Subject: Re: case report From: Kartik Narayanan <akartik1@xxxxxxxx> Date: Sat, 24 Feb 2007 15:53:15 -0800 List-Archive:<http://lists.mcgill.ca/scripts/wa.exe?LIST=AUDITORY>--0-1132880743-1172361195=:48082 Content-Type: multipart/alternative; boundary="0-288464728-1172361195=:48082" --0-288464728-1172361195=:48082 Content-Type: text/plain; charset=iso-8859-1 Content-Transfer-Encoding: 8bit Note: forwarded message attached. --------------------------------- Any questions? Get answers on any topic at Yahoo! Answers. Try it now. --0-288464728-1172361195=:48082 Content-Type: text/html; charset=iso-8859-1 Content-Transfer-Encoding: 8bit <BR><BR>Note: forwarded message attached.<p>  <hr size=1>Any questions? Get answers on any topic at <a href="http://answers.yahoo.com/;_ylc=X3oDMTFvbGNhMGE3BF9TAzM5NjU0NTEwOARfcwMzOTY1NDUxMDMEc2VjA21haWxfdGFnbGluZQRzbGsDbWFpbF90YWcx">Yahoo! Answers</a>. Try it now. --0-288464728-1172361195=:48082-- --0-1132880743-1172361195=:48082 Content-Type: message/rfc822 Content-Transfer-Encoding: 8bit Received: from [125.238.29.192] by web43143.mail.sp1.yahoo.com via HTTP; Sat, 24 Feb 2007 15:52:28 PST Date: Sat, 24 Feb 2007 15:52:28 -0800 (PST) From: Kartik Narayanan <akartik1@xxxxxxxx> Subject: Re: case report To: hari prakash <h.prakash.p@xxxxxxxx> In-Reply-To: <c03ea5370702231749n1405effbxb0bdfe5d0fe6d7d3@xxxxxxxx> MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="0-594687638-1172361148=:83649" Content-Transfer-Encoding: 8bit Content-Length: 3228 --0-594687638-1172361148=:83649 Content-Type: text/plain; charset=iso-8859-1 Content-Transfer-Encoding: 8bit Dear Hari, There have been many such devaint cases noted in literature, where CI is not an obvious choice as per candidacy guidelines. i think we should follow the following steps: 1. The child must be given a fair hearing aid trial for suspected hearing loss. The reason for this being that there are two schools of thought w.r.t. Hg aid utility in clients with auditory neuropathy. So, we are giving equal priority to both schools. 2. There should be an evaluation repeated after 6- 8 months post-amplification (trial). If the client is a case of auditory maturational delay, it would definitely avoid missing the sensitivity period/ critical age benefits. And, hearig aid would be an obvious choice or he could even be an individual with normal hearing sensitivity (at a later evaluation). 3. And if there is no post-amplificatory benefits found, then it would leave us exactly at FDA guidelines (i.e. 18 months) for implantation to take place. I think this would be the safest means of making sure that we are making the right decision. Awaiting to hear soem comments from other members of the community. Kartik hari prakash <h.prakash.p@xxxxxxxx> wrote: Dear list, Greetings from India. Here I report a child with Auditory Neuropathy... please give ur suggestions regarding Cochlear Implant The child had HyperBillirubinemia and blood transfusion was done, following which he developed stiffness and developmental delay. When the child was 4 months he was evaluated for Hearing... the results were... BOA - 40 dB for speech stimuli. ABR - absent OAE - present in one ear and absent in other ear CM - Robust in one ear and feeble in other (polarity reversal) LLR - Present but prolonged. Second evaluation was after a period of 6 months, and the results of the second evaluations shadows the first. Now can we suggest cochlear Implant for this child? Is there any pediatric Auditory neuropathy been implanted earlier with similar cause? Before implantation what tests can be used to confirm the functional ability of the spiral ganglion cells If u still has patience to read, here is another interesting case of auditory neuropathy... A 30 year old female had metastatic adenocarcinoma with unknown primary. CT and MRI showed, a ring enhancing lesion in the occipital lobe, but increased intracranial pressure was not present. Surgery was done to remove only the largest tumor on the occipital lobe. After the surgery she came for Audiological evaluation to establish a base line audiogram before chemotherapy was started. Audiological evaluation showed the following... PTA - R - moderate sloping HL L - Profound HL SI - 0% in both ears ABR - Absent in both ears OAE - present in both ears CM - enhanced in both ears (polarity reversal) LLR - P1-N1-P2-N2 with very good morphology, amplitude and well within normal latencies. Diagnosis: Auditory Dsynchrony. The second evaluation was done after one month and results are shown below PTA - Unchanged SI - 85% ABR - V peaks occurs consistently but prolonged, earlier peaks absent. OAE - Present CM - present LLR - same as that of first evaluation. What would be cause for such a reversible AN in this patient? we delineated hypothermia, anoxia, TIA, etc.... But either that cause has not incurred in this case or that possible conditions will not correlate with present findings.Have any one encounter such a case? Is there any other causes? -- Hari Prakash.P. Msc Audiology. Lecturer, Dept. of Speech and Hearing MCOAHS, Manipal - 4 karnataka, India. mobile - +91 9886135522 --------------------------------- Want to start your own business? Learn how on Yahoo! Small Business. --0-594687638-1172361148=:83649 Content-Type: text/html; charset=iso-8859-1 Content-Transfer-Encoding: 8bit <div><FONT color=#00007f>Dear Hari,</FONT></div> <div><FONT color=#00007f></FONT> </div> <div><FONT color=#00007f> There have been many such devaint cases noted in literature, where CI is not an obvious choice as per candidacy guidelines. i think we should follow the following steps:</FONT></div> <div><FONT color=#00007f></FONT> </div> <div><FONT color=#00007f>1. The child must be given a fair hearing aid trial for suspected hearing loss. The reason for this being that there are two schools of thought w.r.t. Hg aid utility in clients with auditory neuropathy. So, we are giving equal priority to both schools.</FONT></div> <div><FONT color=#00007f></FONT> </div> <div><FONT color=#00007f>2. There should be an evaluation repeated after 6- 8 months post-amplification (trial). If the client is a case of auditory maturational delay, it would definitely avoid missing the sensitivity period/ critical age benefits. And, hearig aid would be an obvious choice or he could even be an individual with normal hearing sensitivity (at a later evaluation).</FONT></div> <div><FONT color=#00007f></FONT> </div> <div><FONT color=#00007f>3. And if there is no post-amplificatory benefits found, then it would leave us exactly at FDA guidelines (i.e. 18 months) for implantation to take place.</FONT></div> <div><FONT color=#00007f></FONT> </div> <div><FONT color=#00007f> I think this would be the safest means of making sure that we are making the right decision.</FONT></div> <div><FONT color=#00007f></FONT> </div> <div><FONT color=#00007f> Awaiting to hear soem comments from other members of the community.</FONT></div> <div><FONT color=#00007f></FONT> </div> <div><FONT color=#00007f>Kartik</FONT><BR><BR><B><I>hari prakash <h.prakash.p@xxxxxxxx></I></B> wrote:</div> <BLOCKQUOTE class=replbq style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid"> <DIV><BR clear=all> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">Dear list, </SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"> </SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"> Greetings from India.</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"> Here I report a child with Auditory Neuropathy... please give ur suggestions regarding Cochlear Implant</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"> The child had HyperBillirubinemia and blood transfusion was done, following which he developed stiffness and developmental delay. When the child was 4 months he was evaluated for Hearing... the results were...</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">BOA - 40 dB for speech stimuli.</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">ABR - absent</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">OAE - present in one ear and absent in other ear</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">CM - Robust in one ear and feeble in other (polarity reversal)</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">LLR - Present but prolonged.</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">Second evaluation was after a period of 6 months, and the results of the second evaluations shadows the first.</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">Now can we suggest cochlear Implant for this child? Is there any pediatric Auditory neuropathy been implanted earlier with similar cause? Before implantation what tests can be used to confirm the functional ability of the spiral ganglion cells </SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">If u still has patience to read, here is another interesting case of auditory neuropathy...</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">A 30 year old female had metastatic adenocarcinoma with unknown primary. CT and MRI showed, a ring enhancing lesion in the occipital lobe, but increased intracranial pressure was not present. Surgery was done to remove only the largest tumor on the occipital lobe. </SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"> After the surgery she came for Audiological evaluation to establish a base line audiogram before chemotherapy was started. Audiological evaluation showed the following...</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">PTA - R - moderate sloping HL</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"> <SPAN style="mso-spacerun: yes"> </SPAN>L - Profound HL</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">SI - 0% in both ears</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">ABR - Absent in both ears</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">OAE - present in both ears</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">CM - enhanced in both ears (polarity reversal)</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">LLR - P1-N1-P2-N2 with very good morphology, amplitude and well within normal latencies.</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">Diagnosis: Auditory Dsynchrony.</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">The second evaluation was done after one month and results are shown below</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">PTA - Unchanged</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">SI - 85%</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">ABR - V peaks occurs consistently but prolonged, earlier peaks absent.</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">OAE - Present</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">CM - present</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">LLR - same as that of first evaluation.</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"></SPAN> </div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">What would be cause for such a reversible AN in this patient? we delineated hypothermia, anoxia, TIA, etc....</SPAN></div> <div class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'">But either that cause has not incurred in this case or that possible conditions will not correlate with present findings.Have any one encounter such a case? Is there any other causes?</SPAN></div> <div class=MsoNormal style="MARGIN: 0in 0in 10pt"><FONT face=Calibri></FONT> </div></DIV> <DIV> </DIV> <DIV><BR>-- <BR>Hari Prakash.P. Msc Audiology.<BR>Lecturer, Dept. of Speech and Hearing<BR>MCOAHS,<BR>Manipal - 4<BR>karnataka,<BR>India.<BR>mobile - +91 9886135522 </DIV></BLOCKQUOTE><BR><p>  <hr size=1>Want to start your own business? Learn how on <a href="http://us.rd.yahoo.com/evt=41244/*http://smallbusiness.yahoo.com/r-index">Yahoo! Small Business.</a> --0-594687638-1172361148=:83649-- --0-1132880743-1172361195=:48082--