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Abstract
Not all audiograms having a high frequency notch are due to noise damage. Head trauma and genetic factors may account for them, and another possible cause has been a presumed idiopathic sensorineural hearing loss having a NIHL-like audiometric configuration. The concept of that diagnostic entity has previously been based only on retrospective evidence, which by its very nature must leave an element of doubt: but the concept is now evidenced prospectively by the case presented here. Seven annual monitoring audiograms between 1991 and 1997 showed very good hearing and no sign of developing NIHL. That would not have been expected anyway in view of both closely supervised and self-reported use of hearing protective devices that were more than sufficient for the noise concerned. Between 1997 and 1998 a hearing loss developed with a NIHL-like audiogram, marked notches at 4 kHz. Its fairly rapid increase over four years and subsequent levelling off has been documented by a further ten audiograms up to 2003 and one post-employment audiogram in 2004. Since 2001 a 1.5 kHz notch also developed and increased at first, but more recently has been decreasing. It is argued on five grounds that noise damage is very unlikely to be the cause of the hearing losses. As no artefact or other cause could be discovered to explain this man's hearing disorder, we have categorized it as idiopathic.