Unilateral and bilateral hearing losses of 245 dB or less shall be assessed using the attached table, the percentage values of which are derived from simplification and re-elaboration (with excess or inadequate rounding) of the table for monolateral or bilateral hearing loss proposals Committee on Conservation of Hearing according to the AMA method 1961. Total unilateral deafness is attributed with a 15% disability score, with a 58.5% degree of total bilateral deafness. Li 'where the percentage values in the table are expressed by decimal numbers with a fraction of half a point will be at the discretion of the Commission, case by case give half point to the full score in excess or in default (for example the score of 58.5 can be brought at 59 or 58).
The score relating to hearing losses with a fluctuating and strongly discontinuous rhythm (transmission hearing loss, mixed-type hearing losses, neuro-sensory hypoacusias with pathological tympanogram, Meniere's diseases, etc.) must result from an observation period of at least 1 year , By performing at least 3 oto-functional tests performed every 3-4 months. The score will come from the average loss between the three exams. Furthermore the revision is recommended every three years.2)
The assessment of the degree of hearing loss and the calculation of the scoresovanno always performed with the naked ear, ie without prosthesis.
This for many reasons:
it is not possible to evaluate the prosthetic efficacy and yield if not after an appropriate training period and variable adaptation from case to case;
the traditional evaluation of prosthetic yield by means of tonal audiometric examination in the free field is not suitable and furthermore it is not acoustically correct to compare answers in the open field with answers in the headphones;
the only valid test to verify the prosthetic output is the vocal audiometry that can be performed only in a few specialized centers, and in this method they are used as dB SPL measurement units that are difficult to convert to dB HTL;
and the same evaluation problems are introduced linked to the use of the free field mentioned above;
the verification of the gain produced by the prosthesis presupposes the simultaneous verification by the Commission of the correctness both of the prescription and of the application of the prosthesis;
noticeably difficult and uncertain is the evaluation in medico-legal terms of the advantage produced by the use of hearing aids, considering the disadvantages they present, the aesthetic damages that make it impossible to use them in noisy environments, the difficulties of using them during the work, auditory fatigue etc;
it seems more appropriate to carry out a theoretical evaluation on the possibility or not of application of a prosthesis for each degree of hearing loss and where this theoretical possibility exists to apply a limited reduction of the invalidity score;
the reduction of the disability in cases of prosthetic hearing loss has been fixed in our table in 9 points and concerns all the hypoacusies equal to or less than 245 dB on the best ear; therefore, starting from bilateral hypoacusies of more than 245 dB, which are difficult to be treated with a 65% disability, we move to bilateral hypoacusies equal to or less than 245 dB on the best ear where prosthetics is possible and to which a invalidity up to a maximum of 59%; the critical level of transition from a well-prosthetic hypoacusia to a difficult-to-repositionable hearing loss was therefore fixed at 245 dB; below this level of loss a reduction of 9% is automatically applied on the basis of the possibility of applying a prosthetic device that can totally or partially guarantee the functional restoration of the hearing system.
2) In cases in which it is not possible to use subjective tonal limiting audiometry, and therefore values expressed in dB HTL, but only objective tests such as auditory evoked potentials, and therefore values expressed in dB SPL, the table can be used in the following:
a) conversion of dB SPL (acoustic pressure) into dB HTL (subjective threshold) where the threshold obtained has been expressed precisely in dB SPL;
b) sum of the loss in dB HTL on the three frequencies 500, 1000 and 2000 Hz in case pure tones or frequency-characterized stimuli have been used;
c) multiplication by 3 of the detected loss value and converted into dB HTL, where only one type of stimulus (eg the click) that can not be characterized in frequency is used.
See table below
For the purpose of granting the communication allowance the term "pre-lingual deaf", as per art. 4, of the Law of 21 November 1988, n. 508, must be considered equivalent to the term "deaf-mute" as per art. 1 of the Law of 26 May 1970, n. 381 ("... is considered deaf and dumb the sensory hearing impaired by congenital or acquired deafness during the developmental age that has prevented the normal learning of spoken language, as long as the deafness is not exclusively psychic or dependent on cause war, work or service ").
The following is specified:
a) for the purpose of applying the aforementioned rules, the final term of the "developmental age" must be identified with the completion of the twelfth year of age;
b) the term "which has prevented the normal learning of spoken language" must be understood in the sense that hearing impairment makes or has made normal the learning of spoken language difficult. The factors that in a hypoacusia can make normal the learning of spoken language difficult are many and complex: first, among all, the epoch of the onset of hypoacusia in relation to the developmental age referred to in point a) and the level of hearing loss referred to in point c).
Other factors that are important, but uncertain and therefore not quantifiable and which can be assessed in the regulations are the precociousness and correctness of the diagnosis and treatment, the socio-cultural level of the family and others.
c) exclusively for the purposes of granting the communication allowance, the hearing loss that entitles you to benefit from this allowance must be:
1) equal to or greater than 60 dB of average between the frequencies 500, 1000, 2000 Hz in the best ear if the applicant has not yet completed the twelfth year of age;
2) equal to or higher than 75 dB if the applicant has reached the twelfth year of age, as long as the onset of hearing loss proves to be demonstrable before the completion of the twelfth year.
To this end, clinical documents issued by public structures and, in the absence of certain chronological data, the evaluation of the qualitative and quantitative characteristics of spoken language and of the communicative powers as a whole from which one can derive an audiogenic origin of phono alterations will be valid. -Languages present;
3) the audiometric examination or examinations to be assessed for the purpose of granting the indemnity must be made after the first year of age;
4) the examination or exams related to patients under the age of 12 must clearly show a certification of reliability of the examination itself (reliable / unreliable) drawn up by the examining doctor;
5) transmission-type hearing losses or anyway accompanied by tympanograms demonstrating tube-tympanic diseases must be evaluated according to the criteria already exposed for civil disability;
6) the impedance test, also to allow an evaluation referred to in the previous point, must be attached to each audiometric test, unless there are clear contraindications (chronic otitis with an open tympanic membrane, stenosis or lesions of the ear canal, etc. ).
d) The recipients of the communication allowance, granted before the age of twelve, due to a hearing loss of less than 75 dB of average between the frequencies 500, 1000, 2000 Hz in the best ear, fall from the enjoyment of the benefit to the achievement of said age.In all cases in which the levels of hearing loss are lower than those indicated above or if a period of onset of the hearing loss included in the evolutionary age is not demonstrable, a evaluation according to the criteria of civil invalidity.
For the purposes of granting the pension as per art. 1 of the Law of 26 May 1970, n. 381 and subsequent modifications, the hearing threshold requirement is to be considered corresponding to a hearing loss equal to or higher than 75 dB HTL of average between the frequencies 500, 1000, 2000 Hz on the best ear, without prejudice to the other requirements of the aforementioned Law.
Health assessments relating to prelingual deafness must be performed by specialists in otorhinolaryngology or in audiology or phoniatrics.
The aforementioned auditory threshold values are to be referred to dB HTL;
in case the clinical exams show values expressed in dB SPL (as in the case of evoked potentials) these must duly be converted into dB HTL