m. 0'. kia B.Sc; (AST) Audiologist & Speech Pathoiugist RCI Reg, No.

A00112 Ashish Dholakia (DHLS) Speech Therapist & Hearing Health Specialist L ROI Reg. No. B0270? A 1st Floor, Shri Narnarayan Palace. Nr. Kothawala Flats, Pritamnagar, Ahmedabad - 380 006

Phone : (079) 26575341

Emaii : hearinghelp2003@yahom:o.in lmran Dharnani MASLP(Go|d Medalist) Master's in Audioiogy and Speech Pathology Ex. Lecturer at Manipai University RCI Reg. No. A1 =9

Audiological Evaluation Report

Patient Information:

Regd. N0.6200 Date of Test: 02f1 M2009 Name: Ketav Modi ' AgefScx: 22 year f Male History:
Ref. Dr.: A I Shah

Audiological Findings: Audiometerz Elkon EDA 3N3 Multi. Test Responses: Reiiable and consistent Test Condition: Sound treated Two-room setup.

Special Tests: S.I.S.I.: Bilateral 0 % (Negative) across the frequencies.

Immitanee Audiometry: indicates Bilateral A type tympanogram with normal MEP, ECV and compliance. Acoustic reflexes are elevated in Left ear and present in right ear. These finding are may be sfo of N0 Significant MEP. PROVISIONAL DIAGNOSIS: Bilateral Hearing Sensitivity with in Normal Limits.
Advice:

- To consult Dr. Shah . D. Dholakia B, So. Senior Audiofogist lmran Dhamani MASLP Audiologist Ashish Dholakia Audiologist

Hearing Eva-Mation Report

Client Name: Modi, Ketav Client #: 0000173
Birthdate: Date of Evaluation:

Sanket Speech Hearing Clinic Address: Is! Pritamnagar Flr Narnarayan Palace Allmcdabad Tel: Fax: 330006 No: l P A T I E N T D A T A F amiiy Name: Mud] . Sex: M II) no: 6200 First NIIITIQ(SII Kiihin . mu: M ID no: 6200 First Name(s): Ketan Age (years): 22 Date (YMD): 2009-1 H12 Address: Title: Tel: Examiner: MUD Instrument: Impedance Audiomrter Impedance Right Tympanogram Left Tympanogram . ml Right Tympanogram Left Tympanogram ' l ml ml 3.0 3.0 2.5 2.5 2.0 2.1] 1.5 1.5

1.0 1.0

I 0.5 L 0.5 K 0 [I
-600 0 300 daIa -600 0 300 cIaPa Volume 0.96 ml Volume ml ms -MI .. vomme ml Cunapliance {.05 ml Compliance 1.3? ml Pressure 23 daPa Pressure 2 d:aP:1 Gradient ml Gradient ml Riilem Type Press TIM Press Type

Sanket Speech Hearing Clinic

LLLL
Speech & Hearing GE
Time: 11.30 to 7.30. Sunday Closed Kothawala Flats, Pritamnagar, Ahmedabad - 380 006 sanketclinicsom Website: www.sanketclinic.mm