PRESIDENT’S MESSAGE | We Don’t Treat Test Results–We Treat People

This article is a part of the January/February 2026, Volume 38, Number 1, Audiology Today issue.

By David Zapala, PhD

A friend of mine, a world-class neurologist, once stopped by my office with a paper audiological evaluation in hand. He told me the evaluation was from his brother, who lived out of town. He had some questions. Here is what the report said:

“Assessment: Bilateral, mild sensorineural hearing loss through 1500 Hz, sloping to moderately severe loss above 2kHz, with a 4kHz notch on the left, normal type ‘A’ tympanograms, present acoustic reflexes (ipsi and contra), and excellent word recognition scores (100%).

Plan: Hearing aids.”

These were his questions:

“I’m not particularly skilled at interpreting audiograms, but I do look for asymmetries as potential signs of focal problems. Examining the graphs (after consulting Dr. Google), it appears that my brother has more hearing loss in his left ear. Should he see an otolaryngologist?”

“I understand that he has hearing loss. It seems to be both mild and moderately severe. If his hearing loss is mild and his speech understanding is perfect, why does he need hearing aids? (ChatGPT says over-the-counter hearing aids [OTCs]) …or is his hearing loss moderately severe? When should he think about cochlear implants? (Google suggests maybe.)”

Can you see why my friend was confused? In this example, test results (objective test data in the Subjective-Objective-Assessment-Plan [SOAP] parlance) were confused with assessment statements (the clinician’s impression of the relevant causes underlying the patient’s hearing complaints). Assessment statements, also known as “problem lists” or “diagnoses”, are professional judgments based on the integration of subjective and objective information. They are not test results.

I am proposing that patients and other health care providers want to know three things as the product of an adult audiological evaluation:

1. Is there any indication of worrisome disease?

2. Is there an audiological explanation for the patient’s auditory complaints?

3. Is there anything in the patient’s life that might increase their risk for future hearing impairment?

I would have written the above evaluation summary this way:

Assessment

1.  Bilaterally, a mild to moderate sensorineural hearing loss, consistent with presbycusis and firearm-related noise-induced hearing loss.

2.  Communicative/perceptual difficulties secondary to hearing loss.

3.  Significant ongoing recreational
(firearm-related) noise exposure.

Plan

1.  Discussed aural rehabilitation options, including amplification and listening strategies, with the patient. He would like to proceed with an aural rehabilitation consult to include hearing aid selection.

2.  Reviewed hearing conservation principles. I recommended double muffling when on the shooting range and suggested a retest in one year to monitor the effectiveness of the hearing conservation efforts.

Is this perfect? Probably not. But it does highlight the key products of the evaluation. The first assessment statement (magnitude, type, symmetry, and likely etiology of recognized hearing loss) determines the need for ENT or other specialty referral. Recognizing presbycusis and noise-induced hearing loss is well within the scope of practice in most states. They are not worrisome ear diseases. Thus, there is no need for specialty referral. If there were indications of worrisome ear disease, we don’t necessarily need to diagnose the condition. We simply state that the etiology is idiopathic and refer appropriately.

The presence or absence of a communicative or perceptual difficulty is listed separately for good reasons. Audiologists like to describe audiometric configuration using terms like “Mild, sloping to moderately severe.” The classification systems from which the categories “mild”, “moderate”, and “severe” are defined (see American Speech-Language-Hearing Association, 1989; Clark, 1981; World Health Organization, 2021) propose a correlation between overall hearing loss severity and expected communication difficulties. As this example illustrates, using these categories to describe audiometric configurations can lead to confusion in both patients and other healthcare providers.

The International Classification of Functioning (ICF, 2001) appropriately recognizes that personal factors (such as depression, social anxiety, inattention, and central auditory processing disorders) and environmental factors may contribute to hearing difficulties, and these vary from one person to the next. These contextual factors, derived from both subjective and objective information, also influence the audiologists’ decision-making. Using hearing loss magnitude as the sole indicator for aural rehabilitation candidacy implies to others that audiological decision-making is a simple audiogram-to-hearing aid algorithm. It shouldn’t be.

Finally, this person presumably had a history of firearm-related noise exposure, which increases the risk of future hearing loss. We typically discuss this informally with patients, but do we systematically recognize it as a diagnostic impression and create a specific plan to manage the risk?

We are a doctoring profession, and we are evolving. To me, this means we diagnose to the limits of our professional expertise and within the scope of our practice (which admittedly varies from state to state – another topic). Our thinking (i.e., what is the product of an adult audiological assessment) and report writing also need to evolve. We will not earn respect as valued healthcare providers if we continue to misreport test results for salient impression statements. After all, we don’t treat test results – we treat people.

These are my personal opinions. I would love to hear from you. E-mail comments to: dzapala@audiology.org