Practice Questions Flashcards by Libby Sarra

A 48-year-old male has been referred for an audiological evaluation by his physician. The patient is experiencing hearing loss with vertigo and nystagmus. Medical history indicates that he has recently experienced head trauma resulting in a longitudinal fracture of the temporal bone.
Which of the following would be the expected audiological finding?
A. Cochlear hearing loss
B. Retrocochlear hearing loss
C. Conductive hearing loss
D. Mixed hearing loss

Longitudinal fracture to the temporal bone will result in ossicular and tympanic membrane injury, thus disrupting sound transmission to the cochlea, producing a conductive hearing loss.

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Which of the following individuals is the most appropriate candidate for a cochlear implant?
A. A 50-year-old woman who has tinnitus
B. A 3-year-old boy who has acquired a profound bilateral hearing loss following a case of
meningitis
C. A 6-year-old girl who has moderate sensorineural hearing loss due to viral infection
D. A 45-year-old woman who has been diagnosed with Meniere’s disease

The key word most in the question stem renders this a comparison question.

A cochlear implant will restore nerve conduction in the cochlea for an individual with a permanent sensorineural hearing loss. Compare the effect on hearing of each of the conditions listed inthe options. (B) is the option that would result in a permanent sensorineural hearing loss.

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The pure-tone audiogram of a 38-year-old female diagnosed with bilateral otosclerosis exhibits a 40 dB air-bone gap. Which of the following will probably reflect the acoustic immittance results?
A. Type C tympanogram; low static compliance; absent acoustic reflexes
B. Type As tympanogram; low static compliance; present acoustic reflexes
C. Type As tympanogram; low static compliance; absent acoustic reflexes
D. Type B tympanogram; normal static compliance; elevated acoustic reflexes

In otosclerosis, stapes fixation often reduces the mobility of the middle ear system, leading to limited tympanic membrane mobility (Type As). Using creativity, conclude that immittance results will reflect a Type As tympanogram with low static immittance and absent acoustic reflexes. Using this knowledge together with grouping, eliminate options
(A), (B), and (D).

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A patient has come to an ASHA-certified audiologist for a hearing aid fitting. In counseling regarding appropriate expectations, which of the following statements by the audiologist to the
patient is not in accordance with the ASHA Code of Ethics?
A. “You will hear some sounds that you have not heard before.”
B. “Your voice may sound different.”
C. “Using your hearing aid guarantees that your hearing will return to normal.”
D. “It may still be difficult to hear people talking in another room.”

Ethically, as well as in accordance with the ASHA Code of Ethics, an
audiologist must not guarantee the results of a treatment or procedure. Therefore, (C) is correct.

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In the battery of immittance tests, which of the following is most likely to be affected by the cognitive effects of aging?
III. Tympanometry
III. Static admittance values
III. Acoustic reflex thresholds
IV. Acoustic reflex decay tests
A. I, II, and IV
B. III and IV
C. All are affected
D. None are affected

Since the immittance test battery is
composed of physiological measurements, cognitive symptoms of aging will not affect the test results.

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Otoacoustic emissions (OAE) testing has been found to be most successful in identifying which
of the following types of lesions?
A. Cochlear
B. Retrocochlear
C. VIIIth nerve
D. Temporal lobe

OAE is successful in identifying lesions within the cochlea that affect outer hair cell function.

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The typical immittance pattern for a left-sided facial paralysis where a VIIth cranial nerve lesion
is located medial to the stapedial muscle will include which of the following when measured
from the left ear?
A. Normal tympanogram, normal static compliance, absent acoustic reflexes
B. Normal tympanogram, normal static compliance, normal acoustic reflexes
C. Abnormal tympanogram, abnormal static compliance, absent acoustic reflexes
D. Normal tympanogram, normal static compliance, elevated acoustic reflexes

When measured from the left ear, a VIIth cranial nerve lesion before the stapedial muscle point of innervation will prevent reflex action, resulting in absent acoustic reflexes, which is marked as T, so (B) and
(D) should be eliminated. Finally, (C) should also be eliminated since tympanogram and static compliance measurements will be normal.

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Sudden hearing loss can result from all of the following except
A. Viral labyrinthitis
B. Vascular occlusion
C. Genetic disposition
D. Ototoxic drug ingestion

Ototoxic drug ingestion results in gradual onset of hearing loss, so (D) should be
marked F since it is false, thereby identifying (D) as the correct answer.

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A 47-year-old man is referred for auditory brainstem response (ABR) testing. The referral
indicates that he is suspected of having a bilateral functional hearing loss. Medical history
indicates that a new medication has been prescribed. Which of the following is a likely
observation of ABR testing?
A. All waves will be delayed
B. Delayed wave I–V interpeak latency
C. A single wave (V) will be identified
D. Results will not be affected by medication

The ABR test provides information on the ability of the peripheral auditory system to transmit information to the auditory nerve and beyond. As such, it does not assess the patient’s hearing, and thus the results will not be affected by the patient’s medication.

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A patient is referred to an ASHA certified and licensed audiologist for central auditory
processing disorder (CAPD) testing. The audiologist has never administered a CAPD test.
According to the ASHA Code of Ethics, which of the following should be the appropriate
action?
A. Refer the patient to another audiologist with experience in CAPD testing.
B. Delegate the testing to an assistant and provide supervision.
C. Refuse to schedule the patient.
D. Administer the CAPD test and request consultation from an experienced audiologist.

Using the values of the profession, as well as knowledge of the ASHA Code of Ethics, the only acceptable action is (A). An audiologist must be able to competently provide clinical services or refer the patient to another audiologist to ensure that competent service is provided.

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In acoustic reflex decay testing, an abnormal decay occurs when the amplitude of the reflex decreases
A. At least one fourth of the initial amplitude
B. At least one half of the initial amplitude
C. Within the first 2 seconds
D. Within the first 5 seconds

In acoustic reflex decay testing, a signal is presented for 10 seconds, and abnormal decay is observed when the amplitude decreases more than half of the initial amplitude.

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An adult patient free of dexterity issues has normal hearing through 750 Hz with a steeply sloping, moderate-to-severe sensorineural hearing loss. Which of the following is most likely to be an appro-
priate hearing aid fitting?

A. Full shell with small vent
B. BTE with open dome
C. BTE with full shell mold and small vent
D. CIC with medium vent

since hearing in the low frequencies is normal, it is important that the hearing aid provide less amplification for low
frequencies than for high frequencies and account for the occlusion effect. A BTE hearing aid with an open dome is the best means for amplifying the high-frequency region and minimizing occlusion by allowing a maximum amount of low-frequency information to escape the ear canal with the open dome.

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In an investigation of infants’ discrimination of auditory stimuli, the investigator presents stimulus sounds and observes changes in the rate of sucking reflex responses. For this investigation, the sucking response is the

A. Intervening variable
B. Dependent variable
C. Independent variable
D. Control variable

In an experimental study, the dependent variable is the response or change that the investigator measures
after applying a stimulus to elicit a response.

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A patient has a conductive hearing loss accompanied by absent middle ear muscle reflexes (ipsilateral and contralateral), delayed waves I, III, and V on the auditory brainstem response, and excellent word recognition scores at 40 dB SL. This result is suggestive of:
A. Cochlear dysfunction
B. Temporal lobe lesion
C. Middle ear dysfunction
D. VIIIth cranial nerve disorder

since the diagnostic profile suggests middle ear dysfunction (conductive loss, absent reflexes, delayed ABR waves, and preserved word recognition at 40 dB SL).

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An audiologist completes an evaluation due to a complaint of recent hearing loss in one ear. Results of the evaluation reveal a moderate-to-severe, flat sensorineural hearing loss in the right ear and
normal hearing in the left ear. The word recognition scores for recorded, full-list NU-6 in quiet at 40 dB SL is 24% in the right ear and 100% in the left ear.

Which of the following is the audiologist’s
appropriate next step?
A. Recommend a Contralateral Routing of Signal (CROS) amplification system
B. Refer the patient for a comprehensive auditory processing disorder (APE) evaluation
C. Refer the patient to a physician
D. Refer the patient for magnetic resonance imaging (MRI)

According to the ethical and professional values of the profession, any recent onset of hearing loss and significant, unexplained, asymmetry between right and left ear requires medical evaluation. Thus,
the patient should be referred to a physician for diagnosis

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Which of the following is the most commonly accepted reason for not using pure tones during soundfield testing?
A. Responses to pure-tone stimuli are less reliable.
B. Pure-tone stimuli are more prone to create standing waves during soundfield testing.
C. Responses to pure-tone stimuli in soundfield are too difficult to hear for most patient
populations.
D. Pure-tone stimuli cannot be accurately calibrated for soundfield testing.

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A long-time hearing aid user is fit with a new set of hearing aids. What is the most likely indicator of good acceptance by the patient of the new technology?
A. New hearing aid processing strategy matches previous aids
B. Client Oriented Scale of Improvement (COSI) goals as described by the patient
C. Improved wireless connectivity features of the new hearing aids
D. Patient’s declaration of high motivation to wear new amplification

since the patient will successfully adjust to a hearing aid when she or she feels motivated to accept it as an alternative for
better communication.

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An audiologist has completed an evaluation of an adult client. After providing informational counseling, which of the following would not be an expected outcome of the counseling session?

A. The client will understand the degree of hearing loss.
B. The client will share feelings about hearing loss and its effect on their life.
C. The client will know about assistive listening technologies.
D. The client will be knowledgeable of aural rehabilitation options.

Sharing of feelings would not be an expected outcome of informational counseling.

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A 40-year-old female experienced trauma to the head during a motor vehicle accident approximately 2 months ago. She was hospitalized for a week after suffering a concussion and lacerations to her head and scalp. Upon discharge from the hospital, she is reporting brief (15–20 second) episodes of
vertigo when going from a sitting to a supine position and when rolling over in bed.
The case history should lead the audiologist to suspect which of the following?
A. Central vestibular dysfunction
B. Temporal bone fracture
C. Benign paroxysmal positional vertigo (BPPV)
D. Ossicular disarticulation

The main concerns of the question are
the brief symptoms of vertigo when moving from sitting to a supine position and/or rolling over in bed. Together with this information, the examinee must then compare each option for its relevance to
the question and assess its potential contribution to the symptoms. head
trauma can lead to BBPV.

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A typically developing middle-school age child who is performing at grade level is referred for further evaluation after failing a school hearing screening. Although she reports no difficulties with her hearing, the audiologist finds hearing loss after a complete audiological workup.
Which of the following hearing losses is most likely to go unnoticed?
A. Bilateral moderate sloping to severe sensorineural hearing loss
B. Precipitously sloping to moderately severe sensorineural hearing loss
C. Bilateral moderate conductive hearing loss
D. Bilateral mild to severe mixed hearing loss

A sharply sloping bilateral sensorineural hearing loss most likely affects only high frequencies, and children with this type of hearing loss may be able to function relatively normally in most situations.
Thus, the hearing loss could be unperceived.

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While recording the auditory brainstem response (ABR), how can an audiologist effectively delineate between true ABR waveforms and a cochlear microphonic?
A. Increasing the click rate
B. Using supraural earphones to eliminate artifact
C. Lowering stimulus intensity
D. Reversing the polarity of the stimulus

The cochlear microphonic response can create “noise” that makes it difficult to interpret the ABR waves, such as in auditory neuropathy spectrum disorder ANSD). The polarity of the cochlear microphonic response, but not that of the ABR, varies with
that of the stimulus, so by reversing (e.g., going from rarefaction to condensation) the polarity of the clicks used as stimuli, the cochlear microphonic response will be canceled out and a true ABR can be visualized.

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Self-advocacy in the realm of adult aural rehabilitation includes listener training wherein the patient is taught to:
A. Ask the talker to slow down their rate of speech
B. Inform the speaker of the listener’s hearing loss
C. Employ a variety of techniques to elicit additional responses from the speaker
D. Employ acoustic information to detect the speaker’s message

The overall objective of self-advocacy training is to facilitate listening skills using multiple phrases directed at the speaker to gain additional information
(e.g., repetition, clearer speech)

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The elements necessary for sound to be created are
III. Energy source
III. Compression
III. Transmitting medium
IV. Vibrator

A. I, II, and IV
B. I, III, and IV
C. I and III only
D. II and III only

the three necessary elements for
sound are I, III, and IV and (B) is the only option that contains all three.

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In a hearing conservation program, a significant threshold shift from baseline audiogram warrants further counseling regarding the use of ear protection. The standard threshold shift is
A. 10 dB at 2000, 3000, and 4000 Hz
B. 20 dB at 2000, 3000, and 4000 Hz
C. 10 dB at 500, 1000, 2000, 3000, and 4000 Hz
D. 10 dB at 1000, 2000, 3000, and 6000 Hz

The Occupational Safety and Health Administration (OSHA) Standard Threshold Shift (STS) is defined as a notable change in the hearing ability in one or both ears of an average of 10 dB or more at three frequencies of 2000, 3000, and 4000 Hz.

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A 64-year-old patient with a unilateral, flat, moderate mixed hearing loss was fit with a single invisible-in-the-canal hearing aid. She reports having trouble tracking the talker when in a group of colleagues or friends. The patient’s complaint is most likely linked to which of the following? A. Disrupted outer ear resonance B. Poor processing of interaural timing cues C. Differences in sound quality between ears D. Diminished frequency selectivity

B The patient’s reported problem implies difficulty in using spatial cues for sound localization, which the patient described as “tracking the talker.” Interaural timing differences are important for spatial listening; notice the similarity of concepts in the words spatial and tracking.

A patient is being evaluated for an osseointegrated device due to microtia, atretic ear canals, and abnormal middle ear structures. The audiologist also notices craniofacial abnormalities (e.g., eyes slant downward with a notch in the lower eyelid, small jaw and mouth) often seen in Treacher Collins syndrome. Which pharyngeal arch is most likely implicated in this patient? a. 1 b. 2 c. 3 d. 4

A Treacher Collins syndrome is a first arch syndrome; the first brachial arch is responsible for the feature changes of the face and aspects of the ear, especially external and middle ears. Since this patient was being evaluated for an osseointegrated device, a conductive component can be safely assumed to be present,

At what gestational age is the cochlea fully developed? a. 6 weeks b. 12 weeks c. 18 weeks d. 24 weeks

D The cochlea begins to develop at approximately 7 weeks (one cochlear turn). At 11 weeks, the cochlear turns are completed, and the following week, cochlear sensory cells are present. The cochlea reaches adult size (i.e., full development) by 20 weeks.

Which of the following is considered a fine structure mechanism within the auditory system: a. Malleus b. Modiolus c. Tectorial membrane d. Reissner’s membrane

C The fine structure refers to the cochlea mechanisms responsible for the conversion of energy from mechanical to electrochemical. The malleus continues the mechanical transfer of energy from the tympanic membrane to the stapes. Modiolus is simply part of the cochlear osseous structure and does not contribute to the transfer of energy. In this instance, the ONLY structure involved in conversion of energy from hydrodynamic to electrical is the tectorial membrane, which is where the hair cells of the stereocilia are embedded .

What region of the basilar membrane will vibrate maximally for 100 Hz tone? a. Apical/apex b. Basal/base c. Mid-basal/base d. None of the above

A The basilar membrane is tonotopically organized and is less stiff and compliant at the apex/apical portion, vibrating best with low-frequency signals. because it vibrates best in the low frequency similar to 100 Hz.

The auditory system serves as a transducer of sensory information. Where does this transduction take place? a. Sound entering the external auditory meatus after being funneled by the pinna b. Fluid filling the middle ear space due to Eustachian tube dysfunction c. Stimulation of hair cells on the basilar membrane in response to sound d. The ear canal changing an auditory event into an electrical signal

C Transduction refers to the conversion of energy from mechanoreceptive as initiated at the cochlear hair cells of the stereocilia contacting or embedded into the tectorial membrane and anchored at the basilar membrane within the organ of Corti to become an equivalent electrical waveform. answer C ultimately results in a conversion of energy from mechanical to electrical, which allows delivery of the signal to the sensory system.

The definition of “matching” relatively low-resistant airborne signals to a mechanism that is highly resistant to airborne signals would be relevant for the following term (choose one that is most appropriate): a. Impairment matching b. Impedance matching c. Incident matching d. Impediment matching

B The major function of the middle ear is to match very low-resistance airborne sounds to the highly resistant fluid contained in the inner ear. This is completed through the mechanical action of the ossicular chain in the middle ear. Answer B The major function of the middle ear is to match very low-resistance airborne sounds to the highly resistant fluid contained in the inner ear. This is completed through the mechanical action of the ossicular chain in the middle ear.

One of the structures found within the organ of Corti is: a. Reissner’s membrane b. Malleus c. Pars flaccida d. Reticular lamina

D The listing of possible answers contains mechanisms that range from the tympanic membrane, middle ear, and the larger cochlea. Not only by deductive reasoning through elimination, the stiff reticular lamina/membrane extends from the outer hair cells to the Hensen’s cells—all reside within the organ of Corti so the correct answer is d.

What is an important characteristic of the outer hair cells? a. Connected to all Type I spiral ganglia b. Responsible for cochlear amplification c. Structurally the strongest hair cell d. Significant afferent connections

B The outer hair cells remain stiff when displaced, but the stiffness varies with potential discharges. They also possess contractile proteins and are populated with more stereocilia at the base than the apex. Though outer hair cells have very few afferent connections, they have the most efferent connections. Their electromotile abilities create the cochlear amplifier so that responses to low-level stimuli are enhanced. Responses a, c, and d are characteristics of the inner hair cells, but this question pertains to outer hair cells. Therefore, the best answer would be b.

Choose the most appropriate choice of term that would fit the following definition: the frequency at which the lowest amount of energy is needed to stimulate the neural response. a. Cochlear amplifier b. Low frequency c. Characteristic frequency d. Compound action potential

C The key terms to guide the reader are lowest amount of energy and stimulate the neural response. Low frequency is neither a relevant nor a logical response. Inarguably, the cochlear amplifier and compound action potential are important in the transduction of energy, but they do not relate to creating more or less energy to trigger the neural response. Therefore, the only logical and relevant term used for energy use at the neural level is characteristic frequency

Which of the following is the reason that the frequency/telephone theory is unable to explain all of frequency encoding abilities displayed by the auditory system? a. Neural refractory period b. Neural restoration period c. Not all neurons fire at the same place in a cycle d. Neural fine tuning is greater than what would be expected

A Though it only lasts a few milliseconds, the neural refractory period can potentially impact the temporal coding of acoustic stimuli by auditory neurons; due to this, the higher frequencies cannot be adequately encoded by the frequency/telephone theory alone. The volley principle involves different neurons firing at the same place in alternating cycles and the place theory is driven by the traveling wave, which has been shown to have broader areas of excitation than are psychophysically measured.

What test confirms a BPPV diagnosis A. Dix Hallpike Test B. Ocular VEMP test C. Fistula test D. headshake test

Best adjustments for hearing aids in noise? A. enable wide dynamic range B. Increase threshold kneepoint C. Decrease compression ratio D. Enable expansion

Which TWO of the following types of medications are considered to be ototoxic medications? A. Lipid-lowering medications (statins) and anti-inflammatory medications (ibuprofen) B. Diuretics (furosemide) and cancer medications (cisplatin)

What does a Type Ad tympanogram suggest? A. Otitis media B. impacted cerumen C. normal middle ear D. flaccid TM/ossicular discontinuity

which hearing aid technology provides the greatest benefit for speech understanding in noisy classrooms? A. Directional mic systems B. slow-acting compression C. direct audio input D. digital noise reduction

what auditory skill involves becoming aware of and learning to attend to sounds? A. Identification B. Detection C. Comprehension D. Discrimination

A 55 yo with normal hearing struggles to hear in groups. Their hearing is normal with word recognition scores at 96% bilaterally. Which test should be added? A. speech in noise B. ARTs C. OAEs D. MCL/UCL

What is the consequence of untreated hearing losses?

cognitive decline

which of the following is a bilateral benign bony growth of the external ear commonly found in persons with a history of cold water swimming? A. exostosis B. glomus jogulare C. cholesteatoma D. otitis externa

what provides the greatest noise reduction? A. foam earplug B. custom silicone earplugs with filters C. passive earmuffs D. custom solid silicone earlplugs

What indicates VEMP test results? A. dysfunction of left saccule/inferior nerve B. dysfunction of left saccule/superior nerve C. Dysfunction of left utricle/inferior nerve D. Dysfunction of left utricle/superior nerve

what is the most sensitive measure of CN VIIIth N dysfunction? A. OAEs B. VEMPs C. speech rec testing D. ABRs

what is the primary reason for limiting hearing aid OSPL 90 for pediatrics? A. smaller ear canal volume increases the SPL B. room noise will be amplified C. loud sounds may frighten children d. parents talk louder than children

Early Meniere's disease typically causes SNHL in what frequency range? A. 250-2000 B. 8000-10,000 C. 4000-8000 D. 2000-4000

What test is best for monitoring ototoxicity A. ARTs B. Tinnitus matching C. Masked word recognition D. Ultra high frequency thresholds

What is the best way to assess the hearing of a 9 month old child for 500-4000 Hz? A. VRA B. ABR C. BOA D. OAEs

Low-pitched pulsatile tinnitus and immittance changes synced with the PTs pulse suggests: A. glomus jugulare tumor B. cholesteatoma C. OTSC D. acoustic neuroma

PT complains that /s/, /f/, and /sh/ sounds are not clear with their hearing aids. What is the best next step to take for the PT? A. deactivate frequency lowering, measure REAR, and reduce the gain for the lows/mids B. use split-directional mic arrays C. activate frequency lowering and measure REOR D. reduce the gain at the lows/mids

Which below lists examples of technical safeguard options that are outlined by the Health Insurance Portability and Accountability Act? A. locked doors, de-identification of data, and two-factor authentication B. data encryption, multi-factor authentication and malware C. remote wipe capabilities, surveillance cameras, and password renewal cycles D. de-identification of data, firewalls, and mobile device management

What is the best way to address a hearing aid that sounds barrel-like? A. add a damper B. widening C. enlarge the vent

PT treated with Cisplatin has complaints of tinnitus and difficulty understanding speech in noise. What could be the reason/cause of their complaints? A. Meniere's B. OTSC C. presbycusis D. ototoxicity

Which condition commonly causes both hearing and visual loss? A. Meniere's disease B. Usher's syndrome C. Treacher-Collins Syndrome D. Erythroblastosis fetal

What should be the next step for a newborn infant that passed/has present DPOAEs but still does not respond to sound? A. try VRA later B. wait and monitor C. rescreen with TEOAEs D. perform a diagnostic ABR

what is the main function of the stria vascularis A. replenish NTs B. generate endolymph and maintain the endocochlear potential C. support stereocilia movement D. regulate the cochelar blood flow

which part of the auditory system is responsible for angular acceleration? A. saccule B. cochlear duct C. utricle D. SCCs

A PT reports that hearing loss in both ears has slowly progressed/worsened and that they are able to hear easier in noisy situations than when they are in quiet. The PT's hearing loss is most likely due to: A. CHL B. SNHL C. presbycusis D. cortical lesion

PTs with reduced otolithic function usually show an increased postural sway

true

Which of the following tests would yield the most important information in the audiological evaluation of an adult with an average unmasked air-conduction threshold of 90 dB HL in one ear and normal sensitivity in the other ear? A. tymps B. Stenger C. QuickSIN D. ARTs

What does a Jerger Type C tymp suggest? A. Occlusion B. Negative ME pressure C. perforation

What term is for age-related hearing loss?

presbycusis

If an audiologist does not account for the real ear to coupler difference (RECD) during a hearing aid fitting for a 6 month old child, the fitting will most likely provide: A. adequate amplification B. overamplification C. underamplification D. inadequate amounts of noise suppression

A PT with ossicular discontinuity will present with what Jerger type tymp? A. B B. As C. A D. Ad

A PT with patent tympanostomy tubes will present with what Jerger type tympanogram? A. B with large ECV B. As C. C D. B with small ECV

Someone sitting 20 meters from a concert stage has an average intensity of 65 dB SPL. Which of the following best indicates the average SPL at a seat 10 meters from the stage? A. 71 dB SPL B. 62 dB SPL C. 68 dB SPL D. 59 dB SPL

Reduced visual function, which can complicate planning for aural rehab, is most likely to be found in PTs with hearing loss who present with A. Erythrobastosis fetalis B. treacher-collins syndrome C. diabetes D. meniere's disease

which of the following is most appropriate to use to determine information about a PTs individual situation and communication needs? A. hearing aid selection profile (HASP) B. client oriented scale of improvement (COSI) C. hearing handicap inventory for adults (HHIA) D. Communciation profile for the hearing impaired (CPHI)

which of the following hearing aid features would MOST benefit a PT who is having trouble understanding speech in background noise? A. directional mics B. compression limiting C. digital noise reduction D. feedback cancellation

Of the following conditions that can affect a child's hearing, which is most likely to cause an acquired SNHL? A. bacterial meningitis B. serious otitis media C. OTSC D. waardenburg syndrome

it is important to consider gestational age of an infant, rather than chronological age, when interpreting which test results? A. ABR Wave V latencies B. Apgar Scores C. TORCH Factors D. DPOAE responses

An audiometer attenuator is set to 0 dB HL. Which of the following is true about the SPL output at the earphone? A. it is lowest at midfrequencies B. it is constant across all frequencies C. it decreases 6dB per octave D. it is highest at 4 kHz

Which of the following is the optimal range of stimulation rates for determining thresholds for a click ABR? A. 11.1 to 21.1 B. 0.37 to 0.99 C. 59.1 to 63.1 D. 25.5 to 40.5

when performing identification audiometry for school-aged children, which of the following types of signals should be used? A. pure tones B. speech stimuli in quiet C. speech stimuli in noise D. frequency modulated signals

a type of otoacoustic emission that requires the use of two oscillators and two attenuators is A. distortion product OAEs B. Stimulus driven OAEs C. spontaneous OAEs D. transient OAEs

A 17-year-old boy presents to the clinic with ear problems. He states that he recently went on vacation, where he was scuba diving multiple times a day. While descending during his dives, he noticed an ear fullness with pain that was alleviated by returning to the surface. However, after multiple dives, he could not alleviate the ear fullness and started to experience bilateral muffled hearing and mild tinnitus, which resolved after a few days. Vital signs are normal. Physical examination shows normal otoscopy and tympanometry findings. What is the function of the anatomical structure involved in this patient's symptoms? A.It sends vibrations to the inner ear. B.It promotes clarity of sound. C.It equilibrates pressure between the inner ear and the atmosphere. D.It protects the middle ear from nasopharynx secretions.

A 4-year-old female patient presents to the clinic with her mother, complaining of ear pain since yesterday evening. The child describes increasing pain from the evening to the night. The mother remembers her child crying until about 4 am. In the wee hours of the morning, the patient finally fell asleep. Her pillow had yellowish stains this morning. Her mother denies having measured fever the night before. Recently, the patient has experienced clear rhinorrhea and a productive cough for the past ten days. She started daycare one year ago. Today, the child appears to be in no distress but clutches her left ear. The patient’s temperature is 36.6 C, her respiratory rate is 14/minute, and her heart rate is 88/min. Lung fields are clear bilaterally. The eyes are clear and bright, without periorbital edema or erythema. Cervical lymph nodes are not enlarged. There is crusting on the pinna of the left ear. On otoscopic inspection, the tympanic membrane is erythematous bilaterally, with a fluid level and bulging in the left ear and a perforation in the right ear. Which of the following is the most probable risk factor causing the symptoms in this patient? A.Visits to the daycare B.The eustachian tube runs more horizontally in children C.Children tend to insert objects and fingers into their ears D.Children who are unable to blow their noses, swallow their phlegm

A 17-year-old female presents with fever, sore throat, and difficulty swallowing. She is diagnosed with group A streptococcus pharyngitis. Further tests show that the patient suffers from otitis media, causing diminished hearing. What is the most likely route for the bacteria to reach the tympanic cavity from the pharynx? A.Pharyngeal tonsil B.Pharyngotympanic tube C.Salpingopharyngeus tendon D.Retropharyngeal lymph node

A 1-year-old boy presents to the clinic with his mother due to left-sided auricular deformity. Physical examination reveals a left side small auricular remnant composed of skin and cartilage with no visible external auditory canal. The mother states that the provider recommended otolaryngology evaluation after a visual audiometry test suggested left-sided hearing loss. Which of the following is the most appropriate management? A.Conventional air conductive hearing aids B.Conventional bone conductive hearing aids C.Canaloplasty and auricular reconstruction D.Osseointegrated bone conduction prosthesis

A 13-day-old boy is undergoing a hearing evaluation before discharge from the neonatal intensive care unit. Delivery was complicated by maternal chorioamnionitis, with resultant neonatal sepsis requiring admission to the intensive care unit. The infant was treated with intravenous antibiotic therapy with a good response. The appropriate definitive hearing test (not the screening test) to evaluate the patient provides information regarding the function of which of the following structures? A.Cochlear outer hair cells B.Vestibular nerve C.Cochlear inner hair cells D.Auditory nerve

A 14-day-old boy presents with increased irritability. He was delivered at full-term with no complications to a G2P1 28-year-old woman. A review of systems is positive for decreased appetite and sleep for the past 3 days and felt warm over the past 2 days. Vital signs are blood pressure 75/50 mmHg, heart rate 150bpm, respiratory rate 50 breaths/min, and temperature 100.2 F (39 C). On physical examination, the patient is crying. When examining the patient's right ear with the otoscope, what direction should the pinna be pulled? A.Anteriorly B.Posteriorly and inferiorly C.Posteriorly and superiorly D.Laterally

A 30-year-old man reports hearing loss after sustaining minor injuries in a blast explosion at work. He has no history of prior significant noise exposure. Following the incident, he experienced temporary ear fluttering, tinnitus, and pain but no dizziness, ear drainage, or facial weakness. He appears anxious and is generally uncooperative, demanding proof of his injury for his worker's compensation claim. He has no significant past medical history, takes no regular medications, and has no known medication allergies. The physical examination findings are unremarkable. Otomicroscopy shows no obvious outer or middle ear trauma, moderate cerumen impaction bilaterally, and intact tympanic membranes. Pure-tone audiometry results are inconsistent, showing a 20 dB difference between ascending and descending intensity levels. However, the pure-tone averages and speech reception levels are consistently within 12 dB HL. What is the best next step in evaluation? A.No further evaluation B.Repeat pure-tone audiometry in 2 weeks C.Auditory brainstem response (ABR) audiometry D.Otoacoustic emissions (OAE) testing

A 36-year-old man presents with new-onset episodes of dizziness, intermittent aural fullness, ringing in his ears, and hearing loss. He says he feels "normal" between episodes except for the ringing. When asked to describe the dizziness, he says it feels like the world is spinning around him, usually lasting for a few minutes. The physical examination findings are unremarkable. Given the likely diagnosis, which of the following best describes the hearing loss associated with this patient's condition? A.It is likely to be at lower frequencies initially. B.It is likely to be at higher frequencies initially. C.It is likely to be at middle frequencies initially. D.Hearing loss rarely occurs with this condition.

A 5-month-old is brought to your office by her parents for hearing loss. They note that she has a history of multiple craniofacial abnormalities that have been present since birth. They are concerned because the patient does not seem to startle or respond to loud noises like her older brother did when he was her age. On exam, she is noted to have bilateral malformed pinnae and atresia of the bilateral auditory canals. You also note retrognathia, colobomas of the bilateral lower lid, a cleft palate, and bilateral malar hypoplasia. A bone conduction ABR is performed which reveals moderately severe conductive loss bilaterally. What is the most appropriate treatment for this patient’s hearing loss? A.Traditional hearing aids B.Surgical placement of a bone-anchored hearing device C.A bone conduction device secured with an elastic band D.Surgical placement of an implantable middle ear device

A 50-year-old man presents with a right-sided hearing loss, ringing in his ear, and a sensation of the room spinning around him. He has a 20-pack year smoking history and a medical history of hypertension for the last five years. The healthcare provider suspects a disorder of the inner ear and orders an audiogram. Deiters cells are located within what structure? A.Organ of Corti B.Utricle C.Saccule D.Spiral organ

A 16-year-old boy presents with decreased hearing in his right ear. The otoscopic examination is significant for impacted cerumen in the right external auditory canal. The patient is asked to apply wax softener for 5 days and follow up for cerumen removal. At follow-up, he reports dizziness as soon as his ear canal is flushed. What is the most likely cause of this patient's dizziness? A.Stimulation of the carotid sinus B.Stimulation of the Jacobsen nerve C.Stimulation of the horizontal semicircular canal D.Stimulation of the dive reflex

A 67-year-old man presents for a routine annual follow-up. His most recent audiogram demonstrates moderate bilateral, symmetric, sensorineural hearing loss. The team develops an aural rehabilitation training plan What is the major objective of aural rehabilitation training for a patient with moderate hearing loss? A.Improve the patient's awareness of the position and movement of the speech mechanism. B.Improve the patient's kinesthetic and auditory awareness. C.Increase the patient's kinesthetic and proprioceptive discrimination. D.Teach the patient to make visual discrimination of speech sounds.

A 45-year-old construction worker presents with progressively worsening bilateral hearing loss and tinnitus. He has a family history of significant hearing loss with age in his maternal grandmother. He denies associated balance difficulty and endorses migraines. The physical examination shows normal tympanic membranes, a midline Weber test, and a positive Rinne test bilaterally at 512Hz. Which of the following is expected on this patient's audiogram? A.Normal hearing except for sensorineural hearing loss of 45 dB HL at 4000 Hz B.Normal hearing in the lower frequencies with bilateral sensorineural loss of 30 dB HL at 2000 Hz, 40 dB HL at 4000 Hz, and 60 dB HL at 6000 Hz C.Bilateral symmetric sensorineural hearing loss of 60 dB HL at 250 Hz, 40 dB HL at 500 Hz, 30 dB HL at 1000 Hz, and normal hearing in higher frequencies D.Normal hearing bilaterally in the low frequencies and thresholds of 30 dB HL with a 15 dB air-bone gap above 2000 Hz

A 7-year-old male presents to the ED with worsening vision loss. He failed his newborn hearing screen and was diagnosed with bilateral profound sensorineural hearing loss on auditory brainstem response. The mother states he would often trip at night and frequently have episodes of severe vertigo. The vision test revealed 20/200 vision bilaterally. The slit-lamp test showed speckles of brown pigments near the retina. What is the inheritance pattern of this syndrome? A.Autosomal dominant B.Autosomal recessive C.X-linked D.Y-linked

A two and a half-year-old girl presents to the clinic along with her mother. This child is diagnosed with moderate hearing loss. The mother explains that the child speaks words that are unintelligible to listeners. The SLP listens to the child then speaks a few words and asks the child to repeat each word to her while the child is not facing the SLP. Which of the following sounds will most likely be missing in the child's speech? A."b," "p," "m" B.“s,” “sh,” "r" C."b," "g," "n" D."a," “e," "o”

A 35-year-old woman presents with a unilateral hearing loss for a few months. On physical examination, the Weber test localizes to the right side, and the Rinne test shows air conduction better than bone conduction bilaterally. The clinician suspects that a medication caused the patient's hearing loss. Which of the following medications did the patient take? A.Penicillin B.Daunorubicin C.Metoprolol D.Bumetanide

An 82-year-old male patient presents with complaints of worsening bilateral hearing loss. He reports gradual loss and cannot identify any worsening factors or recent environmental exposures that may have contributed. He has difficulty hearing conversations, causing him to withdraw from most social interactions. Results of his audiogram show a comparable hearing loss in both air and bone conduction, with the higher-frequency loss being the most severe. What is the most likely diagnosis for this patient? A.Presbycusis B.Meniere's disease C.Cerebellopontine angle tumor D.Otosclerosis

A 3-year-old male presents to the office for bilateral hearing loss. The ears are clean on the physical exam without any signs of infection or obstruction. He was also noted to have a soft midline neck mass on palpation. A CT scan of his head was done, which showed normal middle ear structures but enlarged vestibular aqueducts. What is the inheritance pattern of this syndrome? A.Autosomal dominant B.Autosomal recessive C.X-linked recessive D.Y-linked

A student is examining a hematoxylin and eosin preparation of a healthy inner ear. He notices an acellular membrane that serves as a base of attachment for stereocilia and has exiting cochlear nerve fibers. In addition to hearing, what is another function of the membrane? A.Separation of endolymph and perilymph B.Balance in linear acceleration C.Regeneration of hair cells D.Balance in angular acceleration

A 56-year-old male presents to the clinic with hearing loss. His past medical history is significant for high blood pressure, oropharyngeal cancer, and recent community-acquired pneumonia. Physical exam shows patent external auditory canals with intact tympanic membranes without signs of infection. Weber is midline. Rinne is positive bilaterally. The audiogram shows a bilateral severe high-frequency hearing loss. Distortion product otoacoustic emissions were abnormal. What medication is most likely the culprit for his symptoms? A.Furosemide B.Clarithromycin C.Carboplatin D.Cisplatin

An occupational health provider is conducting hearing threshold level screening for employees at a construction site. A 42-year-old male worker presents for assessment. He reports a history of working in loud environments for more than 20 years and mentions occasional ringing in his ears after long shifts. During the screening, the provider observes that the worker has difficulty hearing low-frequency sounds and requires higher volumes for speech comprehension. Which of the following tests can further quantify the type of hearing loss in this patient? A.Tympanometry B.Evoked response audiometry C.Pure-tone audiometry D.Otoscopy

A 12-hour-old newborn is brought to the newborn nursery overnight. This was the mother’s first pregnancy, which was largely unremarkable, aside from a mild backache in the third trimester that was managed with acetaminophen. The mother was HIV negative, varicella and rubella immune, group B streptococcus negative, and blood type A+. The baby was born at 38 weeks via spontaneous vaginal delivery with no complications. Apgar scores were 8 and 9 at minutes 1 and 5, respectively. The baby’s vital signs are temperature 98.8 F (37.1 C), pulse 140/minute, and respiratory rate 40/minute. While in the newborn nursery the first night, the technician obtained a failed otoacoustic emissions hearing screen. What is the most likely explanation for the initial failed screen? A.Amniotic fluid in the auditory canal B.Cytomegalovirus congenital infection C.Maternal acetaminophen use D.Somnolence during screen

A 65-year-old man suffers from acute audiovestibular loss due to an acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA). A branch of the anterior inferior cerebellar artery (AICA) gives rise to which of the following two arteries that supply the inner ear? A.The internal auditory artery and anterior vestibular artery B.The internal auditory artery and the common cochlear artery C.The common cochlear artery and the basilar artery D.The common cochlear artery and anterior vestibular artery

A 3-year-old presents for a hearing test. There is no significant medical history and the child is at the expected developmental level for age. Which of the following is the most appropriate hearing test for this child? A.Pure tone audiometry B.Visual reinforcement audiometry C.Otoacoustic emissions D.Distraction techniques

A 55-year-old man presents with left-sided tinnitus. The physical examination shows intact tympanic membranes without middle ear disease. Audiometry demonstrates normal hearing on the right and moderate hearing loss on the left, with poor left ear word recognition scores. Which of the following is an auditory brainstem response most likely to show? A.Increased interpeak latency of wave III to V B.Increased interpeak latency of wave I to III C.Decreased latency of wave V D.Decreased interpeak latency of wave III to V

A 65-year-old male patient comes in with difficulty hearing certain sounds. After a complete physical exam and testing, the clinician explains that this is a normal part of aging. Which of the following types of cells are predominantly damaged? A.Outer hair cells B.Inner hair cells C.Spiral ganglion cells D.Tectorial membrane

A 63-year-old man presents with facial paralysis and intolerance to the usual environmental sounds. He says that previously normal sounds now seem unbearably loud in his right ear. He has no significant past medical history. On physical examination, he is unable to move the right side of his face. Paralysis of which muscle is responsible for the abnormal hearing findings? A.Anterior auricular muscle B.Stapedius muscle C.Stylohyoid muscle D.Posterior belly of the digastric muscle

An 11-month-old boy is seen by a medical provider. His mother is concerned that he does not respond to her voice if he cannot see her. The infant was born in a refugee camp in Kenya. His mother had no antenatal care, and this is the baby's first visit to a provider. On examination, the infant appears well-nourished and without obvious facial or body dysmorphia. He is at the 55th percentile for weight and height, and the 58th percentile for head circumference. He is given his first immunizations but fails his hearing test. Which of the following first-trimester infections is most commonly associated with this condition in the developing world? A.Influenza B B.Rubella C.Cytomegalovirus D.Toxoplasmosis

A 72-year-old presents with a chief complaint of reduced hearing. The patient states that he cannot hear well with his left ear. His vital signs are stable. With his eyes closed, the patient can hear whispered words in his right ear but cannot hear anything in his left. The patient has a past medical history of hypertension and was recently taking antibiotics for a complicated urinary tract infection. The patient was recently prescribed tobramycin. Which of the following most likely caused his reduced hearing? A.Malformation of the ossicles in the middle ear B.Loss of hair cells in the inner ear C.Abnormally shaped pinna D.Demyelination of the vestibulocochlear nerve

A researcher performs an experiment using fibroblast growth factor (FGF) knockout mice. All of the mice fail to develop a cochlea and mature vestibular system. Failure of which embryological process most likely resulted in these findings? A.Invagination of the otic placodes during the fourth week of development B.The lateral extension of the tubotympanic recess towards the floor of the first pharyngeal cleft during week 5 of development C.The fusion of the auricular hillocks on each side of the external meatus during the fourth week of development D.Endochondral ossification of Meckel and Reicherts cartilage

A 23-year-old woman presents with hearing loss after attending a music concert. The concert was several hours long, with continuous music at an overall level of 100 decibels of sound power level (dB SPL). The hearing loss is distressing her. A history of present illness is negative for similar episodes in the past. She has no past medical history. How will the hearing loss be characterized? A.Tinnitus and a temporary threshold shift in the high frequencies. B.Tinnitus and a decrease in speech perception. C.Temporary threshold shift in the low frequencies. D.Permanent threshold shift.

A 75-year-old woman presents with significant dizziness over the past 24 hours. She reports dizziness when she looks left and right and "sometimes just all at once." She denies hearing loss or medication changes but does admit to fatigue, blurred vision, and a persistent headache. The patient's husband is with her and states, "She has been really forgetful the last few days." Her past medical history includes diabetes mellitus, hypertension, coronary artery disease, and atrial fibrillation. Which of the following is the best initial step in treating this patient? A.Dix-Hallpike maneuver B.Immediate neurology referral C.Epley maneuver D.Caloric testing

Mr. Miller is a 34-year-old patient scheduled for a workers’ compensation examination. He is a mechanic who reports hearing loss in his left ear following a tire exploding to that side when he was working on a vehicle. The right ear had normal hearing thresholds, but the left ear was consistent with a flat severe to profound hearing loss (unmasked and at levels exceeding interaural attenuation). Mr. Miller had very few false-positive responses on the left ear and a positive Stenger; speech reception threshold was not in agreement with the pure-tone average for the left ear. What form of response bias did he likely demonstrate? a. Conservative b. Hypoactive c. Liberal d. Neutral

A Mr. Miller is likely exaggerating a hearing loss in the left ear, which can be assumed given the amount of hearing loss exceeding interaural attenuation levels, SRT not agreeing with PTA, and the positive Stenger. Other tests that could confirm malingering would include objective measures such as middle ear muscle reflexes and otoacoustic emissions. Behaviorally, with the low false positives and suprathreshold responses (misses), Mr. Miller likely demonstrated a conservative response bias by waiting until the signal is above threshold to respond to the presented tones (equating to a miss),

A calibration company has contacted an audiologist reporting that they only had 6-cc couplers available for use for an upcoming appointment. What devices could be sufficiently calibrated? a. Insert earphones b. Immittance probes c. OAE probes d. None of the above

D 2-cc couplers are used when the ear canal volume is expected to be reduced as opposed to 6-cc couplers, which are used when the canal volume is expected to be larger (e.g., in the case of supra-aural headphones). Probes for immittance and OAEs are inserted into the ear canal, reducing its volume, so 2-cc couplers are appropriately used in those cases. Similarly, insert earphones reduce the ear canal volume, which necessitate the use of a 2-cc coupler.

A clinician runs a real ear aided response (REAR) and compares it to a real ear unaided response (REUR) for a patient. The difference between those two values is referred to as: a. Real ear insertion gain (REIG) b. Real ear saturation response (RESR) c. Real ear to coupler difference (RECD) d. Real ear occluded response (REOR)

A REIG is a measure of gain provided by amplification placed in the ear and turned on. It is calculated by subtracting REUR from the REAR.

Assuming equal auditory sensitivity between the right and left ear, at which of the following degrees are interaural phase/timing differences the greatest? a. 45° b. 90° c. 130° d. 180°

B Research has shown that the strongest IPDs/ITDs occur at 90° and 270°.

An audiologist is conducting speech recognition in noise testing and wishes to use a masker that provides a high degree of informational masking. Which of the following would meet the audiologist’s need? a. White noise b. Pink noise c. 2-talker babble d. 20-talker babble

C Recall that instances of informational masking contain meaningful content. White and pink noise provide energetic masking due to a lack of meaningful content. While 20-talker babble is composed of speech from 20 talkers and individually their productions would provide informational masking, when combined, the effects of informational masking are lost due to a loss of intelligibility of speech from any speaker. In the case of 2-talker babble, a significant amount of meaningful content is perceptible.

During a biological check, an audiologist notices that a signal presented through one channel of the audiometer to the right headphone is heard in the left headphone, which is set to the second channel. Which of the following potential calibration issues should the audiologist report to the calibration company? a. Crosstalk b. Rise-fall time c. Ambient level d. On-off ratio

A Recall that crosstalk occurs when the presentation of a signal through one channel of the audiometer is present (and often audible) in the transducer set to the other channel. The output is measured in one earphone (test) and compared to the output of the other earphone (nontest). Significant crosstalk is present if the difference between these two measurements is less than 70 dB.

A new hearing aid has a sampling rate of 22 kHz. Using the Nyquist theorem, at which frequency is distortion most likely to occur? a. 4 kHz b. 6 kHz c. 9 kHz d. 11 kHz

D The Nyquist theorem/frequency is a sampling rate that is double the highest frequency of a signal that will be encoded. Thus, half the reported rate (22 kHz) would be 11 kHz. The closer you get to the maximum frequency that is encoded, the more likely the signal is going to be distorted. In this question, the frequency closest to that maximum frequency of 22 kHz is 11 kHz.

An audiologist is asked to perform sound-level measurements at a local factory. The company is concerned that a new piece of equipment is exposing an employee to excessive levels of noise. The audiologist is at the site and setting the decibel scale for recordings. Which scale is the most appropriate to use? a. dBA b. dBB c. dBC d. All of the above are equivalent

A Recall that the dBA weighting provides a measurement that weights the input similarly to the response of the human auditory system. Thus, if the goal is to estimate sound levels experienced by the worker, dBA would provide the most accurate estimate.

Your patient is a 3-year-old female. Her parents report that the child speaks but does not say as many words as her friends in kindergarten. They also report that her vocabulary is likely around 100 words. During your evaluation, she produces the following statement about her dog: “That Mommy da.” Which type of error is the omission of ’s? a. Pragmatics b. Phonology c. Morphology d. Semantic

C The omission of ’s is an error in morphology. The ’s is a bound morpheme that adds meaning to the word.

Your patient is a 3-year-old female. Her parents report that the child speaks but does not say as many words as her friends in kindergarten. They also report that her vocabulary is likely around 100 words. During your evaluation, she produces the following statement about her dog: “That Mommy da.” The likely age of elimination for the phonological process of final consonant deletion (i.e., “da” for “dog?”) is ____. a. 2 years b. 3 years c. 5 years d. 8 years

B Omitting /g/ in “dog” is final consonant deletion. The phonological process of final consonant deletion is likely eliminated by 3 years of age.

Your patient is a 3-year-old female. Her parents report that the child speaks but does not say as many words as her friends in kindergarten. They also report that her vocabulary is likely around 100 words. During your evaluation, she produces the following statement about her dog: “That Mommy da.” How many words should a 3-year-old have in their vocabulary? a. 50 words b. 500 words c. 1,000 words d. Over 2,000 words

C At 36 months or 3 years, a child should have approximately 1,000 words in their vocabulary. This child is delayed in vocabulary development if her vocabulary consists of a total of 100 words.

C This patient has Wernicke’s aphasia, which is characterized by fluent speech, jargon or new words that do not have meaning, and poor auditory comprehension.

Your patient is a 70-year-old adult male. Recently, your patient suffered a stroke. After introducing yourself, you start the appointment by asking a few simple questions. You quickly notice that your patient is speaking with ease, but using utterances that are not words. His answers do not answer the questions you are asking. You: How are you today? Patient: We have stived here for a bet and talked to them over here. You: Can you tell me why you are here? Patient: We went over there to the hands. I talk of thets and more. Aphasia is an acquired language disorder. This patient is having difficulty understanding language and producing language that matches his intended message. This patient continues to be just as intelligent as before his stroke. Knowing this, how might you adjust your evaluation? a. Use pictures, gestures, or video without language to facilitate comprehension b. Repeat instructions several times, until he understands c. Cancel the evaluation. Language comprehension is required for many tasks. d. Write all instructions for him to read.

A Use of pictures, gestures, or videos would not require language for compre- hension. Any adjustment that did not include language may facilitate understanding for completion of your evaluation. Repeating instructions may not be helpful, since he is having difficulty comprehending language. Although writing may be helpful, writing involves language. Individuals with Wernicke’s aphasia may have difficulty reading written language.

Which of the following is true when considering standardized language and speech assessment measures for children with hearing loss? a. Standardized tests should never be used with children with hearing loss. b. Standardized tests should rarely be used with children with hearing loss. c. Standardized tests may be used with no restrictions for children with hearing loss. d. Standardized tests may be used but results must be reviewed with caution for children with hearing loss.

D Standardized assessment measures for language and speech may be utilized for children with hearing loss. However, the clinician must review the measure and apply any assessment results with caution.

Joyce no longer attends a weekly board game night with her friends because she is having difficulty following along with the conversation due to her hearing loss. What is Joyce not attending the game night an example of? a. Participation restriction b. Activity limitation c. Bluffing d. Anticipatory strategy

A A participation restriction is how hearing loss affects life participation in a broader sense. Choosing not to attend a weekly game night because of deficits related to hearing loss would be a participation restriction.

James demonstrated difficulty with friends in part because of his difficulty with skills related to theory of mind (ToM). Which of the following might have contributed to his difficulty with ToM skills? a. Difficulty using functor words when communicating b. Difficulty using appropriate word order when creating sentences c. Lack of an age-appropriate language base to mediate ToM skills d. Lack of phonological awareness skills

C One reason ToM skills can be difficult for children with hearing loss is due to deficits in expressive and receptive language. Without an adequate language foundation, it can be difficult for children with hearing loss to utilize metalinguistic and metacognitive skills to process a concept like ToM.

An audiology patient nods in agreement during an audiological evaluation but does not understand what was said. What is this an example of? a. Acknowledgment gesture b. Bluffing c. Anticipatory strategy d. Message tailoring strategy

B Bluffing is a maladaptive strategy where the person with hearing loss does not under- stand what was said by a conversational partner but nods or smiles in agreement. This contrasts with and hinders the use of supportive strategies that a person with hearing loss might utilize during a conversation.

A preschool child demonstrated a conditioned play response to a pure tone presented in the sound booth. What level of auditory skill development was demonstrated? a. Identification b. Comprehension c. Discrimination d. Detection

D Conditioned play audiometry involves game or play-like activities (e.g., dropping a block into a bucket or placing a ring on a ring stacker) to elicit a response from a child to determine if they detect a sound. A conditioned play response would only indicate the detection of a sound without higher-level auditory skills required.

A 37-year-old female is on your schedule for a comprehensive audiological evaluation. Which assessments should be completed as part of this evaluation? a. Pure-tone air and bone conduction, SRT, and word recognition b. Pure-tone air conduction, SRT, and word recognition c. Pure-tone air and bone conduction, SRT, and acoustic immittance d. Pure-tone air conduction, SRT, word recognition, and acoustic immittance

A To be considered a full comprehensive audiologic evaluation, all four assessments of pure-tone air- and bone-conduction audiometry along with SRT and word recognition must be completed. When all four are completed in one session, this is defined as a comprehensive audiologic evaluation and billed using the CPT code 92557. Acoustic immittance is billed under separate codes and is not necessary for a comprehensive evaluation.

The speech recognition threshold (SRT) can be best defined as: a. The lowest level an individual can understand at least one NU-6 word b. The lowest level that an individual can understand at least 50% of spondee words c. The lowest level that an individual can understand at least 75% of spondee words d. The lowest level that an individual can understand at least 50% of NU-6 words

B The SRT is defined as the level that a patient can understand a closed set of words 50% of the time. Familiarization and verification of the words to the patient is an important step in SRT testing as it has been shown to influence the threshold by as much as 5 dB. This is important because one of the most common clinical uses of SRT is cross-check validation of pure-tone thresholds.

Your next patient of the afternoon is a 58-year-old male who was referred to you with the complaint of right constant acute tinnitus. Based on your knowledge of tinnitus, the time frame for acute tinnitus would mean that the patient has been suffering from tinnitus for: a. Three months or less b. Six months or less c. Six months or more d. A year or less

B When describing the duration of tinnitus, the terms chronic and acute are used. When an individual is experiencing acute tinnitus, that means they have experienced these symptoms for 6 months or less.

Mr. Friedman, a right-handed 24-year-old male with complaints of difficulty listening in background noise and on the phone, is seen for an audiological evaluation. Otoscopy was clear bilaterally, and the next test was immittance. Type A tympanograms were recorded bilaterally. On reflex testing, there are present responses in the left ipsilateral and contralateral conditions, but absent responses in the right ipsilateral and contralateral conditions. Without further testing, where would the suspected lesion be? a. CN VIII right b. CN VIII left c. CN VII right d. CN VII left

A remember that ANSI standards for MEMRs are based on the stimulus ear. Present left ipsilateral responses suggest that the middle ear, cochlea, cranial nerve (CN) VIII, ventral cochlear nucleus (VCN), superior olivary complex (SOC), facial nerve nuclei (FNN), and the facial nerve (CN VII) are functioning properly on that side. Absent right ipsilateral responses suggest that there is an issue in one of those structures on the right side. Present left contralateral responses suggest that the left cochlea, left CN VIII, left VCN, right and left SOC, right FNN, and right CN VII are functioning. Absent right contralateral responses suggests that the issues are either in the right CN VIII or VCN

A 42-year-old male presents to your office with complaints of right hearing loss and tinnitus. He stated that he is a factory worker and noted the issues suddenly after work one day when an explosion occurred. Tympanometry revealed Type A tympanograms bilaterally. DPOAEs were present and robust. MEMRs were present bilaterally. Audiometry revealed a unilateral moderate to moderately severe sensorineural hearing loss in the right ear. You completed the Stenger test, during which the patient did not respond. What would be your diagnosis? a. Conductive hearing loss b. Presbycusis c. Retrocochlear hearing loss d. Nonorganic hearing loss

D Although the patient presented with hearing loss and tinnitus in the right ear, the objective tests (tympanometry, DPOAEs, and MEMRs) do not align with our subjective findings (audiometry). Additionally, the patient did not respond during the Stenger test (positive Stenger). As such, the patient would be diagnosed with nonorganic hearing loss and would be referred for further testing such as an ABR, ENT, and/or psychology.

Which of the following is true of otoacoustic emissions? a. They are impacted by disorders of the auditory nerve. b. They are by-products of OHC function and the cochlear amplifier. c. They are not impacted by middle ear dysfunction. d. The strength of the emission is the most important quality of the response.

B The cochlear amplifier is created by OHC motility. As the traveling wave moves through cochlear fluid creating displacement of the basilar membrane, there is a significant energy loss due to viscous drag. Because of this energy loss, the cochlear amplifier is a necessary component of cochlear function. The cochlear amplifier enhances the traveling wave as it loses energy. As a result of the cochlear amplifier, there is displacement of the basilar membrane that creates energy movement back toward the basal end of the cochlea generating vibration on the oval and round windows and thus vibration of the ossicular chain and tympanic membrane.

What is one of the main advantages of DPOAEs over TEOAEs? a. DPOAEs offer better cochlear frequency resolution. b. Middle ear status does not impact DPOAE responses. c. DPOAEs can be observed with higher degrees of hearing loss. d. DPOAEs are a better predictor of behavioral hearing thresholds.

C Due to the continuous tone presentation used with DPOAEs, they tend to be impacted less by subtle ear conditions compared to TEOAEs. Therefore, DPOAEs can be recorded in individuals with up to moderate hearing losses, whereas TEOAEs are typically absent in individuals with more than a mild hearing loss (20–30 dB HL).

You completed a neurodiagnostic ABR on a 49-year-old male patient. You noted that wave __ was absent. As such, you completed an ECochG to attempt to see this wave, which is generated where? a. I; distal end of the VIIIth nerve b. I; proximal end of the VIIIth nerve c. III; distal end of the VIIIth nerve d. III; caudal brainstem; near superior olivary complex (SOC) and trapezoid body

A An ECochG is a variation of an ABR, which increases the amplitude of wave I due to different click rates, intensity levels, and transducers. When wave I is not present, an ECochG can be utilized. Wave I (also referred to as AP) is generated at the distal end of the VIIIth nerve

A 36-year-old male presents with an onset right hearing loss and tinnitus in the last 2 days. He denied any hearing loss, tinnitus, and other audiologic symptoms prior to this occurrence. He denied recent noise exposure, otalgia, aural fullness, and dizziness. Audiological testing revealed normal hearing in the left ear and a moderate flat SNHL in the left ear. Tympanometry was normal. Ipsilateral MEMRs were present in the left ear and absent in the right. Clinically, this is most consistent with which pathology? a. Otosclerosis b. Sudden SNHL (SSNHL) c. Otitis media with effusion d. Ménière’s disease

B Based on patient complaints, timeline (of 2 days), and audiological findings, the most consistent pathology is SSNHL. Therefore, b is the correct answer. It is imperative for audiologists to refer these patients to ENT for treatment as soon as possible. Treatment should be initiated as soon as possible after the onset of the hearing loss and generally consists of systemic (oral pill) or intratympanic injection of corticosteroids in order to reduce inflammation or swelling. Treatment is difficult because only about 10% of patients with SSNHL have an identifiable etiology. When treatment is delayed by 2 weeks or more, it becomes less likely that permanent hearing loss will improve.

A 48-year-old female presented in the clinic with the following findings: normal hearing sensitivity in the right ear and a mild sloping to moderate SNHL in the left ear. Word recognition scores were 92% in the right ear and 24% in the left ear. High-intensity ABR testing revealed normal findings in the right ear and prolonged wave V latency in the left ear with a prolonged wave I to V interpeak latency. These findings would be most consistent with which pathology? a. Ménière’s disease b. Otosclerosis c. Otitis media d. Acoustic neuroma

D The patient is presenting with left SNHL, poorer than expected word recognition scores, and prolonged absolute and interpeak latencies on an ABR. Additionally, findings are asymmetrical for all testing completed. Therefore, these findings point to a suspected acoustic neuroma

Jason is having difficulty in Spanish class perceiving the rolled or trilled “r” but does not have any difficulty with the single “r.” The audiologist called and spoke to the Spanish teacher, who indicated that the only difference between the two speech sounds is the speed at which they are produced. If auditory processing difficulties are the reason for his issue correctly perceiving the rolled “r,” which area of auditory processing is most likely affected? a. Auditory figure-ground b. Temporal processing c. Discrimination d. Dichotic listening

B The correct answer is temporal processing as it refers to the effectiveness of processing auditory information over time, and the Spanish instructor indicated that the difference between the two sounds is a difference in production speed. Figure-ground is related to hearing in noise. Discrimination is related to a person knowing two sounds are different from one another. Dichotic listening applies when there are two different signals presented, one to each ear.

Which anatomical location is attributed to the initial stage for processing of the natural speech signal? a. Medial geniculate body b. Dorsal cochlear nucleus c. Lateral superior olivary complex d. Auditory cortex

a The medial geniculate body, which is located within the thalamus (a site known for inte- gration of multiple neural pathways), is the site believed to be responsible for the initial processing of speech. The perception of speech requires the integration of several spectral and temporal cues provided by various lower auditory regions and integrated in the MGB of the thalamus. The cochlear nucleus has the role of transmitting precise timing patterns, whereas the superior olivary complex relates to interaural timing and regulates the efferent systems. The auditory cortex is responsible for processing the suprasegmental cues and then transferring the information to the left side to assign meaning to the signal via the corpus callosum.

Jillian has a mild to moderate hearing loss, bilaterally. The audiologist wishes to examine her performance in an academic setting. Which of the following is/are teacher checklist(s)/rating scales that can be used to determine how a student with hearing loss is functioning in the classroom: a. Functional Listening Evaluation b. Categorical Individual Performance Profile c. Screening Instrument for Targeting Educational Risk d. Beliefs About Deafness Scale

C The SIFTER is a checklist that examines a child’s performance on different functional aspects needed for educational success (e.g., academics, participation). A functional listening evaluation examines a child’s performance in various listening conditions to determine the impact of noise,distance, and visual cues on sentence repetition. It is used to measure amplification and HATS benefits. The BADS is a scale to examine how the patient versus other significant people in the life feel about hearing loss. It is more often used for adults.

Sylvia, a 5-year-old, is being evaluated. By case history report, Sylvia started kindergarten this year. She is in the process of having her speech and language evaluated by the school speech-language pathologist. According to her parent, they can understand approximately half of Sylvia’s speech. The parents feel she understands them when they talk to her. You find a mild bilateral sensorineural hearing loss. You now want to test word recognition for Sylvia. Which of the following is the best option: a. PBK words b. NU-6 words c. Spondee words d. WIPI words

D Given the difficulties in understanding Sylvia’s speech, a picture-pointing task such as the WIPI would be appropriate. The PBK words would be appropriate age-wise, but interpretation/scoring would be impacted by Sylvia’s articulation difficulties. The NU-6 words are an adult word list; spondee words are typically used for speech threshold testing, not word recognition.

A 5-month-old (George) is scheduled for a hearing evaluation. His mother noted that she was sick in the first trimester of her pregnancy with a fever, sore throat, and fatigue, but she did not seek medical care at that time. The mother reports that George was born at 27 weeks gestational age and was in the NICU for 8 weeks. During that time, George received oxygen due to underdeveloped lungs. His mother also noted that George did not show any other symptoms of sickness at birth and that George passed his ABR newborn hearing screening in the NICU. George has had approximately four ear infections in the past 3 months, which have been treated with antibiotics. His most recent ear infection was last week. At this time, George’s pediatrician is talking to his family about getting PE tubes for George. On the test date, George showed normal movement of the tympanic membranes and absent otoacoustic emissions. You are scheduling additional testing for this child to estimate hearing ability. How would you estimate hearing ability in this patient? a. Soundfield VRA thresholds b. BO results c. Air- and bone-conduction ABR thresholds d. VRA thresholds under headphones

C This child was born 13 weeks prematurely; even though the child is 5 months chrono- logical age, he is approximately 2 to 3 months developmentally. You must base the choice of behavioral Testing on developmental age rather than chronological age. Because the child is developmentally 2 to 3 months of age, VRA is not appropriate. Responses to sound could be seen via BO, but such responses cannot be used to estimate hearing sensitivity. As such, air- and bone-conduction ABR should be utilized to estimate hearing sensitivity of this child.

A 5-month-old (George) is scheduled for a hearing evaluation. His mother noted that she was sick in the first trimester of her pregnancy with a fever, sore throat, and fatigue, but she did not seek medical care at that time. The mother reports that George was born at 27 weeks gestational age and was in the NICU for 8 weeks. During that time, George received oxygen due to underdeveloped lungs. His mother also noted that George did not show any other symptoms of sickness at birth and that George passed his ABR newborn hearing screening in the NICU. George has had approximately four ear infections in the past 3 months, which have been treated with antibiotics. His most recent ear infection was last week. At this time, George’s pediatrician is talking to his family about getting PE tubes for George. On the test date, George showed normal movement of the tympanic membranes and absent otoacoustic emissions. You are scheduling additional testing for this child to estimate hearing ability. Related to embryological development of the ear, which risk factor is of most significant concern? a. Mother’s sickness in first trimester b. George’s premature birth c. Oxygen given to George after birth d. George’s history of ear infections

A The largest risk for the ear development is in the first trimester, which is when the mom’s sickness occurred. This is the time when the major portions of the ear are developing. While there is maturation in the third trimester, it would not be the biggest concern (ruling out the premature birth). The oxygen after birth and the ear infections are not in utero, and as such would not constitute an embryologic concern.

A 5-month-old (George) is scheduled for a hearing evaluation. His mother noted that she was sick in the first trimester of her pregnancy with a fever, sore throat, and fatigue, but she did not seek medical care at that time. The mother reports that George was born at 27 weeks gestational age and was in the NICU for 8 weeks. During that time, George received oxygen due to underdeveloped lungs. His mother also noted that George did not show any other symptoms of sickness at birth and that George passed his ABR newborn hearing screening in the NICU. George has had approximately four ear infections in the past 3 months, which have been treated with antibiotics. His most recent ear infection was last week. At this time, George’s pediatrician is talking to his family about getting PE tubes for George. On the test date, George showed normal movement of the tympanic membranes and absent otoacoustic emissions. You are scheduling additional testing for this child to estimate hearing ability. Your additional test results indicate a moderately severe sensorineural hearing loss of a progressive nature. Based on case history, what would be the most likely cause of the hearing loss? a. Loss due to ear infections b. Common cavity deformity c. Cytomegalovirus d. Michel’s aplasia

C Cytomegalovirus impacts the ear during development and is associated with a progressive hearing loss. This is why the child may have passed the hearing screening at birth. A loss due to ear infections is typically associated with a temporary conductive hearing loss. Both the common cavity deformity and Michel’s aplasia would be associated with significant hearing loss at birth (leading to a failed newborn hearing screening).

A 5-month-old (George) is scheduled for a hearing evaluation. His mother noted that she was sick in the first trimester of her pregnancy with a fever, sore throat, and fatigue, but she did not seek medical care at that time. The mother reports that George was born at 27 weeks gestational age and was in the NICU for 8 weeks. During that time, George received oxygen due to underdeveloped lungs. His mother also noted that George did not show any other symptoms of sickness at birth and that George passed his ABR newborn hearing screening in the NICU. George has had approximately four ear infections in the past 3 months, which have been treated with antibiotics. His most recent ear infection was last week. At this time, George’s pediatrician is talking to his family about getting PE tubes for George. On the test date, George showed normal movement of the tympanic membranes and absent otoacoustic emissions. You are scheduling additional testing for this child to estimate hearing ability. If you could obtain only one piece of information, which of the following would be best for fitting amplification on this child? a. Behavioral results b. Click-evoked ABR c. Tone-burst ABR d. OAEs

C Tone-burst ABR results would provide frequency and ear-specific results that can be used to fit amplification. With the infant being too young developmentally for VRA, you would only be able to see behavioral responses to sound using BO, which is not appropriate for diagnosing a hearing loss or programming hearing aids. The OAEs do not provide threshold estimates, and the click-evoked ABR results are not frequency specific.

A 5-month-old (George) is scheduled for a hearing evaluation. His mother noted that she was sick in the first trimester of her pregnancy with a fever, sore throat, and fatigue, but she did not seek medical care at that time. The mother reports that George was born at 27 weeks gestational age and was in the NICU for 8 weeks. During that time, George received oxygen due to underdeveloped lungs. His mother also noted that George did not show any other symptoms of sickness at birth and that George passed his ABR newborn hearing screening in the NICU. George has had approximately four ear infections in the past 3 months, which have been treated with antibiotics. His most recent ear infection was last week. At this time, George’s pediatrician is talking to his family about getting PE tubes for George. On the test date, George showed normal movement of the tympanic membranes and absent otoacoustic emissions. You are scheduling additional testing for this child to estimate hearing ability. Because of the history of possible middle ear dysfunction, you want to perform immittance testing. How would you perform immittance testing on this child? a. Utilize a lower-frequency probe Hz for tympanometry and acoustic reflexes b. Utilize a higher-frequency probe Hz for tympanometry and acoustic reflexes c. Perform tympanometry and reflexes in same manner as for older children/adults d. You cannot perform tympanometry or acoustic reflexes on children of this age

B Higher-frequency probe frequency, such as 1000 Hz, is recommended for children under 6 to 9 months of age. The lower-frequency probe tone does not provide reliable results in young infants/toddlers, and the older children/adults are tested typically with the lower-frequency probe tone.

The patient is a 55-year-old male reporting sudden onset of left ear hearing loss, tinnitus, and vertigo 2 weeks ago. He reports that he experienced rotational vertigo for a few hours, which gradually reduced to a consistent feeling of unsteadiness. The patient reports no change in hearing and tinnitus in his left ear. VNG testing demonstrates 7°/second right-beating nystagmus in gaze center and gaze right with vision denied. Remaining oculomotor testing is within normal limits. Dix-Hallpike testing is negative bilaterally. Static positional testing demonstrates 7° second geotropic nystagmus in head right and head left positions. Caloric responses are as follows: right warm = right beating, 15°/second; right cool = left beating, 12°/second; left warm = left beating, 4°/second; left warm = right beating, 3°/second. Fixation suppression is appropriate. What disorder do you suspect with this clinical presentation? a. Vestibular neuritis b. Superior semicircular canal dehiscence syndrome c. Benign paroxysmal positional vertigo d. Labyrinthitis

D While vestibular neuritis, benign paroxysmal positional vertigo, and labyrinthitis present with acute onset vertigo, only labyrinthitis presents with concurrent unilateral hearing loss.

The patient is a 55-year-old male reporting sudden onset of left ear hearing loss, tinnitus, and vertigo 2 weeks ago. He reports that he experienced rotational vertigo for a few hours, which gradually reduced to a consistent feeling of unsteadiness. The patient reports no change in hearing and tinnitus in his left ear. VNG testing demonstrates 7°/second right-beating nystagmus in gaze center and gaze right with vision denied. Remaining oculomotor testing is within normal limits. Dix-Hallpike testing is negative bilaterally. Static positional testing demonstrates 7° second geotropic nystagmus in head right and head left positions. Caloric responses are as follows: right warm = right beating, 15°/second; right cool = left beating, 12°/second; left warm = left beating, 4°/second; left warm = right beating, 3°/second. Fixation suppression is appropriate. What is the canal paresis for the above case? a. 59% b. 6% c. 100% d. 74%

A Use Jongkees’s formula to calculate the canal paresis. Total eye speed is 27°/second for the right ear and 7°/second for the left ear. Canal paresis is calculated as: [(27 – 7)/(27 + 7)].

The patient is a 55-year-old male reporting sudden onset of left ear hearing loss, tinnitus, and vertigo 2 weeks ago. He reports that he experienced rotational vertigo for a few hours, which gradually reduced to a consistent feeling of unsteadiness. The patient reports no change in hearing and tinnitus in his left ear. VNG testing demonstrates 7°/second right-beating nystagmus in gaze center and gaze right with vision denied. Remaining oculomotor testing is within normal limits. Dix-Hallpike testing is negative bilaterally. Static positional testing demonstrates 7° second geotropic nystagmus in head right and head left positions. Caloric responses are as follows: right warm = right beating, 15°/second; right cool = left beating, 12°/second; left warm = left beating, 4°/second; left warm = right beating, 3°/second. Fixation suppression is appropriate. What degree of nystagmus is noted in gaze testing? a. First degree b. Second degree c. Third degree d. Fourth degree

B Significant gaze-evoked nystagmus is noted in gaze center and gaze right. Since nystag- mus is noted in two conditions, it is considered (b) second-degree nystagmus.

The patient is a 55-year-old male reporting sudden onset of left ear hearing loss, tinnitus, and vertigo 2 weeks ago. He reports that he experienced rotational vertigo for a few hours, which gradually reduced to a consistent feeling of unsteadiness. The patient reports no change in hearing and tinnitus in his left ear. VNG testing demonstrates 7°/second right-beating nystagmus in gaze center and gaze right with vision denied. Remaining oculomotor testing is within normal limits. Dix-Hallpike testing is negative bilaterally. Static positional testing demonstrates 7° second geotropic nystagmus in head right and head left positions. Caloric responses are as follows: right warm = right beating, 15°/second; right cool = left beating, 12°/second; left warm = left beating, 4°/second; left warm = right beating, 3°/second. Fixation suppression is appropriate. You complete sinusoidal harmonic acceleration testing. What are your expected results? a. Normal gain, phase, asymmetry b. Normal gain, low-frequency phase lead, normal asymmetry c. Reduced gain, low-frequency phase lead, significant asymmetry d. Reduced gain, normal phase, normal asymmetry

C Acute vestibulopathy most often presents with reduced gain, low-frequency phase lead, and significant asymmetry.

VEMP responses are expected to be abnormal in cases of SSCD. What is NOT an expected abnormality? a. Absent response in the affected ear b. Enhance amplitude in the affected ear c. Present response at 4 kHz d. Reduced threshold in the affected ear

A SSCD provides an unexpected “third window” into the inner ear, enhancing sound pressure conduction. VEMP responses are expected to demonstrate enhanced amplitude, reduced threshold, and present responses at unexpected frequencies.

What is an expected characteristic of peripheral nystagmus? a. Down-beating nystagmus noted in gaze center b. Nystagmus follows Ewald’s law c. Nystagmus is enhanced with fixation d. Nystagmus changes direction in eccentric gaze

B Peripheral nystagmus follows specific expectations outlined by (b) Ewald’s law. Vertical nystagmus, nystagmus that enhances with fixation, and nystagmus that changes direction are characteristics of central nystagmus.

What stimulus frequency is most commonly used for VEMP testing? a. 125 Hz b. 250 Hz c. 500 Hz d. 750 Hz

C VEMP responses are influenced by the frequency tuning characteristics of the otolith organs. Responses are most reliably recorded using (c) 500 Hz stimuli.

In a patient with acute vestibulopathy, what SOT conditions are expected to be abnormal? a. Conditions 1–6 b. Conditions 3, 6 c. Condition 5 d. Conditions 4–6

C SOT condition patterns relate to underlying balance dysfunction. An acute vestibu- lopathy most often presents with (c) abnormal 5. Balance performance in this condition relies on appropriate vestibular system performance.

Which aspect of vestibular rehabilitation is used for a patient with bilateral vestibular areflexia? a. Habituation b. Substitution c. Adaptation d. Rehabilitation

B A patient with bilateral vestibular areflexia does not have adequate VOR performance. Therefore, the patient must use (b) substitution for maintaining appropriate balance performance.

Which measure of VOR performance is most appropriate for evaluating a 4-month-old child? a. vHIT b. oVEMP c. SHA d. Caloric testing

A The most effective method for evaluating children <6 months of age is (a) vHIT. For these young children, vHIT is usually done with a remote camera system. Due to tolerance, the remaining options are not typically attempted until 6 months for SHA, 3 years for oVEMP, and 6 years for caloric testing.

An audiologist is performing annual audiometric testing for a company that manufactures oil field pipelines. According to requirements of the Occupational Safety and Health Administration (OSHA), which of the following criteria must be used to determine if each employee has had a standard threshold shift compared to their baseline audiogram? a. Hearing thresholds have changed by an average of 15 dB or more at 1000, 2000, and 4000 Hz in either ear. b. Hearing thresholds have changed by 10 dB or more in either ear at any of the following frequencies: 1000, 2000, or 4000 Hz. c. Hearing thresholds have changed by 15 dB or more in either ear at any of the following frequencies: 500, 1000, 2000, or 4000 Hz. d. Hearing thresholds have changed by an average of 10 dB or more at 2000, 3000, and 4000 Hz in either ear.

D OSHA (1983) defines a standard threshold shift (STS) as an average change of 10 dB or more at 2000, 3000, and 4000 Hz in either ear compared to the baseline audiogram. NIOSH (1998) defines a standard threshold shift as a change of 15 dB or more in either ear at any of the following frequencies: 500, 1000, 2000, 3000, 4000, or 6000 Hz. Therefore, d is the correct answer.

An adult who works in very high-intensity noise wears “double” hearing protection: foam earplugs with a noise reduction rating (NRR) of 32 dB and protective earmuffs with a noise reduction rating of 25 dB. According to OSHA regulations, wearing the earplugs and earmuffs simultaneously should provide approximately how much noise reduction (attenuation)? a. 30 dB b. 37 dB c. 47 dB d. 57 dB

B According to OSHA (1983), employers can require double hearing protection if there is evidence of progressive NIHL. Wearing the second hearing protection device is assumed to provide an increase of 5 dB over the attenuation of the HPD with the higher NRR. In the example, the higher NRR is 32, so adding a second HPD would provide approximately 37 dB of attenuation.

A 50-year-old adult wears earmuffs over his baseball cap and safety glasses at work. Which of the following types of individual fit testing would be most appropriate for the audiologist to use to measure the amount of noise reduction (attenuation) the worker actually receives when wearing his hearing protection at work? a. Real ear attenuation at threshold b. Loudness balance c. Field microphone in-the-ear d. OSHA correction factor

A Real ear attenuation at threshold (REAT) is the gold standard for fit testing. It can be performed in a sound booth and involves measuring the patient’s thresholds with and without hearing protection. This will allow the patient to wear his own earmuffs over his baseball cap and safety glasses as he normally would at work. F-MIRE systems typically come with special earplugs with the probe built in, which means the patient could not be tested while wearing his own earmuffs. Loudness balance systems require the patient to wear headphones over earplugs. The OSHA correction factor is only applied to the NRR reported for a particular type of hearing protection. It allows for estimation of the attenuation provided by different types of hearing protection and does not involve actually measuring the attenuation.

A 41-year-old male works in a tire factory. His job involves working in two different areas of the factory, one inside and one outside. Noise measurement results reveal 97 dB LAeq at his indoor work location and 88 dB LAeq at his outdoor location. On average, he spends 6 hours at the indoor location and 2 hours at the outdoor location each day. Which of the following is closest to the worker’s daily noise dose using recommendations from the National Institute for Occupational Safety and Health (NIOSH)? a. 200% b. 1,250% c. 1,600% d. 1,800%

B According to NIOSH (1998), a person can be exposed to 97 dBA safely for 0.5 hours and 88 dBA for 4 hours. Using these values and the equation for dose shown below, the worker’s daily dose would be approximately 1,250%. Therefore, b is the correct answer. D = [C1/T1 + C2/T2 + Cn/Tn] × 100 D = [6/0.5 + 2/4] × 100 D = [12 + 0.5] × 100 D = 1250% Where: Cn = total time of exposure at a specified noise level Tn = exposure time at which noise for this level becomes hazardous

In order to comply with the Occupational Safety and Health Administration’s (OSHA) noise regulation, which of the following workers would not be required to wear hearing protection devices? a. A worker who is exposed to an 8-hour time-weighted average (TWA) of 92 dBA b. A worker who is exposed to an 8-hour time-weighted average (TWA) of 85 dBA who has not experienced a standard threshold shift (STS) c. A worker who is exposed to an 8-hour time-weighted average (TWA) of 88 dBA and has experienced a standard threshold shift (STS) d. A worker who started working at the company 8 months ago and is exposed to an 8- hour time-weighted average (TWA) of 89 dBA but has not received their baseline audiogram yet

B According to the OSHA (1983) noise regulation, hearing protection must be worn by employees when: -Exposure is 90 dBA TWA or greater -Exposure is 85 dBA TWA or greater if: No baseline audiogram has been obtained after 6 months of exposure at or above 85 dBA TWA or An STS has occurred

A child with noise-induced hearing loss is most likely to show a noise notch at which of the following frequencies? a. 2000 Hz b. 3000 Hz c. 4000 Hz d. 6000 Hz

D Research shows that for children with noise-induced hearing loss, the noise notch typically occurs at 6000 Hz (Niskar et al., 2001).

A 56-year-old male works around heavy machinery in a factory, but he does not consistently wear hearing protection because he feels that he cannot hear speech when he wears them. Which of the following types of hearing protection would be most appropriate to protect the worker’s hearing while still addressing his concerns regarding hearing speech? a. Custom earplugs (no filters) b. Semi-insert earplugs with a band that goes behind his head c. Flat attenuation (high-fidelity) earplugs (custom or noncustom) d. Traditional earmuffs

C Traditional earplugs and earmuffs typically attenuate high frequencies more than mid and low frequencies. Flat attenuation earplugs and earmuffs (also called uniform attenuation, high fidelity, or musicians plugs) are designed to provide approximately even attenuation across the frequency range, thus preserving the natural balance between the low-frequency fundamental energy and the high-frequency harmonic energy. This can be beneficial for music listening and speech understanding.

An audiology practice has contracts with several large companies to conduct their employees’ annual audiological evaluations. In order to comply with OSHA regulations, which of the following lists all the frequencies that are required to be tested? a. 250, 500, 1000, 2000, 3000, and 4000 Hz b. 500, 1000, 2000, 3000, 4000, and 6000 Hz c. 250, 500, 1000, 2000, 4000, and 8000 Hz d. 500, 1000, 2000, 3000, 4000, and 8000 Hz

B OSHA (1983) and NIOSH (1999) both require that the baseline and annual audio- metric evaluations include measuring pure-tone air conduction thresholds at 500, 1000, 2000, 3000, 4000, and 6000 Hz. Neither organization requires testing at 250 or 8000 Hz.

A newborn has been in the neonatal intensive care unit (NICU) for 7 days. Which of the following would be the most appropriate hearing screening method to use based on Early Hearing Detection and Intervention (EHDI) guidelines? a. Otoacoustic emissions for the initial screening and any rescreening b. Otoacoustic emissions for the initial screening and automated auditory brainstem response (AABR) for rescreening c. Automated auditory brainstem response (AABR) for the initial screening and otoacoustic emissions for rescreening d. Automated auditory brainstem response (AABR) for the initial screening and any rescreening

D The Joint Committee on Infant Hearing (JCIH, 2007) recommends use of an automated auditory brainstem response (AABR) screening for newborns who stay more than 5 days in the NICU due to increased risk of neural hearing loss. Use of the AABR allows for detection of auditory neuropathy.

A 7-month-old baby is seen for a diagnostic ABR test. Parents report the baby failed the newborn hearing screening performed 7 days after birth and the rescreening performed 2 weeks later. A diagnostic ABR was recommended, but the family was unable to attend the appointment because the family moved to a different state for the father’s job. Due to challenges in establishing a new pediatrician and obtaining a referral to a local audiologist, the child is now being seen for his first diagnostic ABR. Results reveal a bilateral moderate flat sensorineural hearing loss. The child is subsequently fit with bilateral behind-the-ear hearing aids at 8 months of age. Based on Early Hearing Detection and Intervention (EHDI) guidelines, which of the following statements is true regarding identification of the child’s hearing loss? a. The initial newborn hearing screening should have been performed within 48 hours of the child’s birth. b. The newborn hearing rescreening should have been performed within 7 days of the initial failed screening. c. Because the child failed the newborn hearing screening and rescreening, the audiological evaluation to confirm his hearing should have been completed by 5 months of age. d. Since a hearing loss was identified, early intervention services (including fitting with amplification) should have begun no later than 6 months of age.

D Early Hearing Detection and Intervention (EHDI) guidelines (ASHA, 2022) recom- mend a minimum of 1-3-6 goals. This includes: -hearing screening completion by 1 month of age, -diagnosis of any hearing loss by 3 months of age, -hearing aid selection and fitting within 1 month of confirmation of hearing loss, and -starting early intervention services by 6 months of age. For programs able to meet the 1-3-6 goal, EHDI guidelines suggest programs consider a new target of 1-2-3.

A patient with high-frequency SNHL related to presbycusis is fit with binaural amplification for the first time. After a few days of wearing her devices, she returns to your office complaining of bothersome noises including the refrigerator at home, the HVAC system at church, and her key chain rattling in her purse as she walks. What programming strategy may best help this patient? a. Implementing a looped system at church to pair to her T-coil b. Implementing expansion into her hearing aid programming c. Reducing overall gain for all input levels d. Creating an earmold with smaller venting

B The bothersome sounds this patient is reporting are soft sounds that she has not likely heard for many years. With her aids, she now has access to these soft sounds. Expansion can be used as a noise reduction strategy for low-level sounds. By implementing expansion into her device settings, we can help the patient experience perceived quiet in quiet environments.

A 3-year-old with CHARGE syndrome is fit with binaural amplification in the form of traditional BTEs coupled with half shell silicone earmolds. His parents report persistent feedback from the devices after the first 10 to 15 minutes that the patient has them in each morning. The feedback stops when the earmolds are pushed into the ear. His earmolds are new and, when they are properly inserted, appear to fit appropriately. What steps can be taken to reduce feedback for the patient? a. Remake the earmolds with a larger vent. b. Purchase a different hearing aid style. Instead of a BTE, the patient could try a RIC. c. Remake the earmold to be a full shell with helix lock for better retention. d. The patient is a better candidate for a cochlear implant due to his diagnosis of CHARGE syndrome. He should be referred to the CI team.

C Based on the parents’ report and troubleshooting descriptions, the feedback seems to result from a poor-fitting earmold. As the half-shell earmolds are new and look well fit when properly inserted, the audiologist should consider switching to a different earmold style. The audiologist could try remaking the earmold to be larger with an additional retention feature. A full-shell earmold with a helix lock may prevent feedback by creating a more secure coupling method.

An adult patient has a moderate SNHL in her right ear and a severe SNHL in her left ear. Her word recognition score was 100% in the right ear and 12% in the left ear. What is the most appropriate amplification option for this patient based solely on the audiometric information provided? a. BICROS; CROS device on the left ear b. CROS; CROS device on the right ear c. BICROS; CROS device on the right ear d. CROS; CROS device on the left ear

a This patient may benefit from traditional amplification in their right ear. The patient has poor word recognition and may not be a good candidate for traditional amplification in her left ear. The patient may benefit from a BICROS system. The CROS device is worn on the poorer hearing ear.

A 4-year-old patient with moderate conductive hearing loss is seen for a hearing aid evaluation. Which is the best air-conduction HA and coupling option based on the information provided? a. RIC with open-dome modular fitting b. BTE with open-dome modular fitting c. BTE with traditional tube and custom earmold d. BTE with slim tube and custom earmold

c Based on the patient’s age and degree of hearing loss, the best HA option is a BTE with a traditional tube coupled with a custom earmold. This provides increased durability and more consistent access to appropriate gain.

A 25-year-old patient is seen for an annual hearing aid check. She has a bilateral, mild to moderately severe, high-frequency SNHL. She is currently fit binaurally with BTEs, slim tubes, and custom earmolds. An electroacoustic check is completed using the Verifit2® real ear speech mapping. Results show that her current aids are not meeting targets for high frequencies. What change could initially be implemented to improve high-frequency audibility? a. Replace slim tubes with traditional diameter tubing b. Switch from custom earmold to closed dome c. Change HA style to IIC d. Change HA style to a CROS system

a Slim tubes can create significant high-frequency roll-off. Switching to regular tubing is one way to try and better meet high-frequency targets.

An adult patient with bilateral moderate sloping to severe SNHL arrives at your office with HAs that they acquired from another audiologist’s office. The HAs are less than 1 year old. The patient reports wearing the devices during all waking hours but still having difficulty hearing in all situations. You evaluate the patient’s aids and find they are not adequately meeting prescriptive targets for their hearing levels. The patient insists that hearing aids do not work for them. What is the best next step for this patient: a. Recommend the patient purchase new HAs from your office. b. Recommend the patient for a cochlear implant evaluation. c. Attempt to adjust the gain on the patient’s current devices. Charge your standard hearing aid adjustment fee. d. Refer the patient for a medical evaluation.

c First, you should try to meet the patient’s needs with the device they have purchased. If you cannot adjust their devices, you could then consider counseling they return to their original audiologist for adjustments. If you cannot adjust the devices to adequately meet their gain needs, then you may counsel them into new devices with more appropriate gain and/or coupling methods.

A cochlear implant recipient arrives for a visit with a chief complaint of increased difficulty in background noise. They were last seen in the office 1 year ago. What is the best next step to address the patient’s concerns? a. Increase the patient’s upper stimulation levels. b. Activate a fixed directional program and counsel them regarding environmental modifications. c. Recommend they utilize remote microphone technology. d. Reevaluate the patient’s internal dynamic range.

D The first thing you should do is reevaluate the internal dynamic range. Optimization of mapping parameters is the key to successful performance. After these are optimized, you can talk about directionality and remote microphone technology.

A cochlear implant recipient is experiencing facial stimulation with their device. Which of these is the best next step to eliminate their facial stimulation: a. Globally lower their upper stimulation levels. b. Increase the pulse width of the patient’s map. c. Contact the manufacturer and order an integrity test. d. Identify the electrode or region that is causing the facial stimulation.

d You should identify the electrode or region that is causing the facial stimulation and try to correct it within that region only without making global changes to the MAP.

A 24-month-old child with auditory neuropathy has been wearing appropriately fitted HAs since age 9 months. The child presents with a moderate SNHL when tested via behavioral threshold measures. They are currently nonverbal with no other diagnoses or syndromes. Which THREE options are appropriate next steps for the child (select all that apply): a. Refer the child for a speech-language evaluation. b. Refer the child to an otolaryngologist for further medical evaluation. c. Recommend the child undergo an audiologic cochlear implant evaluation. d. Contact the child’s pediatrician and recommend an evaluation for autism spectrum disorder.

a, b, & c This child should undergo evaluation by the pediatric cochlear implant team members. Regardless of behavioral thresholds, children with ANSD may not be able to adequately access speech and language with HAs and should be considered for cochlear implantation.

Which of the following is considered current best practice for programming upper stimulation levels that are equally loud for an adult that can participate in behavioral mapping techniques? a. Electrically evoked compound action potential b. Electrically evoked stapedial reflex threshold c. Psychophysical loudness scaling d. Creating a map based on the manufacturer-specified population mean

b Even when the patient can participate in psychophysical loudness scaling, they may not be skilled at listening to loudness differences through the electrode array, especially if they are a new user. ESRT is the best way to ensure equal loudness regardless of the patient’s subjective scaling abilities.

Mr. Kellogg is a 68-year-old male who was recently fit with his first set of HAs. HA output was verified using real ear measures. Datalogging shows a consistent 10 hours of use per day, and postfitting scores on the HHIE showed a significant reduction compared to prefitting scores. He reported satisfaction with the devices, specifically in quiet environments, but noted that he still struggles to hear when there is background noise present. He specifically expressed frustration with communication with his wife when they go out to dinner. Which of the following AR activities would be most appropriate for Mr. Kellogg? a. Problem identification exercises b. Psychosocial exercises c. Internet-based auditory training program d. Communication strategies training

d As Mr. Kellogg is a new HA user, it is important to discuss communication strategies, especially in the context of HA limitations. Mr. Kellogg and his wife should be counseled on strategies they can use in situations where the HA benefit is limited such as preferential seating, sitting with your back to the noise (when noise reduction strategies, like directional microphones are in use), and strategies for communication repair.

After 3 years of successful use and perceived benefit, Mr. Kellogg starts to notice that he is more tired at the end of the day and feels like he is not hearing as well as he used to, despite updated diagnostic testing and objective measures showing appropriate HA output. He is also struggling to understand his wife more and is frustrated and embarrassed with how often he has to ask for repetition. What AR activities could you suggest to him now? a. Addition of a TV streamer b. Participation in a GAR program with FCPs c. Speech perception exercise worksheet d. Advocacy/self-management training

B Mr. Kellogg is reporting more than one issue related to his hearing impairment, sug- gesting the need for multiple activities. Since his complaints pertain more to the psychosocial impacts of hearing loss, a GAR program might help connect him with others experiencing the same issues. In a GAR setting, the impact of stigma is reduced, and participants can share solutions to problems in a more supportive environment. Specific GAR activities could also provide him with communication strategy tips to use with his FCPs, stress reduction exercises to help him cope with frustration, and informational content about HATS.

Mr. Kellogg was planning to attend a play at the downtown center for the arts. Before going, he wanted to make sure he knew how to procure and use the loop system installed in the facility. What type of activity would this be called? a. Repair strategy b. Self-efficacy activity c. Anticipatory strategy d. Synthetic strategy

c Mr. Kellogg is doing “homework” ahead of time to prevent or reduce the occurrence of communication breakdown. Since he is making this effort as a proactive measure, it is an anticipatory strategy.

What type of activity would be best suited for a patient who states, “HAs will make me look old”? a. Informational counseling b. Personal adjustment counseling c. Analytic counseling d. Advocacy counseling

b This patient is demonstrating self-stigma, that is, applying labels that are negatively associated with hearing loss (in this case “old”) to himself as a person with hearing loss. We know that stigma can impact acceptance of hearing loss and serve as a barrier to successful intervention; therefore, personal adjustment counseling would be appropriate to promote adjustment to the hearing loss.

Mr. Maxwell is an 82-year-old, long-term bilateral HA user. His current BTE HAs are 2 years old, and prior to today’s appointment, he expressed satisfaction and demonstrated benefit on objective outcome measures with the devices. At today’s appointment, Mr. Maxwell expressed frustration that his HAs are not working, noting that he is struggling to understand others. You retested his pure-tone hearing thresholds and noticed no significant change since his last evaluation. You also performed a listening check and verified gain using real ear measures to match HA output to the appropriate targets. What would be an appropriate next step for you as the clinician? a. Perform a cognitive screening to rule out age-related cognitive decline as a source of the problem b. Retest word recognition scores to look for age-related declines in speech perception c. Recommend a HAT, like a Bluetooth remote microphone, to help the patient understand speech better d. Advise the patient to attend HLAA meetings to better manage the psychosocial impact of the reported problem

b While you could argue that all of these options may help the patient, the next logical step would be to assess the patient for age-related changes in word recognition scores. As we age, our ability to understand speech can decline. If this testing did demonstrate a significant decline in word recognition abilities, then you could counsel the patient on these changes and recommend some options, including a HAT or psychosocial exercises.

Baby J was identified at 5 weeks of age with bilateral moderate to severe sensorineural hearing loss. Her caregivers decided to use an LSL approach for communication and recently had impressions made for her first pair of earmolds. Which of the following would not be an appropriate AR activity for this family at this time? a. Written information on communication strategies for infants and young children b. Referral to a local program where parents of children with hearing loss serve as mentors to families of newly diagnosed children c. Referral for an Individualized Education Plan (IEP) to outline necessary AR services d. Referral to a certified LSLS specialist for AVT

c An IEP is only for children aged 3 or older who need specialized school instruction. All of the other answers would be appropriate activities for a newly diagnosed family who chooses LSL.

A patient-centered AR program is one that: a. Considers background, current status, needs, and wants to develop a custom treatment plan b. Has an ultimate goal of persuading a patient to take up and maintain services offered in the treatment plan c. Covers as many activities as possible in the shortest amount of time d. Includes informational counseling and personal adjustment counseling

a Patient-centered care occurs when a practitioner takes into account all of the individual patient factors to provide information about all available treatment options so that the patient can make an informed choice.

Elena is a 4-year-old with bilateral hearing loss and has a 504 Plan that stipulates that she attend therapy with an SLP at her school three times per week. One of the activities she has been working on targets sound identification through playing the game Candyland. The SLP notices that Elena has steadily improved and is now responding correctly during game play at least 90% of the time. What should the SLP do next? a. Seek to terminate the 504 Plan on the grounds that therapy is no longer needed b. Change to a comprehension task, like 20 questions c. Change to a closed-set task that works on sound discrimination d. Change to a communication strategies task

b Auditory skills training is typically done on a continuum. Since the child is doing well with an identification task, the next step would be to move to a harder task on the continuum, in this case a comprehension task.

During therapy, Elena’s SLP notes that her conversational fluency has improved since her last evaluation. How could the SLP measure this? a. Informally through talking with Elena and observing interactions with her classmates b. By recording a structured conversation and then using the recording to calculate mean length turn (MLT) ratio c. By asking her teachers to rate Elena’s fluency on a scale of 1 to 10 d. Both a and b

d Conversational fluency can be measured formally by calculating the MLT ratio or infor- mally by a trained professional (in this case the SLP). While Elena’s teacher may be able to provide some input, evaluating conversational fluency is beyond her area of expertise so a subjective rating from the teacher would not be of much value.

Which of these would not be considered an effort to improve cultural responsiveness at your practice? a. Recruit and retain minority staff b. Attend a cultural competence workshop c. Use family members as interpreters d. Engage in introspection to discover any implicit biases

c Using family members as interpreters is strongly discouraged in a healthcare setting. Family members are not likely to be neutral when relaying information, and any emotional impact that the information may contain could result in it not being correctly relayed. It is recommended to always retain a qualified medical interpreter to ensure that the patient is getting all the information they need. The rest of the responses are all appropriate examples.

Counseling in audiology is defined as intentional communication with patients and families impacted by audiological conditions. Which of the following types of counseling is intended to the educational needs of a patient/family? a. Informational counseling b. Adjustment counseling c. Diagnostic counseling d. Intervention counseling

a In this question, educational needs of a patient/family are best addressed through informational counseling.

Which of the following questions is the best example of a closed question? a. Tell me more about the music you’ve been hearing in your head? b. Other than your husband, son, and daughter-in-law, is there anyone else who would like you to get hearing aids? c. Are you taking any medications? d. Is there anyone else who you would like to better communicate with at home?

c Closed questions often lead a patient to respond with a short or sometimes yes/no type of answer.

Sally, an 18-year-old female with bilateral cochlear implants, has been working with the same cochlear implant audiologist since she was a toddler. There were times she got along well during mapping sessions and others she would’ve rather been someplace else. She is nearly ready to graduate from high school. Which of the following is an example of a patient goal that Sally, her parents, and her audiologist could work together on setting? a. Being reliable and decisive b. Scheduling her own appointments c. Showing respect and dignity d. Being courteous and civil

b Only one goal is provided: “showing up on time.” Values are attitudinal characteristics that drive and motivate actions, including being reliable, respectful, or courteous.

Which of the following statements best demonstrates an example of a patient who is resistant to changing their hearing health behavior? a. My wife thinks I am having trouble hearing at home and I have noticed similar things. b. I need to hear and understand people better at work, or I may lose my job. c. My wife is nagging me to get hearing aids, I don’t think I have enough hearing loss yet. d. I would like to get the best hearing aids to meet my communication needs possible.

c All listed answers are examples of a desire to change, except for the one that presents a statement of denial.

Mr. Echohawk, a 55-year-old male from a Native American background, was diagnosed with a bilateral flat moderately severe sensorineural hearing loss. When discussing options after his hearing test, he is having a hard time understanding the audiologist’s words and does not make eye contact. The audiologist notices this and offers Mr. Echohawk a handheld personal sound amplifying device (e.g., a Pocket Talker) to use for the remainder of the appointment. Mr. Echohawk is relieved that he can now hear the audiologist’s voice better without having to rely on visual or lip cues. What cultural counseling principle did the audiologist apply in this encounter? a. Cultural humility b. Cultural humiliation c. Cultural adaptation d. Cultural disrespect

a In this question, the audiologist was culturally familiar with Native Americans not making direct eye contact out of respect and demonstrated cultural humility by offering an alternative solution to help them communicate better.

Ms. Hampton, an 88-year-old female, who lives on limited Social Security income and has no Medicare hearing aid benefits was recently diagnosed with a mild steeply sloping to severe sensorineural hearing loss in both ears and is greatly interested in purchasing hearing aids. Which of the following is the best example of an external barrier that may be present to Ms. Hampton in reaching her hearing health goal of acquiring hearing technology? a. Emotional b. Financial c. Cognitive d. Stress

b In this question, the only external variable listed is “financial” due to Ms. Hampton’s limited income. All other answers are example of internal barriers to patient goals (i.e., emotional, cognitive, stress).

Consider the following audiological encounter: Audiologist: “How long were you exposed to this loud music at the concert?” Patient: “About 2 hours.” Audiologist: “Were you wearing any hearing protection?” Patient: “I had some foam plugs, but I don’t think I had them deep enough.” Audiologist: “What sort of foam plugs were they?” Patient: “Ones I got at a local drug store.” Audiologist: “Did you take them out at any point during the concert?” Patient: “Yes, they were getting sore after about an hour in, so I just went the rest of the concert without them.” Audiologist: “Can you remember if the music got any louder toward the end of the concert?” Patient: “Now that you mention it, yes, I do remember the band getting really loud during the closing number and seeing a bunch of kids around me starting to plug their fingers into their ears when a guitar amp burst.” Which of the following types of questions best describes the types of questions used by the audiologist to gather more and more detail in developing levels? a. Funnel questions b. Closed questions c. Leading questions d. Clarifying questions

a General questions that drill down to a more specific point in each, asking for more and more detail at each level that are interrogative in nature act like a funnel, and are thus called funnel questions.

Jimmy, a 2-year-old male, was recently fit with a pair of wireless rechargeable BTE hearing aids with custom earmolds compatible with direct streaming to mobile technologies like smartphones and tablets. He and his family live a 2.5-hour drive from the children’s hospital where his pediatric audiologist works. Jimmy’s parents own a tablet device with videoconferencing abilities and the pediatric audiologist expressed that due to their state’s licensure laws permitting, they would like to set up some intermittent follow-up teleaudiology appointments to see how Jimmy is doing at 1 week and 3 weeks postfitting to reduce the travel burden on the family. What type of service category would these types of appointments fall under? a. Synchronous b. Asynchronous c. Hybrid d. None of the listed options

a For videoconferencing appointments, synchronous sessions would provide for the best setup in this case

Which of the following best describes what a discharge note for a Medicare patient should include? a. Assessment of progress/improvement and/or changes to goals b. Diagnosis and functional assessment scores from earliest encounters c. All information a future provider may need to pick up patient care d. The most recent encounter and notes on intervention

c Medicare suggests a discharge note should include documentation of all treatment since last progress report in the form of a handover document explaining to a patient or any other healthcare professional why the patient was admitted or enrolled in treatment, what happened to them during treatment, and all information that they may be needed in the future for another provider to pick up the care of the patient efficiently and effectively.

Which of the following statements is true of electronic medical record (EMR) systems? a. There are no Medicare requirements for electronic submission of billing information when using an EMR. b. They offer substantial flexibility to locate any available relevant patient history. c. It is not possible to use documentation templates in an EMR system. d. They are not as secure as paper charts.

b EMR systems offer substantial flexibility to providers, including from multiple profes- sions, to locate any relevant patient history when working easily and conveniently in a setting such as a hospital network.

An audiology practice provides hearing care services for employees of a large multinational company whose health benefits include full coverage for hearing aids. The practice also participates with governmental insurance, including Medicare and Medicaid. The audiologist routinely encourages individuals with normal hearing who are close to retirement to obtain hearing aids while they still have insurance since that benefit is not available in retirement. The audiologist uses the diagnosis code for bilateral sensorineural hearing loss (H90.3) for these patients. In this situation, which legal statute is the audiologist violating? a. Anti-Kickback Statute b. False Claims Act c. Stark Self-Referral d. Autonomy act

b The patient does not have a sensorineural hearing loss. The audiologist is selecting an inaccurate code for the purposes of insurance coverage and violating the False Claims Act.

Which of the following is the ethical principle that requires audiologists to be faithful and honest in professional relationships? a. Autonomy b. Beneficence c. Nonmaleficence d. Fidelity

d Fidelity is defined as personal responsibility to be honest and truthful in relationships.

An adult patient with developmental disabilities is being seen for a comprehensive audiological exam. The audiologist must end the appointment after obtaining results only for the right ear. Which of the following modifiers would be the best for the audiologist to use? a. -52 b. -59 c. -72 d. -99

a The billing CPT code 92557 assumes testing of pure-tone air and bone conduction, speech threshold testing, and speech recognition testing bilaterally. If the appointment was ended without obtaining all of the required results for both ears, the audiologist should use the -52 modifier to indicate to the payer that the testing was incomplete.

The parent of your 18-year-old patient is seeking to obtain the educational records (to share with you) from the local university that the student attended during the previous year. Which of the following legal statutes applies to this situation? a. Family Educational Rights and Privacy Act (FERPA) b. Health Insurance Portability and Accountability Act (HIPAA) c. Public Law 94-142 d. Individuals With Disabilities Education Act (IDEA)

a FERPA is a federal privacy law that protects the privacy of student educational records and restricts access and disclosure of those records.

The owner and audiologist of a single-provider private practice retires and closes his practice. Prior to the closure, he fails to notify patients and provide information regarding alternative providers from which they could receive services. Which of the following concepts is relevant in this instance? a. Patient abandonment b. Patient abuse c. Patient mismanagement d. Patient separation

a Because the patients were not provided notice or information regarding how to obtain services from another provider once the audiologist retires, patient abandonment was committed.

Which of the following insurance types is typically characterized as having the lowest premium, requires a “gatekeeper” for specialty care, and is often more limited in the choice of providers? a. Health maintenance organization (HMO) b. Point of service (POS) c. Preferred provider organization (PPO) d. Health savings account (HSA)

a PCPs are the “gatekeeper” for HMO plans because a PCP referral is typically needed for access to specialty provides. HMOs also try to keep costs down by offering limited provider that are in-network providers.

An audiologist is considering the purchase of a piece of vestibular equipment but notes a decline in the number of vestibular evaluations provided by the practice. There is concern that if new equipment is purchased, it will become nonfunctional prior to generating revenue for the practice. Which of the following calculations would be most helpful to the audiologist in deciding whether to purchase the equipment? a. Gross profit margin b. Costs of goods sold c. Breakeven analysis d. Key performance indicators

c The breakeven analysis is the process used to determine the number of services it will take to recoup the expense of a given expenditure. In this case, the breakeven analysis would calculate the number of vestibular tests that are likely to be performed over the expected lifespan of the equipment and compare the reimbursement for the tests compared to the cost of purchasing the equipment. This will allow the audiologist to determine what the breakeven point for the equipment is and if they are likely to perform enough vestibular tests to make a profit from the purchase of the equipment.

The provision of outpatient audiological services in a private practice setting should be billed to which component of Medicare insurance? a. Part A b. Part B c. Part C d. Part D

b Medicare Part B covers medical services obtained on an outpatient basis. Audiology services are typically provided at outpatient clinics.

An audiology practice bills an insurance company for a comprehensive audiological evaluation (92557) and tympanometry (92567) completed on a patient. Until the insurance company reimburses the practice for these services, the amount due is placed in which of the following accounts? a. Accounts receivable b. Accounts payable c. Cost of goods sold d. Diagnostic revenue

a Once a service is provided but yet to be reimbursed, the amount owed the practice is placed in accounts receivable until payment is received.

Which of the following allows an audiologist to legally provide clinical services in a given state? a. American Board of Audiology (ABA) certification b. Malpractice insurance c. Licensure d. Certificate of Clinical Competence (CCC) ‘

c Licenses to practice in a healthcare field are awarded by federal, state, or local gov- ernment agencies and are a requirement to practice. Certifications are awarded by nongovernmental organizations and are optional. Malpractice insurance is highly recommended but not required unless by state law.

A patient is seen for an auditory processing disorder evaluation. The portion of the assessment specific to evaluating areas of auditory processing lasted 1 hour and 20 minutes. Which CPT code(s) should the audiologist select based on the testing? a. 92627 b. 92620 c. 92620 & 1 unit of 92621 d. 92620 & 2 units of 92621

c The total evaluation time is 80 minutes. 92620 is the CPT code for the first 60 minutes of an evaluation of central auditory processing, with report. The additional 20 minutes meets the criteria to bill one unit of 92621 (each additional 15 minutes) but not 2 units since the assessment time did not meet the criteria of at least 51% of the next 15-minute time increment.

According to IDEA, the audiologist’s recommendations for this child should be addressed in which of the following documents? (A) Individualized Family Service Plan (B) Individualized Education Program (C) Behavioral intervention plan (D) Cumulative academic record

A 6-month-old child born with bilateral bony atresia is seen for an audiological evaluation and treatment recommendation. Radiological evidence indicates the probable presence of an intact middle ear and cochlea. ABR responses have been obtained at near-normal levels to bone-conducted signals. Of the following, the most (A) defer treatment until growth of the external and middle ear is complete at about age 6 (B) suggest that surgery be initiated on at least one ear to permit a normal air-conducted pathway (C) recommend an implanted bone-anchored hearing aid (D) investigate the use of a bone-conduction hearing aid until audiological test results can be confirmed and surgery initiated when the child is older

Which of the following statements about a caloric response yielding a left unilateral weakness in the interpretation of videonystagmography results is most accurate? (A) It suggests a right peripheral vestibular disorder of the labyrinth. (B) It suggests a nonspecific (nonlocalizing) vestibular disorder. (C) It suggests a left peripheral vestibular disorder of either the labyrinthine or the VIIIth nerve. (D) It suggests a central vestibular disorder.

The accuracy of a hearing screening test in correctly identifying those individuals who actually have a hearing disorder is referred to as the screening test’s (A) reliability (B) validity (C) specificity (D) sensitivity

Carol is a 34-year-old woman with a sudden-onset, left-sided facial paralysis that has been diagnosed as Bell’s palsy. Acoustic reflexes are present at normal levels bilaterally for both ipsilateral and contralateral stimulation. Which of the following statements accurately applies to this situation? (A) The pathology is proximal to the stapedial branch of the VIIth nerve. (B) The pathology is distal to the stapedial branch of the VIIth nerve. (C) The facial paralysis is probably nonorganic in nature. (D) No reliable statement can be made about VIIth nerve function, since the responses could be due to Vth nerve activity.

According to professional practice guidelines services that audiology assistants can perform include which of the following? (A) Conducting hearing and tympanometry screening tests on older children and adults (B) Contributing to and participating in Individualized Education Programs (IEPs) (C) Disclosing test results and protected health information to patients (D) Instructing patients and making referrals for additional services

An Individualized Family Service Plan (IFSP) is mandated under which of the following provisions of the Individuals with Disabilities Education Act (IDEA) ? (A) IDEA Part A (B) IDEA Part B (C) IDEA Part C (D) IDEA Part D

Which of the following is typically the best choice of amplification for a person with bilateral moderate conductive hearing loss and chronic drainage from both ears? (A) Behind-the-ear aids with vented earmolds (B) A body-worn hearing aid (C) A bone-conduction hearing aid (D) A multichannel cochlear implant

In the measurement of real-ear sound-pressure levels with a probe-tube microphone system, insufficient probe-tube depth will tend to (A) increase the high-frequency response (B) decrease the high-frequency response (C) decrease the low-frequency response (D) increase the low-frequency response

The measurement of distortion product otoacoustic emission (DPOAE) involves the presentation of pairs of pure tones to the patient’s ear. Which auditory response does this test measure? (A) Cubic difference tone (B) Summation tone (C) Resonance in outer hair cells (D) Resonance in inner hair cells

A client with a history of bilateral profound sensorineural hearing loss, lack of vestibular function, and progressive retinal deterioration is scheduled for an audiological assessment. Which etiology is consistent with the client’s history? (A) Auditory neuropathy (B) Vestibular schwannoma (C) Neurofibromatosis (D) Usher syndrome

The area of the ear canal where most cerumen is generated is (A) at the isthmus (B) the bony portion (C) the middle third of the canal (D) the outer third of the canal

A child comes to the clinic due to problems understanding the teacher at school. The child has a moderate hearing loss and wears bilateral hearing aids. Aided speech- recognition scores at 55 dB HL in quiet were 88 percent correct, with scores being 60 percent correct with a +5 SNR. Which of the following would be the best recommendation for the child? (A) Increase the gain of the hearing aid. (B) Utilize directional microphones with the hearing aids. (C) Utilize a personal frequency modulation (FM) system with the hearing aids. (D) Utilize a low-gain frequency modulation (FM) system with headphones.

Which THREE of the following can known types of presbycusis be attributed to? (A) Degeneration of sensory hair cells (B) Degeneration of auditory neurons (C) Degeneration of the stria vascularis (D) Degeneration of the ossicular joint (E) Degeneration of the tectorial membrane

a, b, & c

Which of the following best identifies the appropriate tools to screen for newborn hearing loss in accordance with the Joint Committee on Infant Hearing Guidelines? a. WB: ABR & ICU: OAE b. WB: OAE & ICU: OAE or ABR C. WB: OAE & ABR & ICU: ABR D. WB: ABR & ICU: ABR & ASSR

In 2002, the American National Standards Institute (ANSI) adopted guidelines for classroom acoustics, intended for use in the design of new classrooms and in the renovation of existing classrooms. The ANSI-recommended average noise levels and reverberation times for unoccupied classrooms (< 10,000 cubic feet) are (A) 25 dBA or less and 2.0 seconds or less (B) 35 dBA or less and 0.6 second or less (C) 45 dBA or less and 2.0 seconds or less (D) 55 dBA or less and 0.2 second or less

A patient fitted with hearing aids for the first time returns for a two-week follow-up appointment. The patient reports feeling uncomfortable when doors slam. Which of the following is the most likely cause for the patient’s complaint? (A) The maximum power output (MPO) is set too high. (B) The dynamic range of the hearing aid is too narrow. (C) The patient is experiencing the occlusion effect. (D) The attack and release times are too fast.

A patient fitted with hearing aids for the first time returns for a two-week follow-up appointment. The patient reports feeling uncomfortable when doors slam. Which of the following strategies is most appropriate for addressing the patient’s complaint? (A) Using expansion (B) Decreasing the output compression threshold (C) Decreasing the input compression ratio (D) Increasing the input compression threshold

The audiometry room used for an occupational hearing conservation program is scheduled for renovation. The renovated room will have four ducts for ventilation. Each duct will have one fan, and all fans must be identical for effective ventilation. In order to obtain valid thresholds, the total noise of the fans must remain below 40 dBA. Assume that the noise from the duct fans radiates equally throughout the room. Which of the following represents the maximum noise level that can be emitted by each individual fan? (A) 34 dBA (B) 28 dBA (C) 20 dBA (D) 10 dBA

Which of the following symptoms is most indicative of superior semicircular canal dehiscence? (A) Dizziness associated with loud sounds (B) Persistent feeling of spinning (C) Inability to walk in a straight line (D) Fluctuating low-frequency hearing loss

Which of the following assessments best determines the integrity of the inferior branch of the vestibular nerve? (A) Bithermal caloric test (B) Horizontal head shake test (C) Cervical vestibular evoked myogenic potential (cVEMP) testing (D) Ocular vestibular evoked myogenic potential (oVEMP) testing

A 38-year-old patient with a moderate midfrequency hearing loss was fit with bilateral in-the-canal hearing aids. The patient complains of difficulty finding the person speaking when in a social or work situation where there are more than three or four people. Which of the following is most likely to be responsible for the patient’s reported problem? (A) Distorted pinna filtering (B) Absent ear-canal resonance (C) Inability to process spatial cues (D) Decreased frequency selectivity

. A person with a hearing loss who requires speech to be 12 dB higher than noise to achieve a 50 percent correct sentence-recognition score most likely has an SNR loss of (A) 6 dB (B) 8 dB (C) 10 dB (D) 12 dB

A solo practitioner audiologist who is in the first trimester of her pregnancy reads the case history information provided by a patient who has CMV. To avoid ethical issues with patient abandonment, the practitioner should do which of the following? (A) Refuse to see the patient for three months (B) Wear a mask and gloves and proceed with seeing the patient (C) Perform only noninvasive audiological procedures using earphones (D) Refer the patient to a colleague at another location

Auditory manifestations of a retrocochlear pathology at the first-order afferent nerve fibers typically include which of the following? (A) Pronounced acoustic reflex decay (B) Reduced compliance (C) Loudness recruitment (D) Normal speech recognition in noise

An audiologist is the first professional to see a patient who has experienced difficulty hearing in one ear for about two months. The audiologist finds the hearing impairment to be a mild-to-moderate unilateral sensorineural hearing loss. The word recognition score for recorded, full-list NU-6 monosyllabic words in quiet at 40 dB above the speech recognition threshold is 24 percent in that ear. Which of the following is the audiologist’s most appropriate next step? (A) Discussing the potential of CROS hearing aids and making an appointment for a hearing aid evaluation (B) Scheduling another session for further audiometric tests (C) Referring the patient for auditory steady state response (ASSR) testing (D) Referring the patient to a physician

The reliability of an obtained waveform on the auditory brainstem response is best checked by doing which of the following? (A) Obtaining another waveform under identical conditions (B) Increasing the stimulation rate (C) Opening the filters (D) Using digital filters after completing the test

A 65-year-old man presents with tinnitus and it sounds as if his co-workers are mumbling when he sits down to eat lunch with them in the dining hall. This is progressively worse over the past several months. He denies exposure to loud noises, headaches, ear pain, congestion, difficulty with balance, and changes in facial sensation. Which of the following changes is most likely the cause of this patient's symptoms? A.A slow-growing tumor pressing on the auditory nerve B.Perforation of the eardrum C.An infection within the ear canal D.Age-related loss of auditory hair cells

A 75-year-old female presents with progressively worsening bilateral hearing loss. Her husband first noticed her decline in hearing ten years ago when the patient started increasing the volume on the television. She also has more difficulty understanding conversations in noisy environments such as restaurants and large family gatherings. She undergoes audiometric testing and has bilateral sensorineural hearing loss, which her clinician explains is most likely secondary to presbycusis. This condition initially affects high-frequency sounds first. Which part of the auditory system is involved? A. Semicircular canals B. Cochlea C. Vestibulocochlear nerve D. Primary auditory cortex

A 55-year-old woman is referred to an audiologist for the evaluation of suspected sensorineural hearing impairment. After the audiometry is performed, the audiologist recommends hearing aids. This patient has small ear canals with poor hand dexterity due to rheumatoid arthritis. She expresses concern about staying within her chosen budget. Which of the following is the most ethical recommendation? A.Recommend the hearing aid brand the audiologist prefers fitting. B.Recommend the most sophisticated technology for the best hearing clarity. C.Refer the patient to a more experienced audiologist. D.Recommend device styles based on the patient's dexterity and budget.

D.Recommend device styles based on the patient's dexterity and budget.

A 4-year-old boy presents for a hearing aid evaluation. On physical examination, the left external ear is normal in shape, with a patent ear canal. The right ear consists of a small nub of soft tissue with no discernable external auditory meatus. Auditory brainstem response testing reveals the presence of wave V bilaterally. Which amplification device is most appropriate for this child at this time? A.Bone-conduction hearing aid B.Cochlear implant C.Air-conduction hearing aid D.Contralateral routing of signals (CROS) hearing aid

A 5-year-old girl with recurrent otitis media is brought to the office by her mother for a consultation. The provider explains that Eustachian tube dysfunction leading to otitis media is more common in children than adults. Which of the following causes a net pressure differential between the middle ear and atmospheric pressure that the Eustachian tube functions to normalize? A.Diffusion of nitrogen gas across venous capillaries in the middle ear B.Diffusion of carbon dioxide and oxygen across venous capillaries in the middle ear C.Diffusion of carbon dioxide and oxygen across the tympanic membrane D.Suction from the nasopharynx during normal swallowing

A laboratory experiment involving fibroblast growth factor (FGF) knockout mice is conducted at a university. After several trials, it is discovered that all of the mice fail to develop a cochlea and mature vestibular system. Failure of which embryological process most likely resulted in these findings? A.Endochondral ossification of Meckel and Reichert cartilage B.The fusion of the auricular hillocks on each side of the external meatus during the fourth week of development C.Invagination of the otic placodes during the fourth week of development D.The lateral extension of the tubotympanic recess towards the floor of the first pharyngeal cleft during week 5 of development

A 36-year-old female presents for evaluation for hearing loss. She has a history of trauma from a motor vehicle collision two years ago, during which she sustained a left-sided temporal bone fracture. Since that time, she has had persistent difficulty hearing on the left. She does have a history of recurrent otitis media requiring tympanostomy tube placement as a child, chronic rhinosinusitis, and diabetes mellitus. A comprehensive head and neck examination is performed, and red-gray patches are noted on the scalp as well as the bilateral hands, neck, and upper chest. A tuning fork exam with a 512 Hz fork showed Weber deviated to the left, air conduction greater than bone on the right, and bone greater than air on the left. An audiogram demonstrates moderately severe mixed hearing loss on the left. She recently saw a TV advertisement for a bone-anchored hearing device that could connect to her phone and inquired whether this was an option for her. Which of the following is a contraindication to a surgically implanted bone-anchored hearing device in this patient? A.History of trauma B.Atopic dermatitis C.History of recurrent otitis media D.Diabetes mellitus

A 55-year-old man presents to the healthcare provider complaining of aural fullness and intermittent clicking sounds in his right ear. After an evaluation, he is diagnosed with dysfunction of the muscle in the ear that normally works to dampen sounds. Where does this muscle insert? A.Posterior crus of stapes B.Head of the malleus C.Lateral process of the malleus D.The handle of the malleus

An 18-month-old boy presents with unresponsiveness to audio stimuli. A history of present illness obtained from his father reveals that the patient does not seem to hear as well as his older siblings. His prenatal course and delivery were uncomplicated, and the patient has not had any major health concerns or hospitalizations since birth. The patient’s father states that his speech has been delayed, with the patient only recently starting to say a few words in the past several weeks. The audiological testing technique most appropriate to optimize the validity of testing may involve which of the following? A.Electrodes measuring the nerve conduction of sound stimulus. B.Placing a ball in a basket in response to a sound stimulus. C.Turning the head in the direction of a sound stimulus. D.Pressing a button in response to a sound stimulus.

An 82-year-old woman presents to the clinic for "vertigo." She reports the onset of vertigo 3 months ago and vaguely recalls "a slight cold" around the time that her symptoms began. The patient has a negative Dix-Hallpike test, negative roll test, and normal oculomotor testing but cannot maintain fixation on target with the head impulse test. She reports varying but minimal dizziness in her daily activities but notes an increase in symptoms when riding in the car or walking her dog in the neighborhood. She walks with a cane and demonstrates decreased gait speed and poor step clearance. Which of the following is the most appropriate initial recommendation for this patient? A.Habituation exercises B.Adaptation exercises C.Substitution exercises D.Canalith repositioning maneuver

An 87-year-old man presents to evaluate his current behind-the-ear hearing aids. He is unaccompanied for the clinic visit and brings the devices in their case. He has a history of arthritis and severe sensorineural hearing loss due to noise-related damage during his years of military service. He says he would like to use his aids to watch television but no longer uses them because he "can't make them work." A listening check after adding batteries confirms that both devices are functioning with appropriate gain. Which of the following factors is most appropriate to address for this patient's needs at this visit? A.Familial support, assistive devices, and motivation B.Vision, dexterity, and level of hearing loss C.Familial support, motivation, and level of hearing loss D.Familial support, vision, dexterity, and assistive devices

A 13-year-old girl is brought in by her mother due to a popping sensation in her ears. She has a history of asthma and had an adenoidectomy at the age of four due to breathing and sleeping difficulties. Tympanometry shows a type C tympanogram for the right ear and a type B tympanogram with normal volume for the left ear. The Eustachian tube dysfunction patient questionnaire (ETDQ-7) mean overall score is 3.0. What is the most likely diagnosis? A.Bilateral eustachian tube dysfunction only B.Tympanic membrane retraction in the right ear and otosclerosis in the left ear C.Eustachian tube dysfunction in the right ear and a middle ear effusion in the left ear D.Otitis media in the right ear and a tympanic membrane perforation in the left ear

A 66-year-old man presents to the clinic for evaluation. He complains of progressive right-sided hearing loss over the last year. His vital signs reveal blood pressure 132/80 mmHg, heart rate 83/minute, respiratory rate 15/minute, and temperature of 98.5 F. He also reports vertigo with nausea and vomiting. Rinne's test reveals air conduction is greater than bone conduction bilaterally. Weber's test reveals lateralization to the left ear. An MRI shows a mass involving the right cerebellopontine angle. What is the most likely diagnosis? A.Meningioma B.Arachnoid cyst C.Vestibular schwannoma D.Acute vestibular syndrome

A 25-year-old male presents with a 3-month history of mild left-sided knee pain. The patient is a professional basketball player and has never experienced pain similar to this. The clinician asks the patient to move from a standing position into a squat as part of the physical exam. He then asks the patient to move back from a squat into a standing position. What organ within the inner ear is responsible for this patient’s perception of his head movements during this exercise? A.Utricle B.Saccule C.Semicircular canals D.Cochlea

A 45-year-old man presents with a pulsatile ringing in his ears and vertigo. He says he has had these symptoms for many years but feels they are getting progressively worse. The ringing is present all the time without associated hearing loss. He avoids loud noises because they worsen his vertigo and hurt his ears. He also describes symptoms of autophony. The head and neck examination findings are largely unremarkable, except for vertigo upon pneumatic otoscopy to the right ear. The audiogram shows supranormal bone conduction. Which of the following is most likely to be observed with further evaluation? A.Absent cervical vestibular-evoked myogenic potential bilaterally B.Stenosis of the left carotid artery C.Absent stapedial reflexes bilaterally D.Lower threshold and higher amplitude on cervical vestibular-evoked myogenic potential when the right is compared to the left

A 55-year-old man presents with ringing in the ear as well as a popping sensation. The clinician suspects a dysfunction of the muscle that arises from the cartilaginous part of the auditory tube and is innervated by the fifth cranial nerve. What is the function of this muscle? A.Enhance transmission of sound. B.Muffle loud sounds. C.Amplify soft sounds. D.Enhance vibratory sounds.

A 2-week-old boy is brought to the clinic for an initial evaluation. His mother reports that her pregnancy was uncomplicated and that he was delivered vaginally by a midwife at home. The child is feeding well and has returned to his birth weight. His mother states that he seems to respond to noises in his nursery at home and actively engages with his parents. On examination, the right auricle is misshapen and smaller than the left. There are no other dysmorphic facial features. The tympanic membrane on the right cannot be visualized due to an extremely stenotic canal, which the clinician cannot reliably consider patent. What is the best next step in evaluating this neonate? A.Auditory brainstem response (ABR) B.Behavioral observation audiometry (BOA) C.Otoacoustic emissions (OAE) D.Tympanometry and acoustic reflexes (immittance)

A newborn is being evaluated in the nursery for severely deformed ears bilaterally. He was delivered by normal vaginal delivery at term with no complications. The mother denies any family history of congenital diseases. Physical examination reveals a bilaterally severely deformed tragus, helix, and cymba concha. Other parts of the ear, including concha, antihelix, and antitragus, appear fully developed. Chest auscultation reveals normal heart sounds with no murmurs. What embryological structure failed to properly develop in this neonate? A.Third pharyngeal arch B.Second pharyngeal arch C.Fourth pharyngeal arch D.First pharyngeal arch

A 10-year-old boy, accompanied by his mother, presents for evaluation of right-sided sudden-onset hearing loss of 2 weeks' duration. History reveals the child has recently been involved in a motor vehicle collision. Even though he remains unharmed, he witnessed the death of his cousin, who was driving the vehicle. He also reports a runny nose and a mild cough for the past week. Otologic examination demonstrates mild retraction of the right tympanic membrane and a normal tympanic membrane on the left side. Pure-tone audiometry was performed 1 week before presentation, which revealed a threshold of 110 dB in the right ear and 20 dB in the left ear. Pure-tone audiometry is repeated, and the patient is encouraged throughout the procedure and praised for his efforts to improve his hearing. The new thresholds are 30 dB in the right ear and 15 dB in the left. Otoacoustic emission test results are normal. What is the most likely underlying etiology of this patient's severe hearing loss? A.Malingering B.Factitious disorder C.Functional neurologic symptom disorder D.Eustachian tube dysfunction

A 68-year-old man is being evaluated for muscle weakness bilaterally, poor foot clearance and stumbling with gait, and being fearful of falling. He had a recent hospital stay due to chronic osteomyelitis in the left upper extremity, with hospital discharge occurring 1 day ago. The patient’s past medical history includes hypertension, diabetes, nicotine dependence, and a history of falls. His medication list includes lisinopril, gabapentin, metformin, multivitamins, and intravenous gentamicin. The patient denies dizziness but demonstrates poor standing and walking balance, inability to maintain tandem or semitandem stance, and difficulty with a narrowed support base. The patient demonstrates negative Dix-Hallpike and negative roll test and refuses oculomotor testing, stating, “That’s just ridiculous.” The patient demonstrates 4/5 manual muscle testing for bilateral lower extremities, a timed up-and-go test of 16.7 seconds, and 2/10 spots on monofilament testing. He can tolerate 2 minutes of activity with minimal shortness of breath and fatigue. The patient does not use an assistive device at this time. Which of the following is the best initial step in treating this patient? A.Epley maneuver B.Habituation exercises and fall risk education C.Substitution exercises and fall risk education D.Endurance exercises and muscle-strengthening exercises

A child with mild to moderate hearing loss struggles with daily assignments at school. The child has had partial hearing loss since birth and uses hearing aids for everyday activities. Which of the following is most challenging for students with hearing disabilities? A.Test-taking B.Note-taking C.Reading D.Interruptions

A 26-year-old man presents with recurrent episodes of rotational vertigo for the last 10 hours. After the first couple of episodes, the patient developed unilateral tinnitus, decreased hearing, hyperacusis, and sensation of fullness, which waxes and wanes. What type of hearing loss will the patient most likely have? A.Hearing loss involving all frequencies B.High-frequency hearing loss C.Mid-frequency hearing loss D.Low-frequency hearing loss

A 35-year-old man presents for continuous ringing in his right ear for the past few weeks. He also reports a constant decrease in hearing on the affected side and occasional headaches worsening over the past few weeks. The physical examination is normal. His audiogram reveals sensorineural hearing loss in his right ear. MRI brain finding demonstrates a 2 cm lesion at the cerebellopontine angle that enhances with gadolinium and does not appear to have a "tail." What is the most likely cause of this patient's presentation? A.Neoplasm of cranial nerve VIII B.Vascular malformation C.Endolymphatic hydrops D.Meningioma

A researcher is studying the vestibulo-ocular reflexes of subjects spun counterclockwise in a rotational chair. The subjects are spun horizontally at a constant speed for less than a minute and then stopped. During the stationary phase, reflexive eye movements were observed that were opposite in direction to the body rotation and equal in magnitude. Which of the following is most likely to be involved in the process of the vestibular response to the motion mentioned above? A.Left horizontal semicircular canals firing in the direction of motion B.Macula, firing in the direction of motion C.Macula, firing in the opposite direction of motion D.Left horizontal semicircular canals firing in the opposite direction of motion

A 45-year-old man was diagnosed with a vestibular schwannoma on the left side 12 months ago. Pure tone audiometry reveals a stable, mild to moderate high frequency sloping sensorineural hearing loss in the left ear with normal function in the right ear. He says he is increasingly struggling at work and would like to try a hearing aid. What is the best next test to assess this patient's need for a hearing aid? A.Speech audiometry B.Auditory brainstem response (ABR) C.MRI scan D.Stapedial reflexes

An 81-year-old woman presents with several years of progressive hearing loss. She reports difficulty understanding her friends in groups and restaurants but has no trouble understanding her husband in conversation. Pure-tone audiometry demonstrates bilateral sensorineural hearing loss. Given the likely diagnosis, which of the following is most associated with this patient’s condition? A.Depression B.Heart disease C.Migraine D.Diabetes mellitus

A 42-year-old woman presents with fluttering left-sided tinnitus that occurs several times per day, often in response to other noises, and lasts from seconds to minutes. She denies any antecedent infections or trauma. She has a past medical history notable for anxiety, depression, and hypertension. She denies any new medications or changes to her medication dosages. She takes escitalopram and captopril daily. On examination, she is anxious but in no distress. Ear examination shows normal pinnae and no middle ear effusion. The clinician notes a rapid movement of the normal-appearing left tympanic membrane, and the patient confirms she hears the tinnitus. The right tympanic membrane exam findings are unremarkable. Auscultation over the left neck does not reveal a bruit. She has undergone pure-tone audiometry, demonstrating bilateral high-frequency sensorineural hearing loss at 4k Hz. What tympanometry results are expected in this patient at this time? A.A sawtooth pattern on the left and type As on the right B.A sawtooth pattern bilaterally C.A sawtooth pattern on the left and type A on the right D.Type C on the left and type A on the righ

A 5-month-old boy presents for a well-child visit. A review of systems obtained from his mother reveals that he does not respond to her voice when calling him from behind. She thinks that her child has some hearing problems as whenever she is in front of him, he smiles and tries to hold her. An auditory brainstem evoked response (ABR) reveals findings suggestive of moderate sensorineural hearing loss. The clinician tells the mother about an audiologic rehabilitation program for infants with moderate sensorineural hearing loss, which may result in improved hearing. What is the major component of this program? A.Development of articulation skills B.Development of cognitive skills C.Development of social skills D.Parent-mediated auditory stimulation

A 32-year-old woman presents with rapid onset hearing loss and tinnitus as well as symptoms of intermittent vertigo. She has no significant medical history and is otherwise well. She recently gave birth and had no complications during pregnancy. Pure tone audiometry shows bilateral mild to moderate conductive hearing loss with a 2 kHz notch. Tympanometry is within normal limits. Her computed tomography (CT) scan is suggestive of otosclerosis. The patient does not want surgery for now but is increasingly struggling to hear her baby crying from another room. She is willing to try a hearing aid but feels self-conscious about how it might look. What type of hearing aid is most suitable for this patient? A.Behind the ear hearing aid with an earmould B.Receiver in the canal hearing aid with rechargeable batteries C.Completely in the canal hearing aid D.Behind the ear hearing aid with open ear tip

A 45-year-old woman presents with progressive hearing loss. A history of present illness reveals that she was hospitalized 2 weeks ago with a urinary tract infection and treated with intravenous fluids and IV aminoglycoside antibiotics for gram-negative coverage. What pathological mechanism explains her new symptoms? A.Altered perilymph ion concentrations resulting in damage to hair cells B.Ruptured tympanic membrane C.Hypersensitivity reaction to aminoglycoside antibiotic D.Autoimmune destruction of the vestibulocochlear nerve

A 68-year-old woman presents for follow-up after having completed pure tone audiometry testing. She reports gradual, progressive difficulty hearing over the past few years. She has had to gradually keep the television at higher and higher volumes, which is disturbing to her grandchildren. She recalls that her grandmother had a similar problem beginning in her 70s. Which of the following standard audiogram patterns supports the most likely diagnosis? A.An overall upward-sloping line that represents impaired hearing at higher frequencies B.An overall upward-sloping line that represents impaired hearing at lower frequencies C.An overall downward-sloping line that demonstrates impaired hearing at higher frequencies D.An overall downward-sloping line that demonstrates impaired hearing at lower frequencies

A child with Treacher-Collins syndrome has a unilateral conductive hearing loss. On examination, this patient has clinically apparent microtia with loss of the normal appearance of the pinna and a restricted external auditory canal. His hearing problems are having an increasingly greater impact on his day to day life and development. Which of these treatment options is most suitable? A.Air conduction behind-the-ear hearing aid B.Cochlear implant C.Contralateral routing of sound (CROS) D.Bone-anchored hearing aid (BAHA)

A 6-month-old boy presents with unresponsiveness to audio stimuli. A history of present illness obtained from his mother reveals that she had decreased levels of amniotic fluid during pregnancy, but she does not remember the cause. Delivery was uneventful, and the patient did not require any NICU stay. The findings of the otoscopic examination are unremarkable. He does not respond to sound stimuli presented to either ear. A small area of pitting is seen just anterior to the tragus, as well as a broad nasal bridge and widely spaced eyes. The patient’s mother asks if these findings are related. What is the most appropriate response? A.The patient's presentation is not consistent with a genetic syndrome, and the noted findings most likely occurred incidentally in this patient. B.The patient's presentation is consistent with a syndromic genetic cause demonstrating autosomal recessive inheritance. C.The patient's presentation is consistent with a syndromic genetic cause demonstrating autosomal dominant inheritance. D.The patient's presentation is consistent with a non-syndromic genetic cause and resulted from random genetic alterations in this patient.

A 6-week-old boy presents for a follow-up visit. A history of present illness reveals that he failed his hearing screening in the newborn nursery. His medical history includes a maternal viral illness during the first trimester of pregnancy. Audiometric testing shows severe to profound sensorineural hearing loss in both ears. Which of the following are the causative agents? A.Cytomegalovirus and hepatitis B B.Rubella and hepatitis B C.Rubella and cytomegalovirus D.Hepatitis B and HIV

A 24-year-old man presents with episodes of a spinning sensation when he moves his head in certain directions. His history of present illness is significant for a blow to the head while playing football. Which of the following activities is most likely to cause episodes of vertigo? A.Using a mirror to comb his hair. B.Bending over the sink while brushing his teeth. C.Lifting weights. D.Exercising on a stationary bicycle.

A 35-year-old woman presents to the clinic for hearing loss on the left side. She also complains of a fever of 100 °F (37.8 °C) for the last 2 days and pain in the left ear. Otoscopy demonstrates a bulging tympanic membrane with a loss of landmarks. The provider suspects an infection of the middle ear and recommends appropriate treatment. Vibrations are transmitted from the footplate of the stapes in which of the following ways? A.From the oval window to the scala vestibuli B.From the oval window to the scala tympani C.From the round window to the scala vestibuli D.From the round window to the scala tympani

An 18-year-old male presents to the emergency department with a complaint of hearing loss in the right ear since attending a heavy metal rock concert a week ago. Which of the following best identifies the germ cell layer/layers that give rise to the damaged structure in this patient? A.Mesoderm B.Ectoderm C.Endoderm D.Endoderm, mesoderm, and ectoderm

An 11-month-old male is brought to the clinic by his father, who worries that the patient has not said any words yet and has difficulty responding to his name. Further evaluation and imaging reveal an immature membranous labyrinth with a severely underdeveloped cochlea. Which of the following embryologic structures most likely failed to develop properly in utero in this patient? A.The dorsal utricular portion of the otic vesicle B.The ventral saccular portion of the otic vesicle C.The tubotympanic recess D.The endolymphatic appendage

A 54-year-old male presents with a gradual decline in hearing bilaterally for the past ten years, which has worsened in the left ear over the past three weeks. Otoscopy of the right ear is unremarkable, but yellowed discoloration with visible bubbles behind the left eardrum is noted. Pure-tone audiometric testing at 250-8000 Hz shows air conduction responses of 35 to 55 dB HL in the right ear and 50 to 80 dB HL in the left ear. Masked bone conduction demonstrates thresholds of 5 to 20 dB HL bilaterally, and acoustic reflex threshold responses are absent for ipsilateral and contralateral stimulation bilaterally. Which of the following best describes this patient's diagnosis? A.Conductive hearing loss involving the tympanic membrane, tympanic cavity, mastoid cavity, or ossicular chain. B.Conductive hearing loss involving the tympanic membrane, tympanic cavity, ossicular chain, or cochlea. C.Sensorineural hearing loss involving the 8th cranial nerve, brainstem, or auditory cortex. D.Sensorineural hearing loss involving the 8th cranial nerve, brainstem, or ossicular chain.

A 65-year-old woman presents with tinnitus and difficulty understanding conversations when she goes out for meals with her friends. Audiometric testing shows significant, symmetric, sensorineural hearing loss above 2000 Hz. What primary histopathological change is expected? A.Loss of receptor hair cells at the basal aspect of the cochlea. B.Bulging of Reissner's membrane. C.Degeneration of cells that are essential for maintaining the appropriate ion composition of endolymph. D.Loss of nerve fibers and spiral ganglion neurons.

A 7-year-old boy is brought to the outpatient department for evaluation with concerns regarding the hearing. The student places a tuning fork midline on the child's head and asks him where the sound is lateralizing. This represents which of the following tests? A.Pneumonic otoscopy B.Tympanometry C.The Rinne test D.The Weber test

During surgery of the middle ear, a muscle innervated by a branch of the mandibular nerve is damaged. This muscle contributes to the development of hyperacusis. Which of the following is the insertion of this muscle? A.Short handle of malleus B.Long handle of malleus C.Superior surface of eustachian tube D.Middle surface of eustachian tube

A 30-year-old male patient is rushed to the emergency department after a car accident with a broken femur. He reports that he was driving and became disoriented when he turned his head to talk to the passenger. He had changed lanes and crashed into an oncoming car. His blood pressure is 150/80 and his pulse is 110 bpm. Which of the following occurred to provide feedback for the movement of his head? A.Depolarization of sodium channels and decreased firing rate B.Hyperpolarization of potassium channels and increased firing rate C.Hyperpolarization of sodium channels and increased firing rate D.Depolarization of potassium channels and increased firing rate

A 65-year-old woman presents with dizziness, lightheadedness, and nausea for the past 2 weeks. The symptoms worsen whenever she bends over, and they resolve after a few minutes of rest. Blood pressure is 128/90 mm Hg, and the heart rate is 75 bpm. The Dix-Hallpike maneuver is used on the left, which causes the patient to exhibit up beating nystagmus. What is the next best step in the treatment of this patient? A.Utilize the canalith repositioning maneuver, starting with the head positioned facing left. B.Utilize the canalith repositioning maneuver, starting with the head positioned facing right. C.Request CT head without contrast. D.Start the patient on betahistine.

A 65-year-old man presents with worsening bilateral hearing loss. He reports that the loss has been gradual and cannot identify any worsening factors or recent environmental exposures that may have contributed. He has had difficulty hearing conversations, which caused him to withdraw from most social interactions. Results of his audiogram show a comparable hearing loss in both air and bone conduction, with higher frequency loss being the most severe. What nerves contact inner hair cells? A.Type I spiral ganglion nerve B.Type II spiral ganglion nerve C.Vestibular nerve D.Facial nerve

Why is it important for audiologists to be familiar with EAC anatomy?

Knowing the landscape of the EAC helps with choosing the appropriately sized probe and insert earphone. It is equally important to know where each bend of the EAC occurs to achieve a deep placement of an otoblock for production-ready earmold investments.

Describe the changes in modes of vibration of the stapes according to sound intensities.

As the ossicular joints (malleoincudal and incudostapedial) pivot, the footplate of the stapes will rotate side-to-side with moderate-intensity signals and rock front to back with high-intensity signals. The TM also changes its vibratory patterns depending on frequency and intensity of the acoustic signal. The stapes does not act like a piston, but has rather more complex movement patterns concomitant with the intensity of the incoming signal.

Practice Questions Flashcards

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