Tinnitus: Noise-Induced Hearing Loss
A 15-year-old girl, ED, was referred to Children's Hospital Boston Audiology Services for audiological evaluation. At her annual physical exam, the child had complained of recent-onset left-sided tinnitus. She is an avid student of violin and had also recently increased her practice time from 60 minutes per day to 90 minutes per day. The case history revealed no other significant noise exposure (recreational or occupational). Her tinnitus was intermittent but was consistently present after violin practice.
The patient was instructed to bring her violin with her to the audiological evaluation, as well as any sheet music she needed to briefly practice her instrument. Pure tone air-conduction audiometry was conducted at audiometric test frequencies of 250 to 8000 Hz, including the interoctave frequencies 1500, 3000, and 6000 Hz in both ears. Normal hearing sensitivity was found at all frequencies, and the configuration was not suggestive of a high-frequency “notch” in either ear. Speech reception thresholds were normal and corroborated tonal findings in both ears. The word recognition score (WRS) was assessed at 50 dB HL in both ears, and WRS was 100% bilaterally. Distortion product otoacoustic emissions (DPOAEs) were performed in both ears at f