A 65-year-old Caucasian male presents to your office and complains of a hearing impairment. He is a manager and runs his own business. He noticed that it is now difficult for him to understand his employees during business meetings. He hears well and speaks fluently while on the phone or when talking to his wife, but he poorly understands 'the people talking on TV shows'. His past medical history is insignificant. He is physically active, and works out in the gym three times a week. He does not smoke or consume alcohol. He is not taking any medications. You perform a speech discrimination test that turns out to be normal. Which of the following actions will most likely reveal an impaired speech discrimination in this patient?

Question

A 65-year-old Caucasian male presents to your office and complains of a hearing impairment.  He is a manager and runs his own business.  He noticed that it is now difficult for him to understand his employees during business meetings.  He hears well and speaks fluently while on the phone or when talking to his wife, but he poorly understands 'the people talking on TV shows'.  His past medical history is insignificant.  He is physically active, and works out in the gym three times a week.  He does not smoke or consume alcohol.  He is not taking any medications.  You perform a speech discrimination test that turns out to be normal.  Which of the following actions will most likely reveal an impaired speech discrimination in this patient?

Quizplus · Accepted Answer

Explanation: This patient presents with symptoms and signs suggestive of presbycusis, a sensorineural hearing impairment in elderly individuals. Usually, the disease is gradually progressive, and initially affects the high-frequency range of hearing. The decreased ability to discriminate speech is especially obvious in a noisy, distracting environment. This is why the patient can participate in a phone conversation and talk to his wife, but has difficulties in understanding spoken language during business meetings and while watching TV shows. The speech discrimination score may be normal in these patients; however, introducing background noise can reveal the hearing loss. (Choices A and E)Patients with presbycusis have difficulties understanding rapid speech and a complex or less familiar vocabulary. (Choices D and B)Decreasing the intensity of sounds and decreasing visual stimulation are less useful in eliciting the hearing problem in this patient. Educational Objective: The decreased ability to discriminate speech in patients with presbycusis is especially obvious in a noisy, distracting environment.

A 65-Year-Old Caucasian Male Presents to Your Office and Complains Of