Audiology Results Letter (Referring Clinician)

Date: [Date]

Patient: [Patient name], [DOB], [MRN]

Date of Service: [Date of service]

Referring Clinician: [Referring clinician name, credentials]

From: [Audiologist name], [Credentials], [Clinic/Department], [Direct contact]

To: [Referring clinician name/clinic]

CC: [Names/roles] (Only include if applicable.)

RE: [Patient name] (DOB [DOB]) — Audiologic Evaluation on [Date of service]

Reason for Referral

[Presenting concern and referrer's clinical question] (1–2 sentences. If the referral question was not specified, state: "Referral question not specified.")

Summary of Findings

(Provide a concise, bottom-line interpretation first. Use 2–4 short sentences or bullets. Use standardized terminology; avoid dense numeric strings. Do not infer medical etiology.)

• [Right ear: hearing status (type and degree); configuration if relevant]
• [Left ear: hearing status (type and degree); configuration if relevant]
• [Middle ear status from tympanometry if performed]
• [Speech understanding summary if clinically meaningful]
• [Comparison to prior testing: stable / improved / worsened / no prior available]

Relevant History

(Include only items that change interpretation, urgency, or recommendations. Attribute to patient/caregiver report. State "History limited due to [reason]" if applicable.)

[Relevant history including symptom onset/timeline, laterality, otologic symptoms, significant exposures, prior ear surgery or ear disease, hearing device use, and pediatric developmental/school concerns as applicable]

Results

(Provide ear-specific objective findings. If a clinically expected test was not performed, state "not performed—[reason]." Maintain internal consistency with the Summary.)

• Right Ear: [Otoscopy findings; tympanometry type and key values; pure-tone thresholds with type/degree/configuration and PTA; speech audiometry with SRT and word recognition score at presentation level; additional tests (OAEs, ABR/ASSR) with interpretation as performed]

• Left Ear: [Otoscopy findings; tympanometry type and key values; pure-tone thresholds with type/degree/configuration and PTA; speech audiometry with SRT and word recognition score at presentation level; additional tests (OAEs, ABR/ASSR) with interpretation as performed]

[Cross-check consistency between behavioral and physiologic measures] (Include for pediatric cases; indicate if electrophysiologic data stand alone pending behavioral confirmation.)

Reliability: [Test reliability/validity and any limitations affecting interpretation]

Impression and Recommendations

[Brief interpretive statement restating hearing and middle ear status with functional implications relevant to the referral context] (Describe objective findings and functional impact; do not infer medical diagnoses.)

• Urgent (24–48 hours): [Action for sudden/rapidly progressive loss, significant asymmetry, or concerning otologic findings; note whether direct clinician contact was attempted] (Include only if indicated.)
• Routine: [Medical referral with specific triggers documented] (Include only if indicated.)
• [Audiology follow-up interval and purpose]
• [Amplification/hearing technology evaluation] (If appropriate.)
• [Communication strategies, hearing conservation, or other counseling]
• [Pediatric next steps: early intervention referral, educational accommodations] (If applicable.)

Please contact me with any questions or if additional information would be helpful.

Sincerely,

[Audiologist name], [Credentials]
[Clinic/Department]
[Direct phone] | [Email]

Enclosed: [Audiogram / tympanograms / other attachments as applicable]