Overamplification: a well-documented case report.

A well-documented case report is presented in which the use of a high-output hearing aid over a 10-year period resulted in significant threshold shifts in the aided as compared to the unaided ear. At no time did the user experience loudness discomfort and she consistently wanted more gain from the hearing aid, indicating that there is no relationship between loudness discomfort levels and the sound pressure levels at which damage to the auditory system occurs. Difficulties in detecting the cause of the threshold shifts and recommendations for case management are discussed.