182 Chapter 9
The trip with your deaf friends has been an exciting wilderness adventure. In the end, you have
learned a lot about canoeing and camping, as well as the wisdom of not relying on your fishing
prowess as the sole source of food. You also appreciate how deeply some in the deaf community feel
about their language and culture and the challenges the emerging technology of cochlear implants
is bringing to their sense of community.
Case Study 9-6: Traumatically Induced Hearing Loss in a
24- Year- Old Man
Who among us has not done something incredibly stupid and walked away from it unscathed?
Darting through traffic instead of using a crosswalk, cutting off a driver to get onto an exit ramp,
skiing the advanced slope without being an expert skier, petting a stray dog, redlining a motorcycle
just to see what it can do, and bolting a bicycle though congested traffic are the kinds of things
every one has done at some time without dire consequences. And then there are the kinds of things
some of us have done under the inf luence of alcohol, when the stupidity index is raised. Usually
no harm is done, but sometimes intoxication and taking chances do not mix, and on one Saturday
night, Sebastian’s luck ran out.
The two couples had been close friends since high school, and clubbing had been a big part of
their social lives. Friday and Saturday nights were party nights, and the four longtime friends were
hard drinkers. They particularly liked to build a campfire at the deserted army base, tap kegs, and
drink into the early morning. On the base was an old two- story wooden geodesic dome, a remnant
of army architectural experimentation, and one eve ning, Sebastian was challenged to climb it.
Filled with liquid courage, this fledgling rock climber agreed.
The decrepit building had several footholds, and soon Sebastian was spidering up it. When he
reached the top, he stood triumphantly with his hands held high above his head. Then, according
to his girlfriend, his footing gave way and he toppled more than two stories, slamming his head
onto a concrete pad. Emergency medical technicians brought the unconscious man to the emer-
gency room of a nearby hospital. According to their report, blood and possibly brain matter were
exuding from his right ear at the accident scene. Sebastian spent several weeks in the hospital’s
acute care section in a coma.
Because of the force of the impact, Sebastian suffered a severe traumatic brain injury. Weeks
later, as he gradually came out of the coma, he was transferred to the hospital’s rehabilitation unit,
where he underwent extensive neuropsychological and speech- language pathology testing. The
test results were suspect, possibly due to Sebastian’s traumatically induced hearing loss, and he was
then sent to the hospital’s audiology section for extensive audiological testing.
Sebastian’s fall had nearly torn off his pinna, and there was bleeding and inf lammation of his
external right ear. The audiologist and otologist administered a battery of tests to the occasion-
ally stuporous man, including an otoscopic examination and pure tones, tympanometry, acoustic
ref lex, otoacoustic emissions, and brainstem auditory evoked tests. Based on the test results,
Sebastian was found to have significant bilateral hearing loss. The ossicular chain of his right ear
was disrupted, causing a 55- dB conductive hearing loss. Because of the impact to the skull and the
accompanying acceleration and deceleration forces, there was also apparent damage to Sebastian’s
left cochlea, with corresponding sensorineural hearing loss. A later complication affecting
Sebastian’s hearing was meningitis, which may have further damaged his auditory pro cessing.
After the testing was completed, the audiologist met with Sebastian’s rehabilitation team
and his family to discuss the results. He explained the results of the testing and presented charts
showing where Sebastian’s hearing was damaged. Eventually, Sebastian underwent surgery to
repair the ossicular chain in his right ear, and the results were successful. Reconstructive surgery
also repaired the damage to his pinna. The audiologist provided amplification for his left ear. At