HAC Tinnitus Management & Treatment 3 — Questions and Answers
Question 1: During a tinnitus evaluation, residual inhibition is tested by masking the tinnitus and then measuring what?
- The degree of hearing threshold shift after noise exposure
- The temporary suppression of tinnitus after the masking sound is removed (Correct answer)
- The loudness discomfort level compared to baseline
- The audiometric pure-tone average before and after masking
Correct answer: The temporary suppression of tinnitus after the masking sound is removed
Residual inhibition refers to the temporary reduction or elimination of tinnitus immediately after a masking sound is turned off.
Question 2: A patient with tinnitus also presents with hyperacusis. Which sound therapy approach requires the most caution?
- Notched music therapy
- High-level broadband masking above the loudness discomfort level (Correct answer)
- Low-level environmental sound enrichment
- Structured desensitization with gradually increasing sound levels
Correct answer: High-level broadband masking above the loudness discomfort level
Using high-level masking in a patient with hyperacusis can worsen sound sensitivity; instead, very low-level sound enrichment is recommended.
Question 3: Pulsatile tinnitus that synchronizes with the heartbeat is most likely associated with which underlying condition?
- Presbycusis
- Vascular or cardiovascular abnormalities (Correct answer)
- Age-related cochlear hair cell loss
- Noise-induced high-frequency notch
Correct answer: Vascular or cardiovascular abnormalities
Pulsatile tinnitus synchronized with heartbeat is commonly caused by vascular abnormalities such as arteriovenous malformations, carotid stenosis, or benign intracranial hypertension.
Question 4: In the Progressive Tinnitus Management (PTM) model developed by the VA, at what level does a hearing care provider first become directly involved?
- Level 1: Triage
- Level 2: Audiologic evaluation (Correct answer)
- Level 3: Group education
- Level 4: Interdisciplinary evaluation
Correct answer: Level 2: Audiologic evaluation
In the PTM stepped-care model, the hearing care provider (audiologist) first becomes directly involved at Level 2 for audiologic evaluation and triage.
Question 5: Which neural plasticity concept underlies why tinnitus often persists even after auditory nerve severing?
- Peripheral adaptation at the inner hair cell synapse
- Central gain increase in auditory cortex after deafferentation (Correct answer)
- Efferent olivocochlear suppression of outer hair cells
- Endolymphatic hydrops in the scala media
Correct answer: Central gain increase in auditory cortex after deafferentation
After deafferentation, the central auditory system increases gain to compensate for reduced input, generating phantom sounds even without peripheral input.
Question 6: Which sleep strategy is commonly recommended to tinnitus patients struggling with tinnitus awareness at night?
- Earplugs to block all environmental noise
- Low-level bedside sound enrichment (e.g., white noise or nature sounds) (Correct answer)
- Complete silence to train the brain to ignore tinnitus
- High-level masking noise played through earphones
Correct answer: Low-level bedside sound enrichment (e.g., white noise or nature sounds)
Low-level bedside sound enrichment reduces the contrast between tinnitus and quiet, making tinnitus less perceptible during sleep.
Question 7: A patient's tinnitus changes in intensity when they clench their jaw or move their neck. This is most consistent with which tinnitus subtype?
- Psychogenic tinnitus
- Somatic tinnitus (Correct answer)
- Objective tinnitus
- Central tinnitus from acoustic neuroma
Correct answer: Somatic tinnitus
Somatic tinnitus can be modulated by somatosensory inputs such as jaw clenching or head/neck movement, suggesting musculoskeletal involvement.
HAC Tinnitus Management & Treatment 3
During a tinnitus evaluation, residual inhibition is tested by masking the tinnitus and then measuring what?