IPP Adult Hearing Loss Case Rubric Sample
Name: Todd Jones
Date: 2/13/2017
Current Diagnosis: Sensorineural bilateral hearing loss
(if applicable)
Date of Birth: 07/06/1957
IPP Team Members
Name
Profession
Name
Profession
1. Craig Newsome
PT
6. Sandy Hart
Nutritionist
2. Beth Walton
Audiologist
7. Molly Lerner
Diabetes Educator
3. Brian Reynolds
Pharmacist
8. Peggy Cross
PCP
4. Amy Jones
Spouse
9. Scott Trainer
Podiatrist
5. Susan Hannah
Cardiologist
Name of Team Facilitator: Beth Walton, Audiologist
Case Rubric
General Medical History: Todd Jones is a 60-year old man,
married with two adult children. Current medical conditions and
concerns reported by Mr. Jones:

History and Concerns
(Share key information
gathered from team)

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
Atrial fibrillation and high blood pressure; currently under
the care of a cardiologist for these conditions. Mr. Jones is
taking Warfarin and Hydrochlorothiazide.
Type II diabetes and is currently under the care of his
primary care physician (PCP). Mr. Jones is taking
Metformin.
Obesity. PCP told Mr. Jones he is obese, which may be
contributing to his health concerns. Blood tests revealed
high cholesterol levels. His PCP prescribed Atorvastatin.
Anxiety, sleep issues, and joint pain. He is self-treating for
these conditions.
o Gingko biloba for anxiety
o Melatonin for sleep problems
o Aspirin for the pain in his joints
o Orlistat for obesity
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
Mr. Jones reported having a sense of tingling and
numbness in his feet.
Recently, Mr. Jones’ boss had a conversation with him about his
performance at work because he is missing important
information at meetings and is making mistakes at work. Mr.
Jones feels that his job may be in jeopardy.
Although he has denied having a hearing loss for many years,
the current work issue has highlighted the need to address
hearing loss. Mr. Jones made an appointment with Audiologist
Beth Walton in hopes of improving his hearing and keeping his
job. His family is supportive of this decision.
Audiologic History: Mr. Jones reported a 30-year history of
noise exposure during past military service and attending rock
concerts in his youth. He described constant noise (tinnitus) in
both ears for many years, though not bothersome. Mr. Jones
stated, “I can hear conversation, but understanding can be
difficult. Everyone mumbles.” His wife reported that he has
difficulty understanding conversations at home. She added, “He
listens to the television at too loud a volume for our children and
me to be in the same room. He is resistant to attend social
gatherings. We are all frustrated when we try to communicate
[with him].” Additionally, the audiologist noticed that he walks
with an unsteady gait.
Beth Walton, AuD, developed a comprehensive test battery and
administered it to Mr. Jones in order to develop a differential
diagnosis.
Assessment Plan






Pure-tone threshold audiogram (PTA) (air and bone)
Speech reception thresholds (SRTs)
Word recognition testing in quiet at a normal conversational
level
Speech-in-noise testing
Otoacoustic emissions test battery
Immittance test battery
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Patient results were judged reliable.





Assessment Results
(Summarize key diagnostic
results)

PTA (air and bone): Mild to severe sensorineural hearing
loss (SNHL) above 1000 HZ, bilateral and symmetrical
configuration
SRTs: Consistent with PTA
Word recognition testing in quiet at a normal conversational
level: 82% in left ear; 86% in right ear
Speech-in-noise testing: Moderate speech-in-noise ratio
loss
Otoacoustic emissions test battery: Absent bilaterally and
consistent with audiometric thresholds
Immittance test battery: Tympanograms normal bilaterally.
Reflexes normal bilaterally on contra and ipsi stimulation.
No acoustic decay in either ear.
Beth Walton, AuD, explained findings to patient and spouse.
Audiometric configuration indicates a bilateral, sensorineural,
sloping, high-frequency hearing loss above 1000 HZ. This loss
above 1000Hz slopes from mild-to-severe degree and is
symmetrical.
Dr. Walton also felt that it would be in the patient’s best interest
to form an IPP team to address health concerns for which Mr.
Jones is self-treating (e.g., weight, sleep, anxiety, joint pain).
Mr. Jones and spouse contributed to the discussion and agreed
with the results and with all recommendations of the
audiologist’s treatment plan.
Audiologic Treatment Plan:


Treatment Plan


Hearing aid evaluation and follow-up counseling
Client Oriented Scale of Improvement (COSI) to record and
establish functional goals, which included understanding
speech at meetings, understanding family’s speech and
participating in conversations, and turning down television
volume to be able to watch television with family
Real-ear measures at first counseling follow-up
Post-questionnaire administered during a follow-up
appointment
IPP Treatment Plan:
The IPP team worked together on the patient’s complex
medical problems and concerns.
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Initial IPP team:
1. Beth Walton: Audiologist (addressed hearing concerns)
2. Craig Newsome: PT (addressed unsteady gait and foot
numbness)
3. Brian Reynolds: Pharmacist (addressed polypharmacy)
4. Amy Jones: Spouse
5. Susan Hannah: Cardiologist (addressed atrial fibrillation and
high blood pressure)
6. Sandy Hart: Nutritionist (addressed Type II diabetes)
7. Molly Lerner: Diabetes Educator (addressed Type II
diabetes)
8. Peggy Cross: PCP
9. Scott Trainer: Podiatrist (addressed Type II diabetes and
tingling and numbness in feet)
Treatment Outcomes
(Discuss results of
treatment)
1. Mr. Jones purchased hearing aids. On a follow-up
counseling appointment, he reported using his hearing aids
daily and doing well. Speech understanding at home and at
work meetings has improved. His family can now enjoy TV
with the volume down to a comfortable range. Speech in
background noise continues to be a bit challenging. Realear assessment was performed, and small adjustments to
programming were made. At next follow-up, post–selfquestionnaire will be administered.
2. Mr. Jones is making progress with diet and weight
management with support from the diabetes educator and
the nutritionist.
3. Balance is improved; he continues with PT and has had a
medical appointment with the podiatrist.
4. Pharmacist, cardiologist and PCP collaborated on
medication management. Modified medication protocol and
dosage was established and will be modified as needed.
IPP Communications:
Team Follow-Up
(Determine meetings and
communication plan)
Weekly team communications and other scheduled check-ins
using a variety of communication methods: e-mail, telephone,
Skype, GoTo meetings, and other video conferencing tools


Urgent team communications, as needed
Face-to-face team meetings every 6 weeks for 1 year
(The team should ensure that all communication aligns with FERPA and HIPAA.)
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