Practice Test Questions

Question 1

A patient comes to a clinic complaining of short, intense dizzy spells. An audiologist suspects that the patient may have benign paroxysmal positional vertigo (BPPV). Which of the following tests is most appropriate to use to confirm the diagnosis?

• Headshaking Test
• Ocular VEMP Test
• Dix Hallpike Test
• Fistula Test

Answer 1

Dix Hallpike Test

The test used to diagnose BPPV is the Dix-Hallpike, which is a positioning test that assesses the presence of otoconia in the semicircular canal.

Question 2

0 dB HL is best described by which of the following?

• The intensity at which the audiometer produces no sound at any frequency
• The different sound pressure levels that occur at different frequencies
• The minimum level at which speech is understood 50 percent of the time
• The intensity of 10 dB10 decibels SPL at 1000 Hz1000 hertz

Answer 2

The different sound pressure levels that occur at different frequencies

0 dB0 decibels HL on an audiometer represents the minimum audible pressure needed at each frequency for an individual with normal hearing to detect a pure tone. This value varies with frequency due to the anatomic and physiologic properties of the auditory system.

Question 3

An audiologist fit a patient with binaural, digital, behind-the-ear hearing aids three weeks ago. The patient reports that the devices have provided suitable amplification in most environments but also complains that soft background noise is distracting.To reduce the adverse noise effect, which of the following is the best adjustment for the audiologist to make to the hearing aids?

• Increasing the threshold kneepoint
• Decreasing the compression ratio
• Enabling wide dynamic range compression
• Enabling expansion

Answer 3

Enabling Expansion

Expansion reduces the gain of low-level ambient sounds.

Question 4

Individuals with normal hearing sensitivity in one ear and a severe hearing loss in the other ear experience which of the following?

• An improvement in speech understanding when the noise source is closer to the ear that has normal hearing
• Improved ability to localize when the noise source is closer to the ear that has hearing loss
• Better speech understanding and localization as the reverberation time increases
• Improved localization when the noise is at 0 degrees azimuth and the source is closer to the ear that has hearing loss

Answer 4

An improvement in speech understanding when the noise source is closer to the ear that has normal hearing

For individuals with unilateral hearing loss, speech intelligibility improves when the ear with better hearing is closer to the noise source. When this occurs, the signal-to-noise ratio improves in the better ear.

Question 5

Which of the following describes the relationship between the solid wave and the broken wave in the figure?

• They are in phase with one another.
• The broken line leads the solid line by 180°
• The solid line leads the broken line by 90°
• The solid line lags the broken line by 90°

Answer 5

The solid line lags the broken line by 90°

The starting phase of the solid line is 0°, and the starting phase of the broken line is 90°. Therefore, the solid line lags the broken line by 90°.

Question 6

A patient is seen for a vestibular evaluation with the primary complaint of persistent imbalance for the past six months. The patient reports one severe attack of true rotary vertigo six months ago and since then fears that another will occur. The patient has limited many activities because quick head movements increase symptoms.Videonystagmography (VNG) results indicate normal saccade, optokinetic, and smooth pursuit testing. A left-beating nystagmus is observed during gaze testing without fixation. Post-headshake nystagmus reveals a left-beating nystagmus. No positioning or positional nystagmus is observed. Bilateral bithermal caloric test results indicate a 50 percent right weakness with no significant directional preponderance. Based on the preceding information, the patient most likely has which of the following?

• A central vestibular pathology
• A statically uncompensated peripheral pathology affecting the right ear
• A dynamically uncompensated peripheral pathology affecting the left ear
• A dynamically uncompensated peripheral pathology affecting the right ear

Answer 6

A dynamically uncompensated peripheral pathology affecting the right ear

Videonystagmography (VNG) results normally provide site-of-lesion specific information to determine the probable side of weakness. In this example, the patient had a 50 percent right peripheral vestibular weakness, suggesting a peripheral pathology affecting the right side. The post-headshake left-beating nystagmus suggests that the lesion is dynamically uncompensated.

Question 7

Research shows that people wait as long as seven years before they seek hearing health care services due to the negative stigma associated with hearing loss. Which of the following is most likely to occur with untreated hearing loss?

• Vision decline
• Cognitive decline
• Chronic fatigue
• Debilitating tinnitus

Answer 7

Cognitive Decline

The consequences of untreated hearing loss include lower signal quality in the brain (leading to a higher cognitive load), a change in the structure of the brain, social disengagement, behavior changes, and health issues like dementia, depression, fatigue, and anxiety.

Question 8

A 65-year-old woman is fitted with her first pair of hearing aids. She and her husband are attending their first audiologic rehabilitation session about communication strategies. She states that she struggles to understand what her husband says “because he uses too many words.” Which of the following facilitative strategies would be the most appropriate to improve the situation?

• She should ask him to write down key words and topics.
• She should make sure the lighting is appropriate for speechreading.
• She should ask him to use shorter phrases and pause often.
• She should encourage him to speak very slowly and exaggerate his enunciation.

Answer 8

She should ask him to use shorter phrases and pause often.

She should use a message-tailoring strategy that teaches her communication partner to use simple syntax and multiple shorter phrases rather than one longer one.

Question 9

A patient with new hearing aids complains of difficulty understanding speech in noisy environments such as restaurants. The audiologist verifies that the cardioid polar plots with fixed directionality are working appropriately. Which of the following is the most appropriate action for the audiologist to take when counseling the patient?

• Encouraging the patient to consider purchasing hearing aids with omnidirectional polar plots
• Recommending that the patient avoid reverberant environments when first wearing the new hearing aids
• Advising the patient to face the noise in certain environments to maximize the directional function of the hearing aids
• Counseling the patient to sit with the back toward the noise to maximize the directional function of the hearing aids

Answer 9

Counseling the patient to sit with the back toward the noise to maximize the directional function of the hearing aids

Counseling patients about where to sit in noisy environments will maximize the capability of the directionality feature of the hearing aids. Cardioid microphones in hearing aids pick up sounds with sensitivity from the front and sides but poorly from the rear. It is therefore best to sit or stand with the back to the noise that is interfering with hearing and let the sound come from the front or sides.

Question 10

A 5-year-old child was recently diagnosed with a bilateral, moderately severe sensorineural hearing loss after a bout of meningitis. She had typically developing speech and language before her illness but now has significant difficulty communicating because of her hearing loss. She also has other comorbidities as a result of the meningitis. Knowledge of which of the following would assist other professionals who are working with this child?

• Use of communication strategies
• Vestibular rehabilitation exercises
• Cochlear implant evaluation
• The etiology of the meningitis

Answer 10

Use of communication strategies

Knowledge and application of repair and facilitative strategies would assist interprofessional practice.

Question 11

Which TWO of the following are accurate statements concerning assessment measures of speechreading ability?

• Speechreading test results are likely to have a high correlation with measures of visual intelligence.
• Speechreading tests are difficult to administer and assess because of intertalker differences and lack of naturalness.
• The most realistic measures of speechreading ability are administered in a visual mode only.
• The most realistic measures of speechreading ability are administered in a combined auditory-visual mode.
• Intertalker differences are eliminated as a test variable when speechreading test results are scored based on viseme recognition.

Answer 11

Speechreading tests are difficult to administer and assess because of intertalker differences and lack of naturalness & The most realistic measures of speechreading ability are administered in a combined auditory-visual mode.

Option (B) is correct because intertalker differences are difficult to control for consistency in speechreading assessments. Option (D) is correct because speechreading in actual use depends on both auditory and visual input for most clients. The measure of speechreading ability that best reflects a client’s real ability is one that is administered in a combined auditory-visual mode. Creating a video assessment is often unnatural and lacks validity in assessing speechreading skills.

Question 12

A 54-year-old patient who will start cisplatin treatment in two days has been referred to audiology. Which of the following is consistent with guidelines for audiological management of the patient?

• Baseline testing should be conducted one week after the first dose is administered and should include pure-tone air conduction testing and speech recognition screening.
• If the patient is able, serial hearing assessment using ultrahigh frequency thresholds should be conducted up to 20 kHz20 kilohertz or the highest frequency with a threshold at or below 100 dB100 decibels SPL.
• A 5 dB5 decibels shift in pure-tone thresholds at one or more frequencies should be considered a significant change in hearing if middle-ear dysfunction has been ruled out.
• If the patient is not able to complete full behavioral testing, transient OAE monitoring should be implemented.

Answer 12

If the patient is able, serial hearing assessment using ultrahigh frequency thresholds should be conducted up to 20 kHz20 kilohertz or the highest frequency with a threshold at or below 100 dB100 decibels SPL.

Cisplatin treatment is ototoxic, impacting ultrahigh frequencies.

Question 13

Which type of hearing protection device provides the greatest amount of noise reduction (attenuation) ?

• A foam earplug
• Passive circumaural earmuffs
• A custom full-shell silicone earplug with musician filters
• A custom solid full-shell silicone earplug

Answer 13

A custom solid full-shell silicone earplug

Solid custom plugs provide the greatest attenuation since adding a filter reduces the maximum attenuation.

Question 14

A 42-year-old male is being seen for vestibular testing. He reports that his primary symptoms are feeling off balance and some triggered symptoms of slight dizziness with head movements. Vestibular evoked myogenic potentials (VEMPs) were performed as part of a comprehensive vestibular evaluation. The results of the cervical (cVEMP) and ocular (oVEMP) responses for each ear are summarized in the following table. Testing was performed at 125125 decibels dB SPL at 500 Hz500 hertz for air conduction stimuli. Otoscopy and tympanometry were performed prior to VEMP testing and verified normal outer and middle ear status. Appropriate electromyography (EMG) levels were maintained throughout testing. Which of the following statements best describes the VEMP test results?

• Possible dysfunction of the left utricle/inferior vestibular nerve
• Possible dysfunction of the left utricle/superior vestibular nerve
• Possible dysfunction of the left saccule/inferior vestibular nerve
• Possible dysfunction of the left saccule/superior vestibular nerve

Answer 14

Possible dysfunction of the left utricle/superior vestibular nerve

The ocular VEMP afferent pathway consists of the utricle and superior vestibular nerve branch and is recorded contralateral to the ear of stimulation. In this example, when the stimulus (125125 decibels dB SPL) is applied to the left ear, there is no recordable response from the right inferior oblique. The ear in question is the left ear as no repeatable waveforms were obtained.

Question 15

A 60-year-old patient has bilateral, mild-to-moderate sensorineural hearing loss. Dissatisfaction is reported by the patient during a behind-the-ear (BTE) hearing aid trial period because sounds heard from behind are louder than sounds heard from the front. The patient wants the issue resolved. Which of the following is the best first option for determining hearing aid directionality?

• Performing real-ear target assessments at different input levels
• Performing real-ear front-to-back ratio measurements
• Returning the hearing aids to the manufacturer to rewire the microphones
• Measuring the patient’s aided signal-to-noise ratio loss

Answer 15

Performing real-ear front-to-back ratio measurements

Directional microphones are designed to reduce sounds from behind the listener. If the listener perceives that sounds are loud from behind, it is likely that the front microphone is functioning like the back microphone and undesirable sounds are not being canceled from behind. Measuring the front-to-back ratio will determine which microphone has greater output and help to resolve the problem.

Question 16

A 61-year-old female patient is referred to the vestibular clinic with symptoms of imbalance and dizziness associated with loud sounds, including her own voice and chewing. She is more sensitive to loud sounds in the right ear. A recent audiogram revealed normal hearing sensitivity with no air-bone gaps in the left ear. A mild low-frequency conductive hearing loss was observed for the right ear with normal tympanometry. The patient denies any additional symptoms. Which of the following vestibular tests is the most clinically appropriate first step to evaluate the patient’s symptoms?

• Computerized dynamic posturography
• Video head impulse test
• Videonystagmography/electronystagmography
• Vestibular evoked myogenic potentials

Answer 16

Vestibular evoked myogenic potentials

The patient reported symptoms, and audiometric findings strongly suggest superior semicircular canal dehiscence (SSCD). Vestibular evoked myogenic potentials (VEMPs) are used to screen for this condition: large VEMP amplitudes, low thresholds, or present responses at high frequency testing (e.g., 4000 Hz4000 hertz ocular VEMPs) are found in patients with SSCD.

Question 17

The hearing of a 47-year-old patient who has worked in an office in a large factory for the last twenty years has been declining for the last five years. The noise measurements on the factory floor were 94 dB LAeq94 decibels equivalent sound level. The patient walked around the factory floor four times a day, and each walk took six minutes. Which of the following is closest to the NIOSH noise dose associated with the worker’s exposure to the factory noise?

• 24%
• 40%
• 100%
• 160%

Answer 17

40%

An exposure to a maximum sound level of 94 dB LAeq94 decibels equivalent sound level would reach a 100 percent noise dose in an hour using NIOSH criteria. As described in the scenario, the patient will have been exposed to the sound for only 24 minutes during the day, which makes option (B), or 40 percent, the best answer.

Question 18

A 78-year-old male presents to a clinic with significant symptoms of imbalance and a recent fall with injury. Upon further questioning, the patient reports a “swirling” feeling when he rolls over in bed to the right and left side. He is now avoiding movements in bed. Supine head-roll testing reveals the following findings. Head roll to the right: 52 degrees/second right-beating nystagmus, which had a crescendo-decrescendo pattern and strong symptom response Head roll to the left: 34 degrees/second left-beating nystagmus, which had a crescendo-decrescendo pattern and less intense symptom response The audiologist concludes that the patient has horizontal canal benign paroxysmal positional vertigo. Which of the following treatment maneuvers is most likely to be recommended?

• Geotropic Gufoni maneuver for right horizontal canal BPPV of canalithiasis type
• Geotropic Gufoni maneuver for left horizontal canal BPPV of canalithiasis type
• Apogeotropic Gufoni maneuver for right horizontal canal BPPV of cupulolithiasis type
• Apogeotropic Gufoni maneuver for left horizontal canal BPPV of cupulolithiasis type

Answer 18

Geotropic Gufoni maneuver for right horizontal canal BPPV of canalithiasis type

The geotropic nystagmus pattern (right-beating with head right and left-beating with head left). The geotropic pattern of nystagmus suggests canalithiasis type horizontal canal BPPV. The supine head roll side with the stronger nystagmus response represents the side involved with the horizontal canal BPPV, which is on the right side in this example.

Question 19

Which TWO of the following measurements are included in a psychoacoustic evaluation of tinnitus?

• Pitch matching
• Speech-in-noise testing
• Residual Inhibition Assessment
• Otoacoustic Emissions

Answer 19

Pitch matching & Residual Inhibition Assessment

Although speech-in-noise testing and otoacoustic emissions are important when determining the patient’s hearing acuity and proceeding with or programming amplification, it is not considered part of the standard test battery for a psychoacoustic evaluation for tinnitus. This evaluation is an important tool to help guide patient counseling, patient education, and baseline information. The psychoacoustic evaluation may include, but is not limited to, a full case history, audiological evaluation, tinnitus pitch matching, tinnitus loudness masking, minimum masking level evaluation, residual inhibition assessment, and subjective patient questionnaires.

Question 20

Diagnostic audiometers generally provide one-third-octave noise bands for use in masking pure tones. Which of the following best explains why one-third-octave noise bands are used?

• They are wider than critical bands.
• They produce more masking than pink noise.
• They produce more masking than do half-octave bands.
• They have less width than do critical bands.

Answer 20

They are wider than critical bands.

Narrow bands of masking noise on audiometers should be wider than a critical band because they provide more effective masking for the frequency being tested without requiring higher overall intensity.

Question 21

A 92-year-old resident of a skilled nursing facility reports that binaural hearing aids are not improving the resident’s ability to understand what coresidents and caregivers are saying, particularly in the common activity room. Which of the following is the best way to address the resident’s concern?

• A personal sound amplification product (PSAP)
• A DM system
• A softband bone-anchored hearing device
• A BiCROS hearing aid

Answer 21

A DM system

Patients who are residents of care facilities and do not benefit as expected from binaural hearing aids can benefit from DM (digital modulation) systems, which improve the signal-to-noise ratio in noisy environments, such as common activity rooms.

Question 21

To which of the following patients would it be most appropriate to recommend a full vestibular evaluation?

• A 70-year-old male who states he has occasional dizziness when he stands up quickly
• A 43-year-old female who states she had an episode of dizziness about 10 years ago following a severe head cold
• A 62-year-old female who denies vertigo but states she often veers when she walks and loses her balance when she turns her head quickly
• A 53-year-old male who reports brief vertigo when turning over in bed or bending over

Answer 21

A 62-year-old female who denies vertigo but states she often veers when she walks and loses her balance when she turns her head quickly

This patient reports symptoms that could suggest either an otolith or semicircular canal dysfunction.

Question 22

An audiometer attenuator is set to 0 dB0 decibels HL. Which of the following is true about the sound pressure level output at the earphone?

• It is constant across all frequencies.
• It is lowest at midfrequencies.
• It increases as a function of frequency.
• It decreases 6 dB6 decibels per octave.

Answer 22

It is lowest at midfrequencies.

The sound pressure level necessary to achieve 0 dB0 decibels hearing level is greatest at low frequencies, lessens in the middle frequencies, and then increases at high frequencies.

Question 23

Tinnitus pitch matching is most useful when the tinnitus assessed is described as

• single or overlapping tones
• pulsing
• musical
• crackling

Answer 23

single or overlapping tones

Tinnitus pitch matching is useful with tonal tinnitus.

Question 24

A patient in the early stages of Ménière’s disease will have an increase in the amount of endolymph in the inner ear. Audiometric assessment is likely to show sensorineural hearing loss that primarily affects which of the following frequency ranges? - 250–2000 Hz - 2000–4000 Hz - 4000–8000 Hz - 8000–10,000 Hz

Answer 24

250-2000 Hz The increase in the amount of endolymph in the inner ear expands the apical end of the cochlea because of a decreasing stiffness gradient of the basilar membrane. Since it is the low frequencies that are sensed in this location, it is the low frequencies that are diminished when there is too much endolymph.

Question 25

Which TWO of the following types of medications are considered to be in the family of ototoxic medications? - Diuretics (furosemide) - Lipid-lowering medications (statins) - Anti-inflammatory medications (ibuprofen) - Cancer medications (cisplatin)

Answer 25

Diuretics (furosemide) & Cancer medications (cisplatin) Diuretics and cancer medications have been shown to cause ototoxicity.

Question 25

For someone sitting 20 meters from a concert stage, the average intensity is 65 dB65 decibels SPL. Which of the following best indicates the average sound-pressure level at a seat 10 meters from the stage? - 59 dB SPL - 62 dB SPL - 68 dB SPL - 71 dB SPL

Answer 25

71 dB SPL According to the inverse square law, the sound intensity decreases by 6 dB6 decibels when the distance from a sound source doubles. Conversely, the sound intensity increases by 6 dB6 decibels when the distance to the sound source is halved.

Question 26

The cochlear implant signal-processing strategy in which brief pulses are presented to each electrode in a nonoverlapping sequence is known as - a filter bank - fine structure - current steering - continuous interleaved sampling

Answer 26

continuous interleaved sampling Continuous interleaved sampling (CIS) is a cochlear implant signal-processing strategy that minimizes channel interaction by presenting pulses in a nonoverlapping sequence.

Question 27

Which of the following are the tests recommended for monitoring hearing when there is concern about ototoxicity? - PI-PB functions and reflex decay - Ultrahigh-frequency thresholds and otoacoustic emissions - Acoustic-reflex thresholds and word recognition with ipsilateral masking - Speech-recognition thresholds and tympanometry with a high-frequency probe tone

Answer 27

Ultrahigh-frequency thresholds and otoacoustic emissions Ultrahigh-frequency thresholds are recommended as ototoxicity may initially be observed in the higher frequencies (10K Hz10 thousand hertz, 12K Hz12 thousand hertz, 14K Hz14 thousand hertz). Moreover, since ototoxicity affects outer hair cells initially, otoacoustic emissions are a sensitive measure of outer hair cell function.

Question 28

A neurodiagnostic auditory brainstem response (ABR) evaluation using different stimulus (click) repetition rates is performed on an adult with a suspected vestibular schwannoma. Which of the following is the most likely outcome if the patient has a vestibular schwannoma when the ABR stimulus (click) repetition rate is increased from 21.121.1 per second to 89.189.1 per second? - Increased waveform amplitudes, increased wave V latencies, and prolonged, shortened wave I–V interpeak latencies - Decreased waveform amplitudes, increased wave V latencies, and shortened, prolonged wave I–V interpeak latencies - Increased waveform amplitudes, decreased wave V latencies, and prolonged wave I–V interpeak latencies - Decreased waveform amplitudes, decreased wave V latencies, and shortened wave I–V interpeak latencies

Answer 28

Decreased waveform amplitudes, increased wave V latencies, and shortened, prolonged wave I–V interpeak latencies Increasing the stimulus repetition rate results in decreased amplitudes, longer absolute latencies, and prolonged interpeak latencies.

Question 28

A 23-month-old child was seen in an audiology clinic. The child presented with a chronic history of upper respiratory infections, middle ear infections, diminished vocabulary, and delayed speech-sound development. She had pressure-equalization (PE) tubes placed when she was 19 months old, and audiologic testing was attempted but was unsuccessful in the ENT office post-surgery. She is the daughter of bilingual parents who divide their conversational speech between English and Spanish in the home environment. The child was cooperative for otoscopy, and PE tubes were observed bilaterally, with subsequent large volumes confirmed by tympanometry. Which of the following tests is most likely to be performed next? - Air- and bone-conducted picture-pointing speech recognition thresholds - Otoacoustic emissions - Sound field visual-reinforcement audiometry - Audiometry played through headphones

Answer 28

Otoacoustic emissions Since the child is cooperative for otoscopy and tympanometry, she will likely be cooperative for otoacoustic emission (OAE) testing, which will provide important information to the parents.

Question 29

Which of the following evaluation measures is most likely to provide valid and reliable information about a typically developing 9-month-old child’s hearing sensitivity at 500 to 4000 Hzhertz? - Visual reinforcement audiometry (VRA) - Otoacoustic emissions - Auditory brainstem response (ABR) audiometry - Behavioral observation audiometry (BOA)

Answer 29

Visual reinforcement audiometry (VRA) At 9 months old, a typically developing child can provide reliable responses to all octave band frequencies, and VRA is the most valid and reliable method.

Question 30

Hearing screening outcomes are displayed in the tables using a 40 dB40 decibel nHL and 30 dB30 decibel nHL screening criteria. Compared to the 40 dB nHL criterion, the outcomes for the 30 dB30 decibel nHL criterion reveal that - sensitivity is higher - specificity is higher - sensitivity and specificity are higher - sensitivity and specificity are lower

Answer 30

sensitivity is higher With a decrease in false negatives, the sensitivity will be higher. Applying the formula for sensitivity (TP/TP +FN) x100open parenthesis, the fraction T P over T P, end fraction, plus F N, close parenthesis, times 100 and specificity (TN/TN+FP) x 100open parenthesis, the fraction T N over T N, end fraction, plus F P, close parenthesis, times 100 also reveals that sensitivity is higher and specificity is lower.

Question 31

On a case history form, a patient reports having low-pitched tinnitus and a hearing loss. While conducting acoustic immittance measures, the audiologist notes periodic fluctuations in admittance that are synchronous with the patient’s pulse. Which of the following medical conditions is the most likely cause of the audiologist’s findings? - An acoustic neuroma - Cholesteatoma - Glomus jugulare tumor - Otosclerosis

Answer 31

Glomus jugulare tumor A low-pitched, pulsating tinnitus synchronous with the heartbeat and acoustic immittance fluctuations are symptoms of glomus jugulare tumors, vascular growths originating from the glomus bodies. These tumors sometimes expand into the middle ear, causing hearing loss by putting the pressure of a pulsating jugular vein on the ossicles.

Question 32

A 60-year-old man has bilateral, moderate-to-severe, precipitously sloping sensorineural hearing impairment. During the hearing-aid trial period, he is extremely dissatisfied because he constantly reports that /s/forward slash, s, forward slash, /f/forward slash, f, forward slash, and /sh/forward slash, sh, forward slash sounds are not clear. Which of the following is the best method of addressing his concern? - Creating hearing-aid program settings with microphone arrays in split-directional mode - Deactivating frequency lowering and performing probe microphone verification by measuring REAR - Reprogramming the hearing aids to reduce low and mid-frequency gain at all input levels - Activating frequency lowering and performing probe microphone verification by measuring REOR

Answer 32

Deactivating frequency lowering and performing probe microphone verification by measuring REAR The best option is to deactivate frequency lowering in the hearing-aid settings and perform Real-Ear Aided Response (REAR). This process will allow the audiologist to rapidly identify maximum audible output across the frequency range and determine whether high-frequency sounds are inaudible or appropriate per the prescription targets.

Question 33

According to the contralateral masked-threshold function shown in the preceding figure, which of the following values represents the true threshold for the test ear? - 50 dB HL - 65 dB HL - 75 dB HL - 95 dB HL

Answer 33

75 dB HL According to the plateau method of determining true threshold, the true threshold is reached when the threshold of a test ear remains stable over a range of at least 20 dB20 decibels increase in masking intensity. In the figure, the test-ear threshold plateaus at 75 dB75 decibels.

Question 34

An audiologist is using a tracking procedure to assess a patient’s progress in communicating under audition-plus-vision conditions. The materials used are articles from popular magazines. Data are collected for fifteen minutes every working day for a week. Word-per-minute scores of 23.4, 43.6, 13.6, 54.2, and 27.3 are obtained. Which of the following is the most likely explanation for the variation in the patient’s scores? - A gradual negative learning effect - Authorial vocabulary or syntax - Normal response variation - Decreased cognitive ability

Answer 34

Authorial vocabulary or syntax Tracking involves having the client repeat phrases read by the audiologist from different sources. Because each author has a different style, there will be considerable variation in how familiar the vocabulary is to the patient and in the number and degree of redundancy of syntactic clues, which are all factors that affect word-per-minute scores.

Question 35

Which of the following best indicates the compression ratio for the input-output function from 50 to 110 dBdecibels SPL? - 1 to 1 - 2 to 1 - 3 to 1 - 4 to 1

Answer 35

2 to 1 The compression ratio is the change in input over the change in output. From 50 to 110 dBdecibels SPL, for every 10 dB10 decibel change in input, there is a 5 dB5 decibel change in output, resulting in a 2 to 1 compression input.

Question 36

Which of the following lists examples of technical safeguard options outlined by the Health Insurance Portability and Accountability Act? - De-identification of data, firewalls, mobile device management - Data encryption, multifactor authentication, malware - Remote wipe capability, surveillance cameras, password renewal cycles - Locked doors, de-identification of data, two-factor authentication

Answer 36

De-identification of data, firewalls, mobile device management Under HIPAA guidelines common technical safeguard options can include but are not limited to antivirus software, multifactor or two-factor authentication, data encryption, de-identification of data, firewalls, mobile device management (MDM), and remote wipe capability. Surveillance cameras and locked doors are considered physical safeguards.

Question 37

A patient wearing a behind-the-ear hearing aid coupled to an earmold returns to an audiologist with a complaint that sound is hollow and the patient’s voice sounds as if it were in a barrel. Which of the following actions by the audiologist would likely be most helpful in this situation? - Lowering the OSPL 90 - Adding a vent or enlarging the present vent - Adding a 680-ohm or 1500-ohm damper to the earhook - Widening the earmold bore

Answer 37

Adding a vent or enlarging the present vent A hollow sound indicates that low frequencies are being overemphasized; a vent would help low-frequency sound to escape before being amplified.

Question 38

A 54-year-old computer sales representative was treated with cisplatin for an infection. Now the patient has trouble understanding speech, especially in noisy situations, and complains of tinnitus in both ears. Which of the following is the most likely cause of the patient’s hearing problems? - Bilateral otosclerosis - Ménière’s disease - Ototoxicity - Presbycusis

Answer 38

Ototoxicity Cisplatin can be ototoxic, and tinnitus and hearing loss are common side effects.

Question 39

When conducting real-ear measurements, which of the following is most appropriate for verifying accurate probe-tube placement in the ear canal? - Performing REUG and monitoring gain at 6 kHz6 kilohertz - Using the intertragal notch for probe-tube insertion depth at 10-15 mm10 to 15 millimeters - Performing REAG and monitoring gain at 6 kHz6 kilohertz - Arranging the probe module on the ear with the reference microphone facing inward

Answer 39

Performing REUG and monitoring gain at 6 kHz6 kilohertz Proper probe-tube placement is crucial to appropriate amplification settings. Measuring unaided gain at 6 kHz6 kilohertz will determine if the probe tube is close enough to the eardrum.

Question 40

An adult with a progressive sensorineural hearing loss is no longer able to use a telephone at work. An audiologist should assist the patient with - learning a manual communication system - obtaining reasonable accommodations for appropriate communication at work - working with vocational rehabilitation to be considered for a cochlear implant - using an assistive listening device that alerts the client that the phone is ringing

Answer 40

obtaining reasonable accommodations for appropriate communication at work The audiologist should counsel the patient about reasonable accommodations in the workplace mandated by the Americans with Disabilities Act.

Question 41

Reduced visual function, which can complicate planning for aural rehabilitation, is most likely to be found in patients with hearing loss who present with - Ménière’s disease - Treacher-Collins syndrome - erythroblastosis fetalis - diabetes

Answer 41

diabetes Diabetes is a major cause of acquired visual impairment; the audiologist should take this fact into consideration when planning rehabilitation for patients with diabetes.

Question 42

A patient who has a moderate sensorineural hearing loss also complains of bothersome tinnitus. Which of the following is the most appropriate recommendation for treatment for the patient? - Fitting the patient with a tinnitus masker - Fitting the patient with a tinnitus instrument - Creating CDs that contain noise that can mask the patient’s tinnitus - Recommending that the patient purchase a sound machine

Answer 42

Fitting the patient with a tinnitus instrument A tinnitus instrument is a device that combines a tinnitus masker, which will help relieve the patient from tinnitus, and a hearing aid, which will help with the hearing loss.

Question 43

An infant who was referred on a first screening for automated auditory brainstem response testing (AABR) passes on a second screening with DPOAEs before discharge from the hospital. The parents bring the infant to the clinic because the infant is still not responding consistently to sound. Which of the following is the audiologist’s best next step? - Rescreening the child with TEOAEs - Rescreening the child with ABR - Counseling the parents that the child will respond better with age - Counseling the parents that they should wait until the child can be tested with VRA

Answer 43

Rescreening the child with ABR The child needs a diagnostic evaluation before being referred out and before meaningful counseling can take place.

Question 44

Which TWO of the following are inappropriate treatments for a patient diagnosed with hyperacusis? - Recommending that the patient wear earplugs - Avoiding exposure to average-level sounds - Desensitizing the patient to listening to average-level sounds - Desensitizing the patient to listening to loud sounds

Answer 44

Recommending that the patient wear earplugs & Avoiding exposure to average-level sounds Patients diagnosed with hyperacusis should avoid wearing hearing protection and need to be exposed to average environmental sounds in order to desensitize them.

Question 45

An audiologist performing otoscopy on an adult noted that the first ear examined had obvious evidence of redness, swelling, and moisture. Based on that finding, what is the best next step for the audiologist to take? - Conducting a test to detect hearing loss in the ear - Removing any discharge from the outer part of the ear - Changing the speculum and examining the other ear - Discontinuing the otoscopy and moving to tympanometry

Answer 45

Changing the speculum and examining the other ear Use of a clean speculum will prevent spreading any infection from one ear to the other.

Question 46

A 79-year-old patient who lives alone has returned to the audiologist following a two-week trial use of new hearing aids. The patient reports trying the hearing aids for the first couple of days, becoming frustrated, and deciding to return them. Which of the following is the best way for the audiologist to help the patient deal with frustration and dissatisfaction? - Spending time going over the instruction booklet to be sure the patient understands how to use the hearing aids properly - Counseling the patient on how to use the directionality and noise reduction features of the hearing aids - Reassuring the patient that the adjustment to hearing aids is an extended process and will take more time before seeing any benefit - Having the patient complete a self-assessment of hearing difficulties and a questionnaire that asks questions about hearing aid benefits

Answer 46

Having the patient complete a self-assessment of hearing difficulties and a questionnaire that asks questions about hearing aid benefits The patient’s self-assessment of hearing difficulties will provide an audiologist with information about areas where improvement is needed, and the questionnaire will allow the patient to see how much benefit the hearing aids are providing.

Question 47

A 1000 Hz tympanogram is obtained on a 1-month-old infant by an audiologist, who reports a flat tympanogram. The parents seek a second opinion from another audiologist, who performs a low-frequency 226 Hz 226 hertztympanogram and reports a normal tympanogram. The discrepancy in the tympanograms is most likely the result of - differences in training between the two audiologists - a misinterpretation of the tympanogram by one of the audiologists - increased cooperation by the infant during one of the measurements - the decreased reliability of low-frequency tympanograms on infants

Answer 47

the decreased reliability of low-frequency tympanograms on infants The middle-ear system of an infant is mass dominated with a lower resonant frequency; thus, a 1000 Hz probe frequency would be more appropriate for detecting changes in middle-ear function than a 226 Hz 226 hertzprobe tone.

Question 48

Which of the following is the most appropriate reason for an audiologist to monitor and evaluate the vestibular function of a patient who has undergone intravenous gentamicin treatment? - The patient experiences light-headedness upon standing abruptly. - The patient exhibits ataxia of gait or stance. - The patient has type B tympanograms. - The patient reports having experienced hearing loss.

Answer 48

The patient exhibits ataxia of gait or stance. Gentamicin is in a class of antibiotics (aminoglycosides) that are known to cause bilateral vestibular loss due to ototoxicity. A sign of bilateral vestibular loss is unsteadiness (ataxia) when standing and walking.

Question 49

While making an earmold impression for a patient, an audiologist allowed the impression material to go beyond the cotton block, resulting in trauma to the tympanic membrane of the patient. The audiologist explained the situation to the patient and made an appropriate referral for follow-up medical care. Which of the following statements about the situation is most accurate? - The audiologist may be guilty of an ethical violation. - The audiologist may be subject to litigation for malpractice. - The audiologist should refer the patient elsewhere for another earmold impression. - The audiologist should use a different type of earmold impression material.

Answer 49

The audiologist may be subject to litigation for malpractice. The audiologist should have received appropriate training for the procedure so that it is always performed correctly. The mistake could be construed as malpractice.

Question 50

Which of the following always applies to nystagmus caused by a labyrinthine lesion? - It is right-beating on right gaze and left-beating on left gaze. - It is enhanced with eyes open. - It is up-beating on up gaze and down-beating on down gaze. - It is suppressed by visual fixation.

Answer 50

It is suppressed by visual fixation. Visual fixation always suppresses nystagmus caused by a peripheral lesion, such as a labyrinthine lesion.

Question 51

A 13-year-old child presents the following audiometric results: normal acoustic immittance battery, pure-tone average of 50 dB50 decibels HL bilaterally, bilateral speech-recognition thresholds of 20 dB20 decibels HL, and word-recognition scores of 100 percent bilaterally at 50 dB50 decibels HL. Which of the following is the most appropriate next step for the audiologist to take? - Administering pure-tone Stenger tests - Obtaining typanograms - Administering a central auditory processing test battery - Reinstructing the child and using an ascending-threshold measurement technique

Answer 51

Reinstructing the child and using an ascending-threshold measurement technique There is poor agreement between the pure-tone average and the speech-recognition threshold, accompanied by discrepancy between word-recognition scores and pure-tone average, suggesting a nonorganic hearing loss. Using an ascending-threshold measurement technique will disrupt the child’s loudness yardstick and provide a better estimate of true organic hearing sensitivity.

Question 51

A patient presents to an audiologist eight weeks after surgery to repair a fistula in the round window in the left ear. The patient reports that the surgeon had, at the time of the patient’s release, pronounced the procedure successful. The patient has not noticed any change in hearing since the operation. Which of the following actions should the audiologist take after reviewing the patient’s previous test results? - Referring the patient for another medical evaluation - Conducting auditory brainstem response (ABR) testing - Conducting a follow-up audiometric evaluation - Evaluating the patient for a CROS hearing aid

Answer 51

Conducting a follow-up audiometric evaluation The follow-up medical evaluation that occurred would normally focus on physical healing and would not include an audiometric evaluation. The audiologist should conduct a routine audiometric examination to determine the precise level of postsurgical hearing loss and compare the new results to previous results.

Question 52

An audiologist evaluates a 2-year-old child with a history of recurrent serous otitis media and limited expressive speech production. Pure-tone audiometry reveals a mild conductive hearing loss from 500 to 2000 Hzhertz. Based on these findings, the audiologist should first recommend which of the following? - An audiometric follow-up in one year - An evaluation for a mild-gain hearing aid - A home language-enrichment program - A medical referral and speech-language consultation

Answer 52

A medical referral and speech-language consultation The recurrent otitis media suggests a medical problem; the child should be referred to a physician for diagnosis of possible middle-ear dysfunction. In addition, speech-language consultation is indicated because of the child’s limited vocabulary knowledge.

Question 52

A patient had recent surgery for otosclerosis in the right ear. The ENT indicated that the procedure was successful. However, the surgeon nicked the chorda tympani. Which of the following is the patient most likely to report? - Decreased hearing in the low frequencies - Difficulty swallowing - Decreased sensation of taste - Numbness on one side of the face

Answer 52

Decreased sensation of taste The chorda tympani, which is a branch of the facial nerve (cranial nerve VII), is responsible for the sensation of taste in the anterior two-thirds of the tongue. Therefore, when it is damaged or nicked, taste is affected.

Question 53

A newborn did not pass the hearing screening while in the hospital, and a test for cytomegalovirus (CMV) was ordered. The baby was found to have congenital CMV and at 4 weeks was diagnosed by auditory brainstem response (ABR) with a severe to profound sensorineural hearing loss bilaterally. The parents want to pursue bilateral cochlear implants. Which of the following is the most appropriate recommendation from the audiologist at this point? - Advising the parents to wait until their child is at least 12 months of age before pursuing implantation - Purchasing an adjustable hearing aid headband to evaluate how their child responds to sound - Having the parents make an appointment as soon as possible for a cochlear implant evaluation - Retesting their child in four months to confirm the presence of a permanent hearing loss

Answer 53

Having the parents make an appointment as soon as possible for a cochlear implant evaluation Even though the child is 1 month of age, the cochlear implant evaluation and process can start right away, because the child does not need to be 12 months of age to receive a cochlear implant.

Question 54

In audiometric testing, a false-negative response means that the signal was - not presented and the patient did not respond - not presented and the patient responded - presented and the patient responded - presented and the patient did not respond

Answer 54

presented and the patient did not respond A false-negative response is a response that occurs when a stimulus is presented, but the patient does not respond.

Question 55

Which of the following lists the most appropriate set of acoustic modifications for an earmold when fitting a patient with a precipitously sloping high-frequency sensorineural hearing loss? - Standard tubing, 2 mm2 millimeter sound bore, no vent - Libby horn, 3 mm3 millimeter sound bore, narrow vent - Libby horn, 4 mm4 millimeter sound bore, no vent - Libby horn, 2 mm2 millimeter sound bore, wide vent

Answer 55

Libby horn, 2 mm2 millimeter sound bore, wide vent Acoustic modification should emphasize high-frequency amplification and de-emphasize low-frequency amplification. A flared horn (Libby), a short sound bore, and a wide vent is the best combination to achieve that goal.

Question 55

Distortion-product otoacoustic emissions (DPOAEs) and transient-evoked otoacoustic emissions (TEOAEs) provide similar information, but they differ in which of the following ways? - DPOAEs provide more frequency-specific information than TEOAEs. - DPOAEs and TEOAEs have different sites of generation. - DPOAEs provide better low-frequency information. - TEOAEs provide better high-frequency information.

Answer 55

DPOAEs and TEOAEs have different sites of generation. DPOAEs arise from two sources of generation, and TEOAEs arise from a single source of generation.

Question 56

An 8-week-old infant born at home is brought to an audiology clinic by the parents, who report that the child appears to respond inconsistently only to very loud sounds. Both the birth and medical history are unremarkable, and there is no family history of hearing loss. Tympanograms are normal, and acoustic reflexes are present bilaterally at 1000 Hz1000 hertz at 90 dB90 decibels HL. Which of the following additional steps should be taken to rule out a significant hearing loss? - Testing the child using visual reinforcement audiometry - Performing an auditory brainstem response evaluation - Scheduling the child to return at 6 months of age for visual reinforcement audiometry - Advising the parents to return in a year for more reliable testing of hearing sensitivity

Answer 56

Performing an auditory brainstem response evaluation An auditory brainstem response would rule out auditory neuropathy and is the only reliable measure for estimating hearing sensitivity in infants less than 6 months of age.

Question 57

Which of the following types of speech recognition materials is most useful to rule out a lesion affecting the VIIIth nerve? - Closed-set monosyllabic and bisyllabic words that vary in stress pattern - Closed-set sentences approximating natural syntax, administered in varying intensity levels as in an ongoing message - Open-set, monosyllabic, phonetically balanced word lists that are representative of the patient’s language - Open-set, monosyllabic, phonetically balanced word lists, administered at several intensity levels

Answer 57

Open-set, monosyllabic, phonetically balanced word lists, administered at several intensity levels Speech understanding may be affected in a patient with a suspected retrocochlear lesion. Administering a performance-intensity function and then calculating rollover would be an appropriate step before referring the patient for more objective tests to rule out a retrocochlear lesion.

Question 57

The clinical-decision matrix shown displays data for screening auditory brainstem response (ABR) test outcomes compared to conventional ABR test outcomes (serving as the gold standard) with the same population of 336 ears. What is the calculated specificity of screening ABR? - 100% - 97% - 93% - 90%

Answer 57

97% Specificity refers to the accuracy of the ABR test to correctly identify those patients who do not have the disorder of interest, where specificity equals true negatives (307) divided by true negatives plus false positives (307 + 11307 plus 11) times 100.

Question 58

Which THREE of the following tests are included in CPT code 92557, which is a comprehensive audiological evaluation? - Air conduction - Immittance - Bone conduction - Otoacoustic emissions - Speech audiometry - Pure-tone screening

Answer 58

Air conduction & Bone conduction & Speech audiometry CPT code 92557 includes the following tests: (A) air conduction, (C) bone conduction, and (E) speech audiometry.

Question 59

A native Spanish speaker who speaks very little English is seen for a hearing evaluation by an audiologist who does not speak Spanish. The audiologist does not have any Spanish materials for speech-recognition testing. Which of the following is the most appropriate course of action for the audiologist? - Referring the patient to a Spanish-speaking otolaryngologist - Rescheduling the patient for a time when a Spanish-speaking interpreter is available - Administering an English word-recognition test and scoring it as accurately as possible based on the patient’s responses in English - Administering an English word-recognition test, having the patient write down the responses in Spanish, and asking a Spanish-speaking interpreter to score the responses

Answer 59

Rescheduling the patient for a time when a Spanish-speaking interpreter is available Given that the audiologist does not speak Spanish, securing the services of a Spanish-speaking interpreter would be the most effective solution to assist the audiologist with speech-recognition testing.

Question 60

An audiologist is selecting hearing aids for a new hearing-aid user who works full time in a loud environment, according to the case history, and finds listening in this environment to be very tiring. Which of the following features would be most appropriate to include in the new hearing aids to specifically address the user’s concern? - Directional microphones - Binaural synchronization - Speech enhancement - Digital noise reduction

Answer 60

Digital noise reduction Digital noise reduction reduces the level of amplification provided by the hearing aids in noisy environments, which provides the patient with more comfort in dealing with noise and with ease of listening.

Question 61

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 dB90 decibels HL in one ear and normal sensitivity in the other ear? - Tympanometry - Reflex decay test - The Stenger test - Acoustic reflex testing

Answer 61

The Stenger A large difference in sensitivity in the ears of an adult is easily verified by the Stenger test.

Question 62

Otoacoustic emissions can often be recorded from the ears of a patient with - severe presbycusis - upper brainstem lesions - otitis media - aminoglycosides in the body

Answer 62

upper brainstem lesions Upper brainstem lesions do not always interfere with otoacoustic emissions, so otoacoustic emissions can be recorded from the ears of patients with upper brainstem lesions.

Question 63

A 55-year-old patient is having trouble understanding others speaking in group situations at work and in the cafeteria at lunchtime. The patient’s audiometric results indicate normal hearing in both ears and that word recognition in quiet is at 96%96 percent bilaterally. Which of the following tests should also be conducted? - Otoacoustic emissions - Loudness discomfort levels - Acoustic reflex decay - Speech-in-noise

Answer 63

Speech-in-noise The audiologist needs to address the patient’s chief complaint of difficulty understanding speech in noisy situations, such as large-group meetings and busy cafeterias.

Question 64

Which of the following children should be referred to a speech-language pathologist? - A 2 month old with no expressive vocabulary - An 18 month old with no expressive vocabulary - A 24 month old who can form short sentences - A 42 month old who can retell stories

Answer 64

An 18 month old with no expressive vocabulary An 18-month-old child should have a spoken or expressive vocabulary of about 50 words.

Question 65

An audiologist owns a private practice and is in partnership with a sibling, who is an ear, nose, and throat (ENT) specialist. The audiologist receives direct referrals from the ENT specialist for hearing-aid dispensing. Which of the following laws are the professionals violating? - Anti-kickback law - Stark law - False Claims Act - Medicare Part B

Answer 65

Stark law The Stark law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient, to an entity providing designated health services (DHS) if the physician (or an immediate family member) has a financial relationship with that entity.

Question 66

What is the most likely cause of the following acoustic reflex results? - VIIIth nerve pathology on the right side - VIIIth nerve pathology on the left side - VIIth nerve pathology on the right side - VIIth nerve pathology on the left side

Answer 66

VIIth nerve pathology on the left side The acoustic reflex relies on the VIIthseventh nerve to carry the stimulus to the stapedial muscle. The absence of any reflex in the left ear suggests that there is a VIIthseventh-nerve pathology preventing measurable reflex contraction on the left side.

Question 67

Click-evoked auditory brainstem response (ABR) thresholds are generally most closely correlated with behavioral thresholds for frequencies of - 250–500 Hz - 500–1000 Hz - 2000–4000 Hz - 6000–8000 Hz

Answer 67

2000–4000 Hz The correlation between ABR and behavioral thresholds is greatest at frequencies between 2000 and 4000 Hzhertz.

Question 67

Which of the following is most likely to result from a head injury that involves a transverse fracture of the temporal bone through the otic capsule? - No hearing loss - Transient sensorineural hearing loss - Permanent sensorineural hearing loss - Conductive hearing loss

Answer 67

Permanent sensorineural hearing loss A head injury that involves a fracture through the cochlea causes fluid drainage and hair cell damage, which creates irreversible sensorineural hearing loss.

Question 68

Parents bring their 7-month-old child to the clinic. They report that the child has had two bouts of otitis media and want to be sure the child’s hearing is okay. The audiologist would like to test using VRA. Before beginning testing, the audiologist should be certain that the child is able to - cross the midline with an object - visually track objects laterally - localize sounds and objects from above - make eye contact when interacting

Answer 68

visually track objects laterally A 7-month-old child can be expected to be able to track objects laterally with their eyes. This skill is essential if a visual reinforcement audiometry (VRA) test is to be used to measure the child’s hearing sensitivity.

Question 69

Which of the following is an effective way to eliminate the cochlear microphonic from the electrocochleography response? - Increasing the distance between the transducer and the electrode sites - Using insert earphones to eliminate artifact - Lowering the intensity of the stimulus - Using alternating polarity clicks

Answer 69

Using alternating polarity clicks Alternating the polarity of the stimulus cancels out the cochlear microphonic, making it easier to visualize the electrocochleography response.

Question 70

Functional gain of a hearing aid is best defined as the difference between which of the following? - Input at the hearing-aid microphone and output into an HA-2 coupler - Input at the hearing-aid microphone and output into the ear canal - Aided and unaided sound-field thresholds - Aided and unaided ear canal resonance

Answer 70

Aided and unaided sound-field thresholds Functional gain is the amount of improvement that the hearing aid brings to the wearer’s hearing levels—more precisely, the difference in decibels between aided and unaided sound-field thresholds.

Question 71

An audiologist suspects that a patient who has had a traumatic brain injury may not have understood the directions given for a pure-tone threshold test. Which of the following is the best test that the audiologist could appropriately use to confirm that the patient’s responses represent true thresholds? - Speech Stenger test - Word recognition test - Speech recognition or awareness test - Most-comfortable loudness level test

Answer 71

Speech recognition or awareness test Individuals with traumatic brain injuries may be more likely to respond to speech than they are to respond to pure tones. Speech-awareness tests have a high correlation with pure-tone thresholds at certain frequencies.

Question 71

Which of the following word-recognition materials is most appropriate to use with a 5-year-old child who has otitis media and a severe articulation disorder? - Central Institute for the Deaf, Test W-22 (CID W-22) - Phonetically Balanced Kindergarten (PBK) test - Northwestern University Test No. 6 (NU-6) - Word Intelligibility by Picture Identification (WIPI)

Answer 71

Word Intelligibility by Picture Identification (WIPI) The WIPI is the only test listed that is both appropriate for a young child and requires no verbal participation by the child.

Question 72

An audiologist who works at a rural speech-language-hearing center is scheduled to conduct several follow-up assessments for patients who have been fitted with hearing aids. The audiologist objects to the charges imposed by the owner of the center for follow-up evaluations and quits on the day several patients are scheduled to be seen for follow-up. There are no other audiologists in the practice. The audiologist’s action could most likely result in which of the following? - The audiologist being found in violation of self-referral guidelines - The audiologist being charged with patient abandonment - The owner of the center being reported to the state licensure board - The patients being reassigned to a center in a neighboring community

Answer 72

The audiologist being charged with patient abandonment The audiologist’s actions leave the patients with no other audiologist present to perform follow-up procedures, which could lead to charges of patient abandonment.

Question 72

Which of the following abnormal eye movements (fast-phase of the nystagmus) corresponds with right anterior canal benign paroxysmal positional vertigo (BPPV) ? - Rightward torsional and down-beating vertical nystagmus - Leftward torsional and down-beating vertical nystagmus - Rightward torsional and up-beating vertical nystagmus - Leftward torsional and up-beating vertical nystagmus

Answer 72

Rightward torsional and down-beating vertical nystagmus Anterior canal BPPV corresponds with a torsional nystagmus that beats toward the involved ear (in this case, the right ear) and a vertical down-beating nystagmus.

Question 73

A 2-year-old child was recently identified as having a severe-to-profound sensorineural hearing loss bilaterally after a bout with meningitis. Before contracting meningitis, the child had developed some speech and language but now uses very few words expressively. The child’s receptive language is at the level of an 18 month old. Initial responses to binaural amplification have been very positive. Parents and siblings, who have normal hearing, are highly motivated to do what is necessary for the child’s development. Based on the preceding information, what communication methodology would be the best option for the family to pursue? - Signed Exact English - Total communication - Oral/aural communication - Simultaneous communication

Answer 73

Oral/aural communication The child had already begun to learn oral speech and language before experiencing the hearing loss, and the family has no known ties to Deaf culture. Because the child is responding well to amplification and the family appears to be willing to be very involved in rehabilitation, auditory-verbal therapy is the best choice for a communication mode.

Question 74

Which of the following provides information about the left horizontal semicircular canal independent of the right horizontal semicircular canal? - Caloric irrigation - Sinusoidal harmonic acceleration - Dynamic posturography - Fistula test

Answer 74

Caloric irrigation Caloric irrigation stimulates the horizontal semicircular canal in one ear at a time.

Question 75

According to the Program for Infants and Toddlers with Disabilities (Part C of IDEA), an infant or toddler with a hearing loss is entitled to which of the following? - Receiving financial assistance for binaural hearing aids - Enrollment in a center-based habilitation program - Documentation in writing of an Individualized Family Service Plan - Training in total communication following cochlear implant surgery

Answer 75

Documentation in writing of an Individualized Family Service Plan Part C of IDEA, PL 99-45, specifies that an Individualized Family Service Plan (IFSP) be developed that lists in detail the early-intervention services that the child through age 2 and the family will receive.

Question 76

Which of the following is the most sensitive measure of VIIItheighth-nerve dysfunction? - Otoacoustic emissions test - Auditory brainstem response test - Speech-recognition testing - Performance intensity-phonetically balanced function

Answer 76

Auditory brainstem response test The ABR test is objective and sensitive, and it can determine whether the VIIItheighth nerve is functioning properly.

Question 77

An absent stapedial acoustic reflex can result from which of the following? - A patent eustachian tube - A space-occupying lesion of the midbrain - A 35 dB35 decibels HL noise-induced hearing loss - Bell’s palsy

Answer 77

Bell’s palsy Absent reflexes have been observed in individuals with facial nerve paralysis.

Question 77

An audiologist is asked to establish a hearing-conservation program for an industrial firm. To ensure validity in monitoring the hearing of workers in conformance with the requirements of Occupational Safety and Health Administration (OSHA) regulations, the audiologist must do which of the following? - Administer tests at the end of the work shift in order to record the observed temporary threshold shift (TTS). - Administer tests at all frequencies in octaves between 250 and 8000 Hzhertz and also at 3000 Hzhertz and 6000 Hzhertz. - Administer tests only to those employees whose daily noise dose exceeds maximum permissible noise levels. - Administer threshold tests in areas where ambient noise levels conform to the regulations published in the Federal Register.

Answer 77

Administer threshold tests in areas where ambient noise levels conform to the regulations published in the Federal Register. The test will not be valid if the background noise is too high, because the noise will mask signals at hearing levels needed for accurate hearing-threshold measures. OSHA provides a table of maximum allowable octave-band sound-pressure levels for audiometric test rooms.

Question 78

The husband of a patient contacts the audiologist and asks for the results of his wife’s hearing test. Before this information can be provided, which of the following must occur? - The wife must give verbal permission to release the results of her testing over the phone. - The wife must sign a HIPAA form listing individuals who may have access to her records. - The husband must request that the referring physician certify the results of testing. - The husband and wife must make an appointment for a data security IT consultation.

Answer 78

The wife must sign a HIPAA form listing individuals who may have access to her records. According to the HIPAA, medical records cannot be released to anyone without written permission.

Question 79

During mapping sessions (programming of the device) for cochlear implant recipients, audiologists may adjust several parameters. What is the most important aspect of the programming to adjust? - Input dynamic range - Stimulus levels - Gain settings - Pulse width

Answer 79

Stimulus levels Cochlear implants (CI) are typically programmed for each patient based on auditory perceptions in response to electrical stimuli. When a patient’s device is initially activated, stimulation levels can change frequently while the patient is learning to listen with the cochlear implant. Stimulation levels can increase during the beginning of a patient’s CI experience, but eventually a plateau is reached and stimulation levels hover in a certain clinical unit range.

Question 80

Test-retest variability in a client’s suprathreshold and word-recognition score is influenced by both the number of test items or words and the initial suprathreshold word-recognition score. The largest test-retest variability can be expected to occur with which of the following combinations of number of test items or words and initial suprathreshold word-recognition score?

Answer 80

of words = 25 WRS Score = 50% Variability depends on the number of test items or words that are used, as well as on the patient’s true recognition ability, since scores in the middle of the distribution are more variable.

Question 80

While performing tympanometry on a patient, an audiologist obtains a seal on the patient’s test ear, which has a large external canal, but the seal is lost intermittently whenever the patient swallows. Which of the following is the most likely cause of the problem? - Eustachian tube dysfunction - A collapsed canal - Otitis media - A perforated tympanic membrane

Answer 80

A perforated tympanic membrane The volume of the external canal is large; the scenario suggests the possibility of a perforated membrane, which is even more likely because of the ear’s failure to maintain the seal.

Question 81

Two audiologists in private practice together discuss hearing aid pricing and verbally agree on fee-for-service prices. During the second quarter, business slows down, so Audiologist B decides to discount hearing aids by 20 percent. Two patients who are friends are fitted with identical hearing aids, one by Audiologist A and one by Audiologist B. Through conversation, the friends discover that the one who bought from Audiologist B paid 20 percent less. The individuals complain to their respective audiologists and threaten to report them to the licensure board and to ASHA. Which of the following best describes this situation? - Both audiologists are professionals and can set their own fee-for-service prices. - Although the practice is not illegal, it can be construed as unethical. - The situation is both illegal and unethical. - The situation provides grounds for a lawsuit.

Answer 81

Although the practice is not illegal, it can be construed as unethical. The agreement was verbal, and it is not illegal to modify prices for audiological services. It is doubtful that a lawsuit would result in damages beyond a refund of the non-discounted hearing aid price. The practice is not illegal but does raise ethical issues in terms of holding the welfare of the patient paramount and also in terms of maintaining harmonious relationships with other professionals.

Question 82

A 76-year-old patient with a primary complaint of hearing loss reports experiencing an unsteady gait and needs assistance walking and climbing stairs. Which of the following would be the most appropriate course of action to take with this patient? - Include a VNG in your evaluation. - Refer the patient to a physical therapist for a risk of falls assessment. - Inform the patient’s primary care provider that the patient is a fall risk. - Screen the patient for risk of falls.

Answer 82

Screen the patient for risk of falls. Further information is needed to determine if a referral or assessment is needed.

Question 83

Which of the following is the primary reason for limiting a hearing aid’s OSPL 90 to a lower level when it is worn by a child than when it is worn by an adult? - Loud amplified sounds may frighten a young child and result in rejection of the hearing aid. - The volume of the external auditory meatus in children is less than that represented by a 2 cc coupler, and consequently the SPL at the eardrum is greater. - Parents and teachers of children with hearing loss typically talk louder than do people who interact with adults with hearing loss. - The primary speech signal will be masked because room noise and reverberation will be amplified.

Answer 83

The volume of the external auditory meatus in children is less than that represented by a 2 cc coupler, and consequently the SPL at the eardrum is greater. The sound pressure level (SPL) at the eardrum is a function of the volume of the external auditory meatus: the smaller the volume, the greater the sound pressure. An OSPL 90 set to a level appropriate for adults may produce an undesirably high maximum SPL in a child.

Question 84

Test results shown in the audiogram were obtained for a 48-year-old patient. The acoustic reflex pattern, immittance results, and pure-tone audiometry are most indicative of which of the following? Note: To expand the image, click on the plus sign (+). - VIIth nerve lesion, right ear - VIIIth nerve lesion, right ear - VIIth nerve and VIIIth nerve lesions, right ear - Cochlear hearing loss, right ear; subtle conductive hearing loss, left ear

Answer 84

VIIth nerve and VIIIth nerve lesions, right ear The data reveal VIIth nerve and VIIIth lesions in the right ear.

Question 85

Which of the following are the most common medical conditions associated with pediatric balance disorders that may require further vestibular assessment and medical referral for treatment? - Skull-base fracture and congenital atresia - Diabetes and thyroid disease - Migraine and benign paroxysmal vertigo of childhood (BPVC) - Respiratory allergies and benign paroxysmal positional vertigo (BPPV)

Answer 85

Migraine and benign paroxysmal vertigo of childhood (BPVC) Migraine and benign paroxysmal vertigo of childhood (BPVC) are the most common medical conditions associated with pediatric balance disorders and may require further vestibular assessment and medical referral for treatment.

Question 86

A 55-year-old sound engineer who works at a local television news company visits an audiologist. He recently obtained receivers in the ears (RITEs) from another audiologist, but he still experiences listening difficulty. His recent audiogram is within normal limits, from 250 Hz250 hertz to 750 Hz750 hertz, progressively sloping to severe impairment at 8 kHz8 kilohertz in both ears. To address his reported listening difficulties, the audiologist reviews his hearing-aid settings and creates a new multichannel expansion program. Also completed was on-ear speech mapping at increasing input levels (50 dB50 decibels SPL to 80 dB80 decibels SPL). Which of the following responses to this adjustment would the patient be most likely to report? - Reporting that the internal noise from his hearing aids has increased - Reporting that high-frequency speech sounds are much clearer - Reporting that there is no difference between soft and loud speech sounds - Reporting increased difficulty hearing low-level, high-frequency speech sounds

Answer 86

Reporting increased difficulty hearing low-level, high-frequency speech sounds Low-level environmental noise or internal noise generated by the hearing instrument should be less audible when expansion is activated.

Question 87

What auditory skill involves becoming aware of and learning to attend to sounds? - Detection - Comprehension - Identification - Discrimination

Answer 87

Detection Once a baby is born, the sounds of the outside world come in loud and clear unless there is a hearing loss. The baby learns to attend and respond to the human voice, the barking of a dog, and other sounds.

Question 88

A stimulus-response table is being maintained to record results of a hearing screening. The trials in which a listener reports hearing a stimulus when a stimulus is not present are recorded in the table as - hits - misses - false alarms - correct rejections

Answer 88

false alarms Experts in childhood hearing screenings found that frequent and thorough screener training, control of instrument calibration, and rigid ambient-noise control reduced false‐positive rates from a range of 40%–90%40 percent to 90 percent down to a more acceptable level of 20%–30%20 percent to 30 percent.

Question 89

What is the most appropriate course of action for an audiologist to take when presented with a patient with test results such as those shown in the accompanying image? Note: To expand the image, click on the plus sign (+). - Refer the patient for medical evaluation. - Administer a battery of speech audiometric tests. - Check for acoustic reflex decay. - Perform a biological calibration.

Answer 89

Perform a biological calibration. A biological calibration or verification is performed to confirm that the system is free of any defects that might erroneously impact test results.

Question 90

A 35-year-old male is scheduled for vestibular testing. In reviewing his case history, an audiologist finds that he is status post mastoid obliteration with surgical ear canal closure following cholesteatoma removal on his right ear two years ago. He did have residual dizziness following his surgery, requiring him to attend vestibular rehabilitation for twelve weeks postoperatively. Which of the following test batteries is the audiologist most likely to recommend for the patient (assuming the audiologist does not have the ability to do bone-conducted VEMPs) ? - Rotary chair, full VNG, bilateral VEMPs - Posturography, calorics, bilateral VEMPs - Rotary chair, vHIT, oculomotor testing - Oculomotor testing only

Answer 90

Rotary chair, vHIT, oculomotor testing While all the vestibular tests shown could provide beneficial information, rotary chair, vHIT, and oculomotor testing are the only tests that can be performed on someone with a surgically closed canal.

Question 91

A patient who has a severe hearing loss takes a consonant recognition test. An analysis of the consonant-confusion error patterns is performed. Results will most likely indicate that the feature recognized most accurately was - manner - nasality - voicing - place

Answer 91

voicing It is most likely that a person with a severe hearing loss will most accurately recognize voicing.

Question 92

The following audiogram, admittance test battery, speech audiometry, and otoacoustic emission (OAE) test results were obtained from a 22-year-old college student who is complaining of having trouble understanding speech, specifically in noisy classrooms. The patient communicates having no tinnitus, dizziness, ear drainage, or family history of hearing loss. Note: To enlarge the image, click on the plus sign (+). The patient’s history and audiometric test battery results are consistent with hearing problems caused by - vestibular schwannoma - damage to the hair cells in the cochlea - otosclerosis or Usher’s syndrome - tympanic membrane (eardrum) perforation

Answer 92

damage to the hair cells in the cochlea Aging and exposure to loud noise may cause wear and tear on the hair cells in the cochlea that send sound signals to the brain. When these hairs or nerve cells are damaged or missing, electrical signals are not transmitted as efficiently, and hearing loss occurs.

Question 93

The following audiogram, admittance test battery, speech audiometry, and otoacoustic emission (OAE) test results were obtained from a 22-year-old college student who is complaining of having trouble understanding speech, specifically in noisy classrooms. The patient communicates having no tinnitus, dizziness, ear drainage, or family history of hearing loss. Note: To enlarge the image, click on the plus sign (+). Which of the following hearing-aid technologies would most benefit the student who needs to understand speech in a noisy listening environment? - Digital noise reduction - Slow-acting compression - Directional microphone systems - Direct audio input

Answer 93

Directional microphone systems The student is most likely to benefit from a hearing aid that deploys directional microphone systems that boost sounds coming from the front of the wearer and reduce sounds coming from other directions. Directional hearing aids are designed to improve signal-to-noise-ratio (SNR) based on the spatial location of the signal of interest relative to unwanted signals. Even though the magnitude of the improvement in SNR provided by directional hearing aids is much smaller than that reported for FM systems, they can still provide improved speech recognition across a range of noisy environments when compared to omnidirectional amplification.

Question 94

Which of the following is most appropriate to use to determine information about a patient’s individual situation and communicative needs? - Hearing Aid Selection Profile (HASP) - Communication Profile for the Hearing Impaired (CPHI) - Hearing Handicap Inventory for Adults (HHIA) - Client Oriented Scale of Improvement (COSI)

Answer 94

Client Oriented Scale of Improvement (COSI) The COSI is a self-reported assessment questionnaire. One of the greatest advantages of the COSI has been to promote a greater focus on the patient’s individual needs when designing a rehabilitation program. The other self-report inventories are too lengthy or may have questions that do not apply to the patient’s specific lifestyle.

Question 95

Which of the following speech-recognition materials should the audiologist use to obtain the steepest possible performance-intensity function? - Nonsense Syllable Test (NST) - Central Institute for the Deaf, Test W-22 (CID W-22) - Synthetic Sentence Identification (SSI) Test - Northwestern University Auditory Test No. 6 (NU-6)

Answer 95

Synthetic Sentence Identification (SSI) Test Performance level rises most steeply with small increases in intensity when the speech sample is large and provides some context; this is true of synthetic sentences, even though they do not provide as much context as natural sentences. In addition, the SSI allows the subject to pick out a word from a list, which provides additional clues.

Question 96

Which of the following is most likely to be detrimental to the recognition of consonants? - Mild low-frequency hearing loss - Moderate conductive hearing across all frequencies - Ménière’s disease - Presbycusis

Answer 96

Presbycusis Presbycusis typically causes a high-frequency hearing loss, which is the most important frequency range for the recognition of consonant letters such as /f/forward slash, f, forward slash, /h/forward slash, h, forward slash, and /s/forward slash, s, forward slash.

Question 97

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

Answer 97

overamplification The output SPL in a 6 month old’s ear is typically higher than it is in a coupler because of the small ear canal volume of an infant’s ear.

Question 98

Which of the following best describes insertion loss? - The difference between coupler gain and real-ear gain - The decrease in natural amplification when the external auditory canal is closed off - Real-ear aided response minus real-ear unaided response - Real-ear saturation response minus real-ear unaided response

Answer 98

The decrease in natural amplification when the external auditory canal is closed off When the ear canal is closed off with an earmold or a hearing aid, there is a loss of natural resonance in the ear canal.

Question 99

A patient reports that hearing loss in both ears has slowly worsened and that hearing is better under noisy conditions than under quiet conditions. The patient’s hearing loss is most likely to be - conductive - sensorineural - caused by a cortical lesion - caused by presbycusis

Answer 99

conductive People speak more loudly in noisy conditions and doing so provides a higher-amplitude speech signal. This improves the signal-to-noise ratio and the sensorineural input for individuals with conductive hearing loss.

Question 100

Individuals with normal hearing use multiple cues to localize sounds. Which of the following are primarily involved in localizing a siren with a frequency of 700 Hz700 hertz? - Interaural time and intensity differences - Interaural time differences only - Spectral cues and interaural intensity differences - Interaural intensity differences only

Answer 100

Interaural time differences only The primary cues used for localization of sounds below 1500 Hz1500 hertz are interaural time differences. The other cues, interaural intensity differences and spectral cues, occur at high frequencies. Therefore, a signal with energy centered at 700 Hz700 hertz would be localized using interaural time differences.

Question 101

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? - Cholesteatoma - Exostosis - Otitis externa - Polychondritis

Answer 101

Exostosis Exostoses are generally bilateral asymptomatic growths found in individuals with a history of cold-water swimming activity.

Question 102

Researchers performed a study on interlist equivalency of four word lists used for word-recognition testing. Each list was presented at five different signal-to-noise ratios (SNR). The word-recognition scores for each SNR for each list were obtained for a group of subjects. Word-recognition performance was evaluated, and the following statistical findings were obtained. There is a significant difference in the mean word-recognition scores among the four word lists at which SNR? - 0 - (-15) - (-20) - (-25)

Answer 102

0 The statistical findings show only one P-value less than 0.05. Therefore, the only statistically significant findings were seen at the 0 dB SNR.

Question 103

A patient who has a unilateral, progressive sensorineural hearing loss accompanied by significant decay of the acoustic reflex and no identifiable waves on auditory brainstem response shows a disproportionately poor word-recognition score. The result is suggestive of - a cochlear disorder - a temporal lobe lesion - a middle-ear dysfunction - an VIIIth nerve disorder

Answer 103

an VIIIth nerve disorder The hearing-loss symptoms described—significant decay of the acoustic reflex, poor word recognition, and no measurable ABR—are consistent with an VIIItheighth-nerve disorder.

Question 104

Which of the following is the most commonly accepted reason for not using 250 Hz250 hertz in screening audiometry in a school environment? - School-age children rarely can respond to the 250 Hz250 hertz tone reliably. - Sound at 250 Hz250 hertz contributes virtually nothing toward the understanding of speech. - Noise in the test environment is likely to interfere with detection of the 250 Hz250 hertz tone. - The responses school-age children give at 250 Hz250 hertz are most likely to be vibrotactile rather than auditory.

Answer 104

Noise in the test environment is likely to interfere with detection of the 250 Hz250 hertz tone. Background noise in schools is likely to be of consistently high amplitude at low frequencies; a 250 Hz250 hertz tone is more difficult to distinguish from such background noise than are higher frequencies.

Question 105

The primary benefit of using FM systems in the classroom is that they - enhance the effects of classroom noise on the student’s speech understanding - reduce the speaker-to-listener distance, thus improving the signal-to-noise ratio - improve speech understanding by extension of the frequency response of the amplification system - convert analog signals into digital signals, which do not often face distortion

Answer 105

reduce the speaker-to-listener distance, thus improving the signal-to-noise ratio FM systems use an FM radio signal to deliver a louder and clearer signal from the teacher to the student, thus improving the signal-to-noise ratio. FM systems help overcome the effects of distance and can greatly reduce the effects of background noise and reverberation.

Question 106

A 13-month-old child has been diagnosed with a severe-to-profound hearing loss. An audiologist has met with the child’s parents to discuss the functional impact of this hearing loss, as well as treatment options, which the parents have read about online. Which of the following is the audiologist most likely to recommend as the next best step for the parents to take? - Obtaining bilateral cochlear implants for the child - Consulting with a pediatric otolaryngologist to obtain medical clearance for amplification - Scheduling a future appointment with the audiologist to review information about their child’s hearing loss - Joining a support group for parents of infants with hearing loss to gain insight into the issues they may face

Answer 106

Consulting with a pediatric otolaryngologist to obtain medical clearance for amplification Given that the child is 13 months of age, the fitting of amplification needs to happen as soon as possible. However, it is necessary to obtain medical clearance before fitting the child with amplification.

Question 107

A patient reports a three-day history of true vertigo, ongoing imbalance, and blurred vision with head movements. Videonystagmography (VNG) oculomotor results indicate normal saccade, optokinetic, and smooth pursuit testing. Rightward torsional and slight down-beating nystagmus is noted in the majority of positions and in postvertical headshaking. No spontaneous, positioning, or gaze nystagmus is noted. Bilateral bithermal caloric results are robust and symmetrical bilaterally. The following results are from ocular and cervical vestibular evoked myogenic potentials (oVEMP and cVEMP) testing. The preceding scenario and the results in the table suggest involvement of which of the following? - The right superior vestibular nerve - The left superior vestibular nerve - The right inferior vestibular nerve - The left inferior vestibular nerve

Answer 107

The left inferior vestibular nerve The cVEMP, which assesses the inferior vestibular nerve, was abnormal for the left ear, and there was a pattern of rightward torsional and slight down-beating nystagmus, indicating involvement of the left inferior vestibular nerve.

Question 108

Which THREE of the following must be included in the written report of an audiologic assessment for a patient with Medicare? - Referral source key - Reason for referral key - Relevant medical history key - Diagnosis and abbreviated codes - Recommendation for annual recheck

Answer 108

Referral source key & Reason for referral key & Relevant medical history key Medicare does not require diagnostic and procedure codes in the report and will not allow a recommendation for annual recheck.