certain, but the physician should state an opinion about causation to a “reasonable medical certainty.” In other words, the physician should identify a cause only if it is more likely than not that it contributed to the patient’s hearing loss.

Treatment Prescribed with Response and Prognosis

In many cases (especially when the hearing loss is conductive or mixed), medical or surgical treatment is advised. For most people applying for Social Security Disability Insurance or Supplemental Security Income because of hearing loss, medical treatment is no longer an issue. Hearing aids or cochlear implants may be advised. Prognosis (including expected response to recommended medical, surgical, or prosthetic intervention) is essential, because of the SSA standard of an “impairment which can be expected to last for a continuous period of at least twelve months.” Hearing impairment that has not been present and stable for at least 6 months will rarely meet this standard.

What the Claimant Can Still Do

Information collected during the history-taking and physical examination is combined with audiometric data and information obtained from previous medical and audiometric records to support an opinion regarding the claimant’s ability to hear and understand in a variety of communication settings.


The history and physical examination described above is typical not only for adults, but also for children of school age. Some parts of the physical examination (e.g., tuning fork tests and assessment of ability to communicate) will not be feasible in very young children, who may require additional evaluations before a determination of causation and prognosis can be made. These additional evaluations may include: medical genetics, ophthalmology, pediatric neurology, and speech-language pathology.


The basic audiometric test battery recommended by the committee includes assessment of pure-tone thresholds by air conduction and bone conduction, speech recognition thresholds, suprathreshold speech recognition in quiet and noise, and acoustic immittance measures. This pro-

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