correct. Many of these individuals are false negatives. Specifying the presentation level of 70 dB SPL in the sound field will certainly reduce these false negatives (but will also create some new false positives, it is hoped few in number compared with the reduction in the number of false negatives).

  2. Under the current medical listings, assuming most SSA personnel don’t permit aided testing, virtually everyone with a cochlear implant is declared eligible. Clearly, many of these individuals are false positives because with the cochlear implant they can perform well in the workplace. Specifying aided sound field testing will certainly reduce false positives (but will also create some new false negatives, it is hoped few in number compared with the reduction in false positives).

SPECIFIC RECOMMENDATIONS

The following discussion on tests for disability determination applies to tests that may be used in Steps 2, 3, 4, or 5 of the SSA disability determination process. Any recommendations for medical listings (Step 3) are identified explicitly as such.

Otolaryngological Examination

Action Recommendation 4-1. The otolaryngological exam that is required for disability determination should be performed by an otolaryngologist certified by the American Board of Otolaryngology. The recommended examination is described in detail in Chapter 3. The committee



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