The specialists who have actually examined the worker identify a different, and more ordinary, pathway: sustained
noise exposure acting as.a physical and psychological stressor, producing a tension-based muscular and autonomic
cascade rather than direct cochlear damage.
Source: Dr Idris Samad, MD, FRCSC, Otolaryngology
“Impression: Le lik dary tc

~~ Head and Neck Surgery, consultation report, May 27, 2026.

er I nfl

d temporomandibular joint dysfunction.

Dr. Samad's examination found mild tenderness on palpation of the left temporomandibular joint and masseter muscle,
a jaw click on wide opening, and signs of bruxism, alongside microscopically normal ears and normal hearing. His
conclusion —~ referred ear pain from a tension-based TMJ and masseter process, exacerbated by the noise exposure —~
is a coherent, examined, physiological explanation for the worker's ear pain that the acoustic-trauma/acoustic-shock
framework in the Opinion never considers, because it is not an audiological mechanism at all.

The worker's reported nocturnal symptoms are consistent with this picture: physical spasms affecting the neck and
hands approximately every thirty seconds for the first four hours of sleep, contributing to measurable neck tension and
requiring sedating medication to manage. A mechanism confined to “was the sound loud enough to damage the
cochica” does not account for, and was never asked to account for, this autonomic and muscular presentation.

5. Ignored Audiological Asymmetry and Confirmed Hyperacusis

The Opinion states that a comparison of pre- and post-incident industrial audiograms shows the worker's hearing
thresholds “have'remained stable.” characterizing differences of 0~10 dB as “test-retest variability” and concluding
there is “no evidence of any significant changes in hearing thresholds.”

Independent testing conducted by the Wavefront Centre for Communication Accessibility — 5 days after the Clinical
Opinion — findings materially inconsistent with that conclusion:

e Asymmetric threshold shift: a 20-30 dB asymmetry between the ears at 10,000—12,500 Hz, with the right ear
demonstrating worse thresholds —- an extended high-frequency range the standard industrial audiogram
comparison in the Opinion does not test.

e Confirmed hyperacusis: reduced loudness tolerance at 4-10 kHz and to running speech, specifically in the
left ear.

e Severity, objectively scored: the Khalfa Hyperacusis Questionnaire returned a score of 32 out of 40, in the
range of “severe level of loudness intolerance.”

An asymmetric high-frequency threshold shift and an objectively scored, severe hyperacusis finding are audiological
findings squarely within Ms. Pang's own area of expertise. Their absence from an Opinion that otherwise relies heavily
on audiogram comparison is a material gap, not a difference of clinical interpretation.

Saurce: Wavefront Centre for Communication Accessibility, audiological assessment report; Khalfa Hyperacusis Questionnaire
results.

6. Selective Use of the January 30, 2026 Emergency Room Record

‘The Opinion's own account of the evidence includes the following entry from the Royal Columbian Hospital
emergency record of January 30, 2026, describing a discussion between the attending physician and Dr. Zahabi, ENT:

Ms. Pang’s own Opinion acknowledges this entry in near-identical terms:

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