NBC-HIS National Competency Exam — Questions and Answers

Question 1: Which of the following best describes a 'canal lock' feature on an earmold?

A locking mechanism that secures the hearing aid to the earmold
A type of vent that prevents acoustic feedback
A silicone coating applied to the canal tip for comfort
A protrusion that fits into the second bend of the canal to improve retention (Correct answer)

Correct answer: A protrusion that fits into the second bend of the canal to improve retention

A canal lock is a small protrusion molded onto the canal portion that engages the second bend of the ear canal, significantly improving earmold retention.

Question 2: A patient with a steeply sloping high-frequency hearing loss is fitted with open-fit RIC devices. A common complaint is difficulty understanding speech in noise. The MOST appropriate adjustment is:

Increase low-frequency gain
Increase compression attack time
Reduce the MPO
Switch to a closed dome or custom earmold (Correct answer)

Correct answer: Switch to a closed dome or custom earmold

Switching to a closed dome or custom earmold improves low-to-mid frequency retention in the canal, reducing the low-frequency noise that leaks in through the open vent and competing with speech.

Question 3: When counseling the family or significant other of a new hearing aid user, which of the following is the MOST important concept to convey to improve communication for everyone involved?

The hearing aids are a complete cure and will restore hearing to normal.
They should always shout to ensure they are being heard by the hearing aid user.
Hearing aids are a significant help, but they can assist by facing the person, speaking clearly, and reducing background noise. (Correct answer)
They should stop trying to help, as the hearing aid user needs to learn on their own.

Correct answer: Hearing aids are a significant help, but they can assist by facing the person, speaking clearly, and reducing background noise.

It is crucial to manage the expectations of communication partners. Counseling should emphasize that while hearing aids provide significant benefit, they do not restore normal hearing. The most effective approach is a partnership where the communication partner actively helps by using clear communication strategies to complement the technology.

Question 4: During earmold impression taking, the cotton or foam dam is placed in the ear canal to:

Reduce patient discomfort
Improve acoustics of the impression
Keep the ear canal dry
Protect the tympanic membrane from impression material (Correct answer)

Correct answer: Protect the tympanic membrane from impression material

The dam acts as a barrier to prevent impression material from contacting or damaging the tympanic membrane.

Question 5: A patient with bilateral symmetrical mild-to-moderate sensorineural hearing loss requests a monaural fitting to save cost. What should the specialist advise?

Only the ear with the better word recognition score should be fitted
Binaural fitting is strongly recommended for superior localization and speech understanding in noise (Correct answer)
Cost is the sole factor when choosing between monaural and binaural fitting
Monaural fitting is equally effective for symmetrical losses

Correct answer: Binaural fitting is strongly recommended for superior localization and speech understanding in noise

Binaural fitting provides significantly better sound localization, speech understanding in noise, and overall benefit compared to monaural fitting for symmetrical losses.

Question 6: Which structure in the inner ear is responsible for converting mechanical vibrations into electrical signals?

Eustachian tube
Semicircular canals
Organ of Corti (Correct answer)
Tympanic membrane

Correct answer: Organ of Corti

The Organ of Corti, located in the cochlea, contains hair cells that transduce mechanical vibrations into neural electrical signals.

Question 7: Which ossicle directly contacts the oval window of the cochlea?

Lenticular process
Stapes (Correct answer)
Incus
Malleus

Correct answer: Stapes

The stapes footplate fits into the oval window, transmitting vibrations from the ossicular chain directly into the perilymph of the inner ear.

Question 8: A hearing aid that works with the battery door slightly open, but shuts off when you close the door:

wires touching the battery. (Correct answer)
Differs at each frequency.
The second and third formants.
SAT- Speech awareness threshold

Correct answer: wires touching the battery.

The correct answer to the options provided would be "wires touching the battery." This scenario suggests that there could be an issue with the wiring or connection inside the hearing aid, possibly due to wires that are not properly connected or are touching the battery when the door is closed.

Question 9: Which statement BEST reflects the person-centered counseling model in audiological rehabilitation?

The clinician sets treatment goals based on audiometric results alone
Goals are collaboratively identified based on the patient's priorities and lifestyle needs (Correct answer)
Treatment follows a standardized protocol regardless of individual circumstances
The patient's family determines the rehabilitation plan

Correct answer: Goals are collaboratively identified based on the patient's priorities and lifestyle needs

Person-centered care prioritizes the patient's own goals, values, and life context over clinician-driven or standardized protocols.

Question 10: Which type of microphone converts sound pressure variations into electrical signals through the movement of a coil within a magnetic field?

Piezoelectric microphone
Condenser microphone
Dynamic (moving-coil) microphone (Correct answer)
Carbon microphone

Correct answer: Dynamic (moving-coil) microphone

A dynamic microphone uses electromagnetic induction: a diaphragm attached to a coil moves within a magnetic field, generating a voltage.

Question 11: Which measure represents the ratio of the sound power output of a device to the electrical power input, expressed as a percentage?

Signal-to-noise ratio
Total harmonic distortion
Sensitivity
Electroacoustic efficiency (Correct answer)

Correct answer: Electroacoustic efficiency

Electroacoustic efficiency expresses how effectively a transducer (e.g., hearing aid receiver) converts electrical energy into acoustic energy.

Question 12: What is the primary advantage of insert earphones over supra-aural earphones in audiometry?

They increase interaural attenuation, reducing the need for masking (Correct answer)
They provide more accurate bone conduction measurements
They are more comfortable for patients with normal ear canals
They are less expensive and easier to calibrate

Correct answer: They increase interaural attenuation, reducing the need for masking

Insert earphones provide interaural attenuation of approximately 70–80 dB, significantly higher than supra-aural earphones, which reduces cross-hearing and masking requirements.

Question 13: A hearing aid wearer complains that their own voice sounds 'hollow' or 'like talking in a barrel.' This phenomenon is called:

Loudness discomfort
The occlusion effect (Correct answer)
Recruitment
Tinnitus masking

Correct answer: The occlusion effect

The occlusion effect occurs when the ear canal is blocked, causing low-frequency bone-conducted vocal energy to resonate in the occluded space.

Question 14: What presentation level is most commonly used for word recognition testing in clinical practice?

30-40 dB above the SRT or most comfortable loudness level (Correct answer)
At 80 dB HL regardless of thresholds
40 dB above the SRT
At the patient's SRT level

Correct answer: 30-40 dB above the SRT or most comfortable loudness level

Word recognition testing is typically performed at 30–40 dB above the SRT or at the patient's most comfortable loudness level to maximize audibility.

Question 15: Which infection control practice is MOST important when handling hearing aids that have been worn by a patient?

Autoclaving the devices between appointments
Wiping devices with a dry cloth before inspection
Placing used devices in a sealed bag for 24 hours before handling
Using appropriate disinfectant wipes or UV sanitizers designed for hearing instruments (Correct answer)

Correct answer: Using appropriate disinfectant wipes or UV sanitizers designed for hearing instruments

Hearing instruments that have been worn should be cleaned and disinfected using products specifically designed for hearing aids (e.g., germicidal wipes or UV sanitizing units). Autoclaving would destroy electronic components. Simple dry wiping is insufficient. Standard precautions require proper disinfection to prevent cross-contamination between patients.

Question 16: A patient works outdoors in varying weather. Which instrument characteristic should be PRIORITIZED during selection?

Extended Bluetooth range
High IP (Ingress Protection) rating for moisture and dust resistance (Correct answer)
Smallest available battery size
Multiple manual program buttons

Correct answer: High IP (Ingress Protection) rating for moisture and dust resistance

A higher IP rating (e.g., IP67 or IP68) ensures the instrument resists damage from water ingress and dust exposure common in outdoor work environments.

Question 17: Which ANSI standard governs the electroacoustic performance specifications of hearing aids tested in a 2 cc coupler?

ANSI S1.4
ANSI S3.22 (Correct answer)
ANSI S3.6
ANSI S3.5

Correct answer: ANSI S3.22

ANSI S3.22 specifies procedures for measuring hearing aid characteristics such as OSPL90, HFA-OSPL90, full-on gain, and distortion using a 2 cc coupler.

Question 18: Which real-ear measurement (REM) probe placement technique minimizes the risk of the probe tube touching the eardrum?

Placing the probe tube 5 mm past the tragus notch
Placing the probe tip flush with the canal entrance
Placing the probe tip within 5–6 mm of the eardrum (Correct answer)
Placing the probe tube at the concha bowl

Correct answer: Placing the probe tip within 5–6 mm of the eardrum

The probe tube should be positioned within 5–6 mm of the tympanic membrane to capture accurate sound pressure measurements while avoiding contact with the eardrum.

Question 19: A patient requests a copy of their own audiogram and hearing aid records. Under HIPAA, the dispensing practice must:

Deny the request if the records might confuse the patient
Charge the patient a flat fee of $50 before releasing any records
Provide the patient access to their records, typically within 30 days (Correct answer)
Provide the records only if the patient's physician co-signs the request

Correct answer: Provide the patient access to their records, typically within 30 days

HIPAA's Privacy Rule grants patients the right to access their own medical records. The covered entity must provide access within 30 days (with a possible 30-day extension). While a reasonable cost-based fee for copying may be charged, access cannot be denied based on the practice's judgment about what the patient can understand, and no physician co-signature is required.

Question 20: A hearing aid wearer reports a high-pitched whistling sound whenever they hug someone or put on a hat. This is a classic example of acoustic feedback. Modern digital hearing aids primarily manage this issue through:

Lowering the overall volume of the device.
Activating the telecoil.
Phase inversion or phase cancellation. (Correct answer)
Using a smaller, more occluding dome.

Correct answer: Phase inversion or phase cancellation.

Modern feedback cancellation systems use digital signal processing to detect the feedback sound almost instantly. The system then generates an opposite sound wave (phase inversion) to cancel out the whistling noise before it becomes audible to the wearer. While a poor fit can cause feedback, the active technological solution within the hearing aid is phase cancellation.

Question 21: A dispensing professional uses a hearing aid test box (coupler measurements) and finds output is 15 dB below the manufacturer's specification. The battery is new. What is most likely?

The patient's ear canal is smaller than average
The test box microphone is uncalibrated
Incorrect NAL target selected
Internal receiver or amplifier failure requiring manufacturer repair (Correct answer)

Correct answer: Internal receiver or amplifier failure requiring manufacturer repair

A 15 dB output deficit compared to manufacturer specifications in a calibrated test box indicates an internal component failure—most commonly the receiver or amplifier circuit.

Question 22: Under IHS ethical guidelines, which practice constitutes fee splitting?

Billing insurance separately from the patient portion
Offering a senior discount on hearing instruments
Accepting a referral fee from a physician for each patient referred to your practice (Correct answer)
Charging different rates for different service packages

Correct answer: Accepting a referral fee from a physician for each patient referred to your practice

Accepting payment in exchange for referrals is fee splitting, which is prohibited under IHS professional ethics.

Question 23: What does the term 'open fit' refer to in hearing aid technology?

A hearing aid programmed without a target
A hearing aid with no battery door
An aid with an open-back receiver housing
A fitting style where the ear canal is not fully occluded (Correct answer)

Correct answer: A fitting style where the ear canal is not fully occluded

Open fit hearing aids use a thin tube or receiver wire with a small dome that leaves the ear canal largely unoccluded, reducing the occlusion effect.

Question 24: A client calls stating their Receiver-In-Canal (RIC) hearing aid is completely 'dead,' with no sound output. They confirm they have already inserted a fresh, new battery. What is the next most common and user-serviceable component the practitioner should instruct the client to check or change?

The wax guard on the end of the receiver. (Correct answer)
The internal circuit board.
The battery contacts inside the battery door.
The microphone cover on the hearing aid body.

Correct answer: The wax guard on the end of the receiver.

The most common reason for a RIC hearing aid to seem dead, after ruling out the battery, is a clogged wax guard. The wax guard is a small filter at the tip of the receiver that prevents earwax from entering the speaker. When it becomes fully blocked, no sound can pass through, making the aid appear non-functional. It is designed to be easily replaced by the user.

Question 25: An IIC (Invisible-in-Canal) hearing aid is best suited for patients with:

Conductive hearing loss requiring bone conduction
Severe to profound hearing loss requiring maximum gain
Single-sided deafness requiring CROS amplification
Mild to moderate hearing loss and adequate ear canal size (Correct answer)

Correct answer: Mild to moderate hearing loss and adequate ear canal size

IIC aids sit deep in the second bend of the ear canal and are appropriate for mild to moderate losses; they cannot accommodate the larger receivers needed for severe-to-profound loss.

Question 26: Which audiometric finding MOST strongly indicates a physician referral BEFORE proceeding with instrument selection?

Unilateral sudden sensorineural hearing loss of 50 dB occurring within 72 hours (Correct answer)
Bilateral symmetrical high-frequency sensorineural hearing loss in a 70-year-old
Gradual bilateral progressive hearing loss over 10 years
Mild bilateral hearing loss with excellent word recognition scores

Correct answer: Unilateral sudden sensorineural hearing loss of 50 dB occurring within 72 hours

Sudden sensorineural hearing loss is a medical emergency requiring immediate physician referral for possible corticosteroid treatment to maximize hearing recovery.

Question 27: Which of the following ceruminolytic (wax-softening) agents is generally considered safe for home use prior to cerumen removal?

Vinegar and water solution
Prescription-only enzymatic drops
Hydrogen peroxide 3% solution (Correct answer)
Isopropyl alcohol 70%

Correct answer: Hydrogen peroxide 3% solution

A 3% hydrogen peroxide solution (or carbamide peroxide drops) is a commonly recommended and FDA-approved ceruminolytic for home use. It softens wax through effervescence. Isopropyl alcohol is drying and potentially irritating; vinegar solutions are not standard ceruminolytic agents.

Question 28: According to federal regulations enforced by the Federal Trade Commission (FTC), what is required regarding the trial or adjustment period for hearing aids?

Sellers are prohibited from charging any fees if the hearing aid is returned during the trial period.
The full terms of the trial period, including any non-refundable fees, must be clearly disclosed in writing before the sale. (Correct answer)
A mandatory 30-day trial period must be offered for all dispensed hearing aids.
Any non-refundable fees can be no more than 10% of the total purchase price.

Correct answer: The full terms of the trial period, including any non-refundable fees, must be clearly disclosed in writing before the sale.

While many states mandate a trial period of a specific length, there is no single federal law that sets a mandatory trial period for all sales. However, the FTC's role in consumer protection requires that if a seller offers a trial or return period, all terms and conditions—especially any non-refundable costs like dispensing or fitting fees—must be provided in writing to the consumer before the purchase is finalized to prevent deceptive sales practices.

Question 29: Frequency lowering technology is MOST beneficial for patients with which audiometric profile?

Symmetrical moderate hearing loss
Severe-to-profound high-frequency hearing loss with poor audibility above 2000 Hz (Correct answer)
Flat mild hearing loss across all frequencies
Low-frequency hearing loss with normal high-frequency thresholds

Correct answer: Severe-to-profound high-frequency hearing loss with poor audibility above 2000 Hz

Frequency lowering shifts high-frequency speech cues (such as /s/ and /sh/) to lower frequencies where residual hearing exists, improving consonant audibility.

Question 30: When should audiometric equipment be calibrated according to ASHA and ANSI guidelines?

Every time a new audiologist uses the equipment
Only when the patient reports the equipment sounds different
Monthly listening checks with calibration every five years
Daily listening checks with full electroacoustic calibration annually (Correct answer)

Correct answer: Daily listening checks with full electroacoustic calibration annually

ASHA and ANSI recommend daily biological listening checks to detect obvious problems and full electroacoustic calibration at least annually per ANSI S3.6 standards.

Question 31: Under HIPAA's Privacy Rule, a hearing instrument specialist may share a patient's protected health information (PHI) without obtaining patient authorization in which of the following situations?

When a family member asks for the patient's audiogram results
When posting a patient success story on the practice's social media
When coordinating treatment with another healthcare provider involved in the patient's care (Correct answer)
When sharing records with the patient's employer at the employer's request

Correct answer: When coordinating treatment with another healthcare provider involved in the patient's care

HIPAA permits sharing PHI without patient authorization for treatment, payment, and healthcare operations (TPO). Coordinating care with another treating provider falls under 'treatment' and does not require a separate authorization. Sharing with employers, family members (without patient consent), or on social media all require explicit patient authorization.

Question 32: When discussing realistic expectations with a new hearing aid user, the clinician should emphasize that hearing aids:

Restore hearing to normal levels in all environments
Eliminate the need for communication strategies
Improve hearing but cannot fully replicate normal auditory function (Correct answer)
Work best without any adjustments after fitting

Correct answer: Improve hearing but cannot fully replicate normal auditory function

Setting realistic expectations reduces disappointment and improves long-term satisfaction and adherence to hearing aid use.

Question 33: A patient reports that soft speech sounds are inaudible even at maximum volume. The MOST likely fitting issue is:

Feedback suppression over-activation
Insufficient gain for soft inputs (Correct answer)
Compression ratio set too high
Excessive high-frequency gain

Correct answer: Insufficient gain for soft inputs

Insufficient gain for soft-level inputs means quiet sounds are not amplified enough to reach audibility.

Question 34: Which behavior best demonstrates adherence to IHS's principle of honesty in advertising?

Advertising 'guaranteed hearing improvement' to attract clients
Claiming your devices are superior without comparative data
Listing credentials and services accurately without unsubstantiated claims (Correct answer)
Using before-and-after testimonials without patient authorization

Correct answer: Listing credentials and services accurately without unsubstantiated claims

IHS standards require that advertising be truthful, non-deceptive, and free from unsubstantiated superiority claims.

Question 35: A client with a history of chronic ear infections mentions that their ear feels full and asks the hearing instrument specialist to 'flush it out' with water. What is the most ethically and professionally appropriate action for the specialist to take?

Refer the client to a physician for a medical evaluation of the ear. (Correct answer)
Explain that while it might be wax, you can only perform a dry removal with a curette.
Advise the client to purchase an over-the-counter earwax removal kit and return in one week.
Use an otoscope to confirm it is just cerumen before attempting a gentle lavage.

Correct answer: Refer the client to a physician for a medical evaluation of the ear.

The client's history of chronic ear infections is a contraindication for water-based cerumen removal (lavage). Furthermore, a feeling of fullness could indicate a medical issue beyond simple cerumen impaction. The most appropriate and safest course of action is to refer the client to a physician for diagnosis and treatment, staying within the professional scope of practice.

Question 36: During the hearing instrument selection process, which of the following is an objective measure used to confirm that the hearing aid's amplification levels are appropriate for the client's specific hearing loss in their own ear canal?

Client Oriented Scale of Improvement (COSI)
Real Ear Measurement (REM) (Correct answer)
Aided soundfield testing
Hearing Handicap Inventory for the Elderly (HHIE)

Correct answer: Real Ear Measurement (REM)

Real Ear Measurement (REM), also known as probe microphone measurement, is the gold standard objective verification tool. It measures the sound pressure level in the ear canal to ensure the hearing aid's output matches the prescribed targets for that individual's hearing loss and ear acoustics. The other options are subjective validation tools that measure perceived benefit.

Question 37: A patient has unilateral profound sensorineural hearing loss with normal hearing in the opposite ear. Which fitting approach is MOST appropriate?

A CROS or BiCROS system (Correct answer)
Binaural RIC instruments
A high-power ITE on the impaired side
A standard power BTE on the impaired side

Correct answer: A CROS or BiCROS system

CROS systems route sound from the non-aidable ear to the normal or better-hearing ear, allowing the patient to hear sounds originating from their deaf side.

Question 38: State licensure for hearing instrument specialists is regulated by:

The FDA exclusively at the federal level
The FTC in coordination with state agencies
The International Hearing Society, which issues a universal national license
Individual state licensing boards, which vary by state (Correct answer)

Correct answer: Individual state licensing boards, which vary by state

Hearing instrument specialist licensure is a state-regulated function. Each state has its own licensing board, requirements (education, exam, continuing education), and scope of practice rules. The IHS is a professional membership organization, not a licensing authority — the NBC-HIS credential is a voluntary board certification, not a government license.

Question 39: A hearing aid with feedback management activated still produces constant whistling when properly inserted. What is the recommended next step?

Increase compression ratio
Switch to a higher-power receiver
Disable feedback management to test if it is causing the issue
Have the patient return for a new earmold impression to improve acoustic seal (Correct answer)

Correct answer: Have the patient return for a new earmold impression to improve acoustic seal

Persistent feedback despite active feedback management usually means the physical acoustic seal is inadequate; a new impression and earmold will correct the venting leak.

Question 40: A first-time hearing aid user complains that their own voice sounds hollow or like they are talking in a barrel. This is most likely caused by:

The occlusion effect (Correct answer)
Feedback cancellation
Excessive compression
Insufficient low-frequency gain

Correct answer: The occlusion effect

The occlusion effect occurs when a closed earmold blocks the ear canal, amplifying bone-conducted low-frequency energy of one's own voice.

Question 41: The FDA classifies hearing aids as which type of medical device?

Class IV (Investigational)
Class II (Special Controls) (Correct answer)
Class I (General Controls)
Class III (Premarket Approval)

Correct answer: Class II (Special Controls)

Hearing aids are FDA Class II medical devices, subject to Special Controls including performance standards and labeling requirements. They require 510(k) premarket notification (demonstrating substantial equivalence to a predicate device) but not the more stringent Premarket Approval (PMA) required for Class III devices.

Question 42: Tinnitus is MOST accurately defined as:

The perception of sound in the absence of an external acoustic source (Correct answer)
Hypersensitivity to moderately loud sounds
A sudden drop in hearing threshold following noise exposure
Fluid accumulation in the middle ear producing a rushing sound

Correct answer: The perception of sound in the absence of an external acoustic source

Tinnitus is defined as the perception of sound — such as ringing, buzzing, hissing, or roaring — that has no external source. It can be subjective (heard only by the patient) or, rarely, objective (audible to an examiner). It is not the same as hyperacusis (sound sensitivity) or hearing loss itself, though these often co-occur.

Question 43: Which factor is MOST important when selecting a hearing instrument for a 3-year-old child?

Bluetooth connectivity for tablets
Cosmetic appearance and discreteness
Manual volume control access
Safety features including tamper-resistant battery doors and pediatric earmolds (Correct answer)

Correct answer: Safety features including tamper-resistant battery doors and pediatric earmolds

Pediatric instruments must include tamper-resistant battery doors to prevent battery ingestion and allow appropriate gain for consistent auditory access during language development.

Question 44: User satisfaction must include:

parallel venting
Calcium deposits.
Loudest frequency
patient preference. (Correct answer)

Correct answer: patient preference.

User satisfaction in the context of a topic like "parallel venting," "calcium deposits," and "loudest frequency" typically involves considerations that prioritize patient preferences. In various fields such as healthcare, technology, and design, user satisfaction is key to ensuring that products or services meet the needs and preferences of the individuals using them. Patient preference specifically refers to the importance of understanding and accommodating the desires, comfort levels, and specific needs of patients when designing or providing healthcare services or products. This focus on patient preferences contributes to overall user satisfaction and can enhance the effectiveness and adoption of the solution or service being offered. Therefore, "patient preference" is the most relevant and appropriate consideration for user satisfaction in healthcare contexts.

Question 45: Which earmold style is most appropriate for a patient with severe-to-profound hearing loss who needs maximum low-frequency amplification?

Full-shell earmold with no vent or a minimal vent (Correct answer)
Skeleton earmold with a large vent
Open-fit dome with a standard vent
Half-shell earmold with a diagonal vent

Correct answer: Full-shell earmold with no vent or a minimal vent

A full-shell earmold with minimal or no venting provides the best acoustic seal to prevent feedback and retain low-frequency energy needed for severe-to-profound loss.

Question 46: The most common cause of chronic subjective tinnitus is:

Sensorineural hearing loss from noise exposure or aging (Correct answer)
Ménière's disease
Otosclerosis
Eustachian tube dysfunction

Correct answer: Sensorineural hearing loss from noise exposure or aging

The most prevalent cause of chronic subjective tinnitus is sensorineural hearing loss, particularly from noise-induced hearing loss (NIHL) or age-related hearing loss (presbycusis). Damage to cochlear hair cells disrupts normal auditory signals, which the brain may interpret as phantom sound. While otosclerosis and Ménière's can also cause tinnitus, they are far less common overall.

Question 47: Which of the following best describes 'informational counseling' in the context of hearing rehabilitation?

Teaching lipreading skills
Exploring the patient's emotional reaction to hearing loss
Providing factual education about audiograms, devices, and communication strategies (Correct answer)
Facilitating a support group discussion

Correct answer: Providing factual education about audiograms, devices, and communication strategies

Informational counseling focuses on facts—degree of loss, device options, and practical strategies—as opposed to personal adjustment counseling.

Question 48: Which of the following actions constitutes an unethical conflict of interest according to the IHS Code of Ethics?

Accepting a commission structure that pays a higher percentage for the sale of premium-level devices over basic-level devices. (Correct answer)
Recommending a specific brand of hearing aid because the specialist has the most experience and success fitting that product.
Attending a free training seminar hosted by a manufacturer to learn about new technology.
Offering a discount on hearing aids to a family member.

Correct answer: Accepting a commission structure that pays a higher percentage for the sale of premium-level devices over basic-level devices.

A commission structure that incentivizes selling more expensive products creates a conflict of interest. It may influence the specialist to recommend a device based on personal financial gain rather than the client's specific hearing needs, lifestyle, and budget. The client's welfare must always be the primary consideration, free from such conflicts.

Question 49: A patient complains that their hearing aid sounds 'tinny' or too sharp after a programming adjustment. Which parameter was most likely increased excessively?

Output limiting level
High-frequency gain (Correct answer)
Attack time
Low-frequency gain

Correct answer: High-frequency gain

Excessive high-frequency gain produces a tinny or harsh sound quality, as the treble components are over-amplified relative to the bass.

Question 50: During immittance testing, the probe tone frequency used in standard clinical tympanometry for adults is:

678 Hz
226 Hz (Correct answer)
2000 Hz
1000 Hz

Correct answer: 226 Hz

A 226 Hz probe tone is the standard frequency used for adult tympanometry because it is sensitive to middle ear pressure changes in the adult ear.

Question 51: Approximately how fast does sound travel through air at 20°C (68°F)?

1,125 meters per second
1,500 meters per second
343 meters per second (Correct answer)
760 meters per second

Correct answer: 343 meters per second

Sound travels at approximately 343 meters per second (about 1,125 feet per second) through air under standard room-temperature conditions.

Question 52: A client fitted using a prescriptive formula reports that speech is clear, but certain environmental sounds, like running water or a kitchen fan, are uncomfortably loud. The initial verification was performed using only an average speech signal. What is the most appropriate next step using real-ear verification?

Switch to a different prescriptive formula like NAL-NL2 or DSL v5.
Perform unaided soundfield testing to re-establish hearing thresholds.
Measure the Real Ear Aided Response for a loud input (e.g., REAR85 or REAR90) to check the MPO setting. (Correct answer)
Decrease the overall gain across all channels by 10 dB.

Correct answer: Measure the Real Ear Aided Response for a loud input (e.g., REAR85 or REAR90) to check the MPO setting.

The client's complaint is specific to loud sounds, not average speech. The Maximum Power Output (MPO) of the hearing aid controls the ceiling for loud inputs. The correct verification step is to measure the output in the ear using a loud input signal (like 85 or 90 dB SPL) to ensure the MPO is set to a level that is safe and comfortable for the user.

Question 53: The scala vestibuli and scala tympani are filled with:

Perilymph (Correct answer)
Aqueous humor
Cerebrospinal fluid
Endolymph

Correct answer: Perilymph

Perilymph, which resembles extracellular fluid in ionic composition, fills both the scala vestibuli and scala tympani.

Question 54: A 78-year-old client has a severe-to-profound sensorineural hearing loss and significant dexterity issues due to arthritis. They also desire a simple, easy-to-handle device. Which hearing instrument style would be the most appropriate initial recommendation?

Completely-In-Canal (CIC)
In-The-Canal (ITC)
Behind-The-Ear (BTE) with a custom earmold (Correct answer)
Receiver-In-Canal (RIC) with a stock dome

Correct answer: Behind-The-Ear (BTE) with a custom earmold

A Behind-The-Ear (BTE) style instrument is larger, making it easier to handle for individuals with dexterity limitations. Paired with a custom earmold, it can provide the necessary power and acoustic seal for a severe-to-profound hearing loss, unlike smaller custom or RIC styles which may not be powerful enough or are more difficult to manage.

Question 55: The DSL m[i/o] prescriptive method was specifically developed for:

Unilateral hearing loss fittings
Patients with conductive hearing loss only
Pediatric populations and infants (Correct answer)
Adults with sensorineural hearing loss

Correct answer: Pediatric populations and infants

DSL m[i/o] (Desired Sensation Level) was designed to optimize audibility of speech for children, including infants.

Question 56: A word recognition score (WRS) of 0–20% at suprathreshold levels most likely indicates:

Mild sensorineural hearing loss
Conductive hearing loss
Normal hearing
Retrocochlear pathology (Correct answer)

Correct answer: Retrocochlear pathology

Extremely poor word recognition scores (0–20%) at comfortable listening levels are a classic indicator of retrocochlear pathology, such as an acoustic neuroma.

Question 57: A new hearing aid user with a long-standing, severe, high-frequency hearing loss is disappointed after their initial fitting, stating, 'Everything sounds so loud and tinny, and I still can't understand my grandchildren perfectly.' What is the most appropriate initial counseling approach?

Tell the client that their brain will eventually get used to it and to come back in two weeks.
Acknowledge their feelings, explain the brain's acclimatization process to new sounds, and reassure them that adjustments will be made over follow-up visits. (Correct answer)
Suggest they purchase a higher-tier technology level, as it would solve these specific problems.
Immediately turn down the overall gain and high-frequency amplification to make it more comfortable.

Correct answer: Acknowledge their feelings, explain the brain's acclimatization process to new sounds, and reassure them that adjustments will be made over follow-up visits.

This approach validates the patient's experience, provides education on the auditory acclimatization process, and manages expectations by outlining a clear plan for future adjustments. It fosters a collaborative relationship and addresses the patient's concerns without being dismissive or making immediate, potentially premature, programming changes.

Question 58: A client with moderate hearing loss insists on the cheapest possible device against your clinical recommendation. What is the ethical response?

Fit the recommended device and bill the client without their consent
Refer the client to a discount retailer
Fully inform the client of the clinical limitations and document their informed decision (Correct answer)
Refuse to fit the client with an inadequate device

Correct answer: Fully inform the client of the clinical limitations and document their informed decision

Respecting patient autonomy means fully disclosing risks and documenting an informed choice, even if it differs from your recommendation.

Question 59: When evaluating hearing aid benefit during a rehabilitation follow-up, the HHIE (Hearing Handicap Inventory for the Elderly) measures:

Insertion gain across frequencies
The patient's perceived social and emotional impact of hearing loss (Correct answer)
Pure-tone thresholds before and after amplification
Word recognition score improvement

Correct answer: The patient's perceived social and emotional impact of hearing loss

The HHIE is a self-report questionnaire assessing the social and emotional consequences of hearing impairment, not audiometric measures.

Question 60: Which of the following structures is responsible for transducing mechanical sound vibrations into electrical signals for the brain to interpret?

Organ of Corti (Correct answer)
Ossicles
Eustachian tube
Tympanic membrane

Correct answer: Organ of Corti

The Organ of Corti, located in the cochlea of the inner ear, contains hair cells that convert the mechanical energy of sound vibrations into electrical signals that are sent to the brain via the auditory nerve.

Question 61: A hearing instrument specialist discovers a client purchased amplification elsewhere but returns asking for adjustments. What is the ethical course of action?

Report the other provider to IHS for selling without proper follow-up
Provide service and charge appropriately, treating them with the same professional standard (Correct answer)
Refuse service since they are not your client
Provide service only if they agree to purchase future devices from you

Correct answer: Provide service and charge appropriately, treating them with the same professional standard

IHS ethics require treating all patients with equal professional care regardless of where they purchased their devices.

Question 62: Reverberation time (RT60) is defined as the time required for sound pressure level to decrease by:

6 dB after the source stops
30 dB after the source stops
60 dB after the source stops (Correct answer)
20 dB after the source stops

Correct answer: 60 dB after the source stops

RT60 is the time it takes for the sound energy in a room to decay by 60 dB once the sound source ceases.

Question 63: What does a Type C tympanogram indicate?

Normal middle ear pressure
Hypermobile tympanic membrane
Negative middle ear pressure, often due to Eustachian tube dysfunction (Correct answer)
Complete absence of middle ear reflexes

Correct answer: Negative middle ear pressure, often due to Eustachian tube dysfunction

A Type C tympanogram shows peak compliance at a significantly negative pressure (beyond -100 daPa), indicating Eustachian tube dysfunction.

Question 64: Which tympanogram type is most associated with otitis media with effusion (fluid in the middle ear)?

Type C
Type As
Type A
Type B (Correct answer)

Correct answer: Type B

A Type B (flat) tympanogram with no discernible peak indicates reduced or absent tympanic membrane mobility, consistent with middle ear fluid.

Question 65: Which of the following is considered an FDA 'red flag' condition that requires medical referral before a hearing aid can be dispensed to an adult client, unless they sign a medical waiver?

A history of tinnitus for more than 5 years
Recruitment and difficulty hearing in noise
Gradual, bilateral high-frequency hearing loss
Visible evidence of significant cerumen accumulation (Correct answer)

Correct answer: Visible evidence of significant cerumen accumulation

The FDA has established specific contraindications, often called 'red flags,' that necessitate a medical evaluation before fitting hearing aids. Visible evidence of significant cerumen accumulation or a foreign body in the ear canal is one of these eight red flags. The other options are common symptoms associated with hearing loss but are not on the specific FDA list requiring mandatory medical referral.

Question 66: A patient's hearing aid purchase is being submitted to their insurance under CPT coding. Which code range is most commonly associated with hearing aid-related services?

CPT V5000–V5999 series (hearing services) (Correct answer)
CPT V codes (vision services)
ICD-10 codes only — CPT codes do not apply to hearing aids
CPT 92000–92999 (special otorhinolaryngologic services)

Correct answer: CPT V5000–V5999 series (hearing services)

Hearing aid dispensing and related services are billed using CPT V-codes in the V5000–V5999 range (e.g., V5010 for assessment for hearing aid, V5014 for repair/modification). These are the standard procedure codes used for hearing instrument services when submitting claims to insurers.

Question 67: The impedance matching function of the middle ear is primarily achieved by:

The tension of the tensor tympani muscle
The resonance of the ear canal
The elasticity of the round window membrane
The ratio of tympanic membrane area to stapes footplate area (Correct answer)

Correct answer: The ratio of tympanic membrane area to stapes footplate area

The large tympanic membrane area (approximately 55 mm²) compared to the small stapes footplate (approximately 3.2 mm²) creates a pressure gain that matches air impedance to fluid impedance.

Question 68: What is the fundamental difference between analog and digital signal processing in hearing aids?

Analog hearing aids can produce louder output than digital hearing aids
Analog processing is continuous, while digital processing samples the signal and converts it to binary data before processing (Correct answer)
Analog hearing aids offer more programmable channels than digital devices
Digital hearing aids only amplify high-frequency sounds above 2,000 Hz

Correct answer: Analog processing is continuous, while digital processing samples the signal and converts it to binary data before processing

Analog processing maintains a continuous electrical representation of the sound wave, whereas digital processing samples the sound at high rates, converts it to binary code, processes it mathematically, then converts it back to an analog output.

Question 69: The Bluetooth LE Audio standard offers several advantages over Bluetooth Classic for hearing aid users. Which of the following is a key benefit of this newer technology?

Lower power consumption, leading to longer battery life during streaming. (Correct answer)
Higher amplification levels for severe hearing losses.
Universal compatibility with all electronic devices made before 2020.
A significantly longer connection range, often exceeding 300 feet.

Correct answer: Lower power consumption, leading to longer battery life during streaming.

Bluetooth LE (Low Energy) Audio is specifically designed to provide high-quality audio streaming while consuming significantly less power than Bluetooth Classic. This results in longer battery life for hearing aid users who stream audio from their phones or other devices. It also enables new features like Auracast broadcast audio.

Question 70: During troubleshooting, you notice corrosion on the battery contacts of a hearing aid. What is the recommended corrective action?

Clean contacts with a dry cotton swab or special contact cleaner, then test (Correct answer)
Increase battery voltage to compensate
Replace the entire hearing aid
Apply a drop of oil to prevent further corrosion

Correct answer: Clean contacts with a dry cotton swab or special contact cleaner, then test

Corroded battery contacts should be cleaned with a dry swab or approved contact cleaner to restore proper electrical connection before replacing the device.

Question 71: A client presents with a unilateral hearing loss, where the right ear has no usable hearing (profound loss) and the left ear has normal hearing. The client's primary complaint is difficulty hearing conversations on their right side. Which of the following is the most suitable amplification strategy?

A traditional hearing aid on the right ear
Bilateral hearing aids
A bone-anchored hearing aid on the left side
A contralateral routing of signals (CROS) system (Correct answer)

Correct answer: A contralateral routing of signals (CROS) system

A CROS system is specifically designed for unilateral hearing loss where one ear is unaidable. It uses a microphone on the poorer ear to pick up sound and wirelessly transmit it to a receiver on the normal-hearing ear, allowing the user to perceive sounds from their deaf side.

Question 72: In a hearing instrument, what is the term for the entire frequency range within which unique, specific signal processing is performed?

memory
program
channel (Correct answer)
band

Correct answer: channel

In a hearing instrument, the term for the entire frequency range within which unique, specific signal processing is performed is called a "channel." Each channel in a hearing instrument processes a specific range of frequencies independently, allowing for customized amplification and signal processing tailored to different parts of the auditory spectrum. This enables the hearing instrument to address specific hearing needs across various frequencies for optimal performance and sound quality.

Question 73: What is the PRIMARY acoustic advantage of a receiver-in-canal (RIC) instrument over a traditional BTE with earmold?

Lower manufacturing cost
Higher maximum power output
Longer battery life
Reduced feedback risk due to greater distance between microphone and receiver (Correct answer)

Correct answer: Reduced feedback risk due to greater distance between microphone and receiver

In RIC instruments, the microphone sits behind the ear while the receiver is in the canal, creating greater physical separation that reduces acoustic feedback.

Question 74: A patient who works in a noisy manufacturing environment with hearing loss should be counseled that the primary purpose of hearing protection in that setting is to:

Prevent further noise-induced hearing loss from occurring (Correct answer)
Improve speech understanding with coworkers
Replace the need for hearing aids while at work
Amplify important warning signals

Correct answer: Prevent further noise-induced hearing loss from occurring

Hearing protection in high-noise workplaces primarily prevents additional noise-induced threshold shift, not to improve communication.

Question 75: When counseling a first-time hearing aid user, which realistic expectation is MOST important to establish?

Maximum benefit is achieved immediately at the fitting appointment
An adaptation period of several weeks is normal and hearing will not sound exactly like pre-loss hearing (Correct answer)
Hearing aids will restore hearing to normal
Hearing aids are effective primarily for telephone use

Correct answer: An adaptation period of several weeks is normal and hearing will not sound exactly like pre-loss hearing

Realistic expectations about the adaptation period and the nature of amplified sound reduce disappointment and improve long-term patient adherence.

Question 76: A tympanic membrane perforation may cause a:

Conductive loss. (Correct answer)
All of above.
Degradation effect.
Place theory.

Correct answer: Conductive loss.

A tympanic membrane perforation may cause a conductive hearing loss. When the tympanic membrane (eardrum) is perforated or damaged, it affects the transmission of sound waves to the middle ear. This disruption leads to reduced efficiency in conducting sound vibrations to the inner ear, resulting in a conductive hearing loss.

Question 77: A patient reports their hearing aid whistles whenever someone gives them a close hug. This is MOST likely due to:

Excessive noise reduction algorithm activation
A defective telecoil component
Insufficient battery voltage
Acoustic feedback caused by amplified sound re-entering the microphone during close contact (Correct answer)

Correct answer: Acoustic feedback caused by amplified sound re-entering the microphone during close contact

Close contact places objects near the microphone while the receiver outputs amplified sound, creating a feedback loop when that sound leaks back to the microphone.

Question 78: To comply with the principle of informed consent, a hearing instrument specialist must ensure the client understands all of the following BEFORE they sign a purchase agreement, EXCEPT:

The potential benefits, limitations, and realistic expectations of the recommended hearing aids.
The technical specifications of the digital signal processor in the hearing aid. (Correct answer)
The total cost of the hearing aids and any non-refundable fees.
The specific warranty details and the trial period/return policy.

Correct answer: The technical specifications of the digital signal processor in the hearing aid.

Informed consent requires the client to have all the necessary information to make an autonomous decision. This includes understanding costs, policies, benefits, and limitations. However, detailing the highly technical specifications of the internal processor is not necessary for informed consent and is typically beyond the scope of what a client needs to know to make a sound decision.

Question 79: In the context of hearing aid programming, 'acclimatization' refers to:

Reducing feedback over the first few weeks of use
Calibrating the device to a new audiogram
Adjusting the hearing aid to outdoor temperature changes
Gradually increasing gain over time to help new users adapt (Correct answer)

Correct answer: Gradually increasing gain over time to help new users adapt

Acclimatization features start with reduced gain and automatically or manually increase it as the user adjusts to amplification.

Question 80: A patient with bothersome tinnitus is being fitted with hearing aids. Which technology feature may provide additional relief beyond standard amplification?

Built-in tinnitus sound therapy programs (Correct answer)
Binaural wireless synchronization
Frequency compression
Extended high-frequency amplification

Correct answer: Built-in tinnitus sound therapy programs

Many modern hearing aids include dedicated tinnitus therapy programs that generate masking or soothing sounds to reduce tinnitus perception.

Question 81: When a patient's communication partner asks how they can better support someone with hearing loss, the clinician should advise them to:

Face the listener, speak at a natural pace, and rephrase rather than repeat if misunderstood (Correct answer)
Speak louder and exaggerate mouth movements
Always write down everything they say
Avoid complex topics to reduce listening effort

Correct answer: Face the listener, speak at a natural pace, and rephrase rather than repeat if misunderstood

Natural clear speech, good visual access, and rephrasing with different words are evidence-based strategies that improve communication without patronizing the listener.

Question 82: A patient with tinnitus reports that it is most bothersome at bedtime in a quiet room. The MOST appropriate rehabilitation recommendation is:

Recommend referral for MRI immediately
Recommend low-level background sound (a fan, nature sounds, or a sound machine) at night (Correct answer)
Suggest increasing hearing aid volume before bed
Advise the patient to sleep with earplugs

Correct answer: Recommend low-level background sound (a fan, nature sounds, or a sound machine) at night

Sound enrichment reduces the contrast between tinnitus and silence, making tinnitus less perceptually prominent and improving sleep.

Question 83: When performing tympanometry, a Type B tympanogram with a large ear canal volume most likely indicates:

Tympanic membrane perforation (Correct answer)
Fluid in the middle ear
Otosclerosis
Eustachian tube dysfunction

Correct answer: Tympanic membrane perforation

A Type B tympanogram with abnormally large equivalent ear canal volume (ECV) is characteristic of a tympanic membrane perforation or patent pressure equalization tube.

Question 84: What is the primary purpose of a hearing aid vent?

To increase amplification in the high frequencies
To house the telecoil antenna
To provide a pathway for moisture to drain
To allow low-frequency sound to escape and reduce the occlusion effect (Correct answer)

Correct answer: To allow low-frequency sound to escape and reduce the occlusion effect

Vents allow low-frequency sound energy and the patient's own voice to escape the ear canal, reducing the plugged or hollow sensation known as the occlusion effect.

Question 85: Which type of cerumen is considered most difficult to remove and most likely to require referral to a physician?

Hard, impacted cerumen occluding the canal (Correct answer)
Flaky, dry cerumen near the outer canal
Soft, recently deposited cerumen
Wet, honey-colored cerumen

Correct answer: Hard, impacted cerumen occluding the canal

Hard, impacted cerumen that completely occludes the ear canal poses the greatest risk of injury during removal and may require softening agents, specialized tools, or physician referral. It can also cause or mimic conductive hearing loss.

Question 86: Before taking an ear impression, otoscopic examination is performed to:

Assess the health of the ear canal and determine safe otoblock placement depth (Correct answer)
Check the patient's hearing sensitivity in the high frequencies
Measure the length of the ear canal for selecting tubing
Determine the appropriate earmold style for the patient

Correct answer: Assess the health of the ear canal and determine safe otoblock placement depth

Otoscopy allows the clinician to inspect the ear canal for cerumen, inflammation, perforation, or other contraindications to impression taking, and to gauge safe otoblock depth.

Question 87: Which of the following is considered a method of hearing aid validation, not verification?

Speech mapping to prescriptive targets.
Using the Client Oriented Scale of Improvement (COSI). (Correct answer)
Test box analysis against manufacturer specifications.
Measuring Real Ear Insertion Gain (REIG).

Correct answer: Using the Client Oriented Scale of Improvement (COSI).

Validation assesses whether the hearing aid is meeting the patient's real-world needs. The COSI is a subjective outcome measure where the client identifies specific listening goals and then rates their improvement, making it a pure validation tool. The other options are all objective measurements of the hearing aid's performance, which are forms of verification.

Question 88: A patient with an open jaw impression shows a significant gap between the impression and the tragus area when the mouth is closed. This most likely indicates:

The otoblock was placed too deeply
The temporomandibular joint movement was not adequately captured (Correct answer)
Insufficient material was injected into the canal
The impression material was over-mixed

Correct answer: The temporomandibular joint movement was not adequately captured

TMJ movement changes the shape of the ear canal, and a gap at the tragus suggests the open-jaw technique did not fully account for this dynamic change.

Question 89: Which audiometric configuration is classically associated with noise-induced hearing loss (NIHL)?

Rising configuration with better high-frequency thresholds
Profound loss across all frequencies above 1,000 Hz
Notch at 4,000 Hz with better thresholds at adjacent frequencies (Correct answer)
Flat configuration across all frequencies

Correct answer: Notch at 4,000 Hz with better thresholds at adjacent frequencies

Noise-induced hearing loss characteristically produces a notch (threshold dip) at 4,000 Hz, with recovery at 8,000 Hz, due to the cochlear resonance response to hazardous noise.

Question 90: What type of screening assessment would need to be scheduled prior to a procedure for pressure equalization tubes?

newborn hearing screening
immitance screening (Correct answer)
otoacoustic emission screening
hearing screening

Correct answer: immitance screening

The type of screening assessment that would need to be scheduled prior to a procedure for pressure equalization tubes is an immitance screening. Immittance screening involves testing the middle ear function and can help assess the need for pressure equalization tubes (also known as tympanostomy tubes) in cases of middle ear dysfunction or chronic ear infections. This screening assesses the mobility of the eardrum and the function of the middle ear system, which is important before considering surgical interventions like the insertion of pressure equalization tubes.

Question 91: In digital hearing aid processing, what is the primary function of 'channels' as opposed to 'bands'?

Channels only control the directionality of the microphones.
Channels are used for manual volume adjustments by the user.
Channels and bands are interchangeable terms for the same function.
Channels allow for the independent operation of features like noise reduction and feedback management across different frequency ranges. (Correct answer)

Correct answer: Channels allow for the independent operation of features like noise reduction and feedback management across different frequency ranges.

Channels are distinct frequency ranges where the hearing aid's digital signal processor can apply different algorithms independently. This allows advanced features like noise reduction or feedback cancellation to work in one channel (e.g., a low-frequency noise channel) without affecting another (e.g., a high-frequency speech channel). Bands typically refer to the adjustment 'handles' the professional uses to adjust gain.

Question 92: When two sounds of slightly different frequencies are presented simultaneously, listeners perceive a rhythmic pulsing called:

Resonance
Beats (Correct answer)
Harmonics
Interference pattern

Correct answer: Beats

Beats arise when two tones close in frequency combine, producing amplitude fluctuations at a rate equal to the difference between their frequencies.

Question 93: Which test is used to assess the integrity of the efferent auditory pathway?

Auditory brainstem response (ABR)
Contralateral suppression of OAEs (Correct answer)
Bekesy audiometry
Acoustic reflex decay

Correct answer: Contralateral suppression of OAEs

Contralateral suppression of otoacoustic emissions (OAEs) tests the medial olivocochlear bundle, which is part of the efferent auditory pathway.

Question 94: The tonotopic organization of the cochlea refers to the specific arrangement of hair cells along the basilar membrane. Where are high-frequency sounds processed?

At the base of the cochlea (Correct answer)
In the helicotrema
At the apex of the cochlea
Uniformly across the entire basilar membrane

Correct answer: At the base of the cochlea

The basilar membrane is narrower and stiffer at the base of the cochlea, which makes it more responsive to high-frequency vibrations. It becomes wider and more flexible towards the apex, which responds best to low-frequency sounds.

Question 95: Which type of microphone configuration in a hearing aid provides the greatest directional benefit in a noisy restaurant?

T-coil input
Adaptive directional microphone (Correct answer)
Omnidirectional microphone
Single directional microphone

Correct answer: Adaptive directional microphone

Adaptive directional microphones continuously track and null noise sources from varying directions, providing superior SNR benefit in complex noise environments.

Question 96: During aural rehabilitation, which activity specifically targets a patient's ability to use context clues to fill in missed speech sounds?

Lipreading without audio
Analytic listening drills
Auditory discrimination training
Speech tracking exercises (Correct answer)

Correct answer: Speech tracking exercises

Speech tracking requires the patient to repeat connected discourse verbatim, forcing use of contextual and linguistic cues when sounds are missed.

Question 97: A client's unmasked air conduction threshold in the right ear at 2000 Hz is 50 dB HL. The bone conduction threshold in the left ear (non-test ear) at the same frequency is 10 dB HL. Using supra-aural headphones with an interaural attenuation of 40 dB, is masking required for the right ear, and why?

Yes, because the difference between the air-conduction threshold in the test ear and the bone-conduction threshold in the non-test ear is greater than the interaural attenuation. (Correct answer)
No, because the bone conduction in the non-test ear is within normal limits.
Yes, because masking is always required when testing at 2000 Hz.
No, because the air conduction threshold is not high enough to require masking.

Correct answer: Yes, because the difference between the air-conduction threshold in the test ear and the bone-conduction threshold in the non-test ear is greater than the interaural attenuation.

Masking is needed to prevent the non-test ear from responding to the signal (cross-hearing). The rule is to mask when the air conduction threshold of the test ear (ACte) minus the interaural attenuation (IA) is greater than or equal to the bone conduction threshold of the non-test ear (BCnte). In this case: 50 dB (ACte) - 40 dB (IA) = 10 dB. Since 10 dB is equal to the BCnte (10 dB), there is a risk of cross-hearing, and masking is required.

Question 98: Damage to which nerve is responsible for sensorineural hearing loss in acoustic neuroma?

Trigeminal nerve (CN V)
Vagus nerve (CN X)
Facial nerve (CN VII)
Vestibulocochlear nerve (CN VIII) (Correct answer)

Correct answer: Vestibulocochlear nerve (CN VIII)

Acoustic neuromas (vestibular schwannomas) grow on CN VIII, compressing it and causing progressive sensorineural hearing loss.

Question 99: Which of the following is the BEST practice for maintaining patient records in a hearing instrument dispensing practice?

Deleting electronic records annually to comply with data minimization rules
Maintaining secure, confidential records for the period required by state law, typically 5–10 years (Correct answer)
Keeping records only for one year after the patient's last visit
Storing paper records in an unlocked filing cabinet for easy staff access

Correct answer: Maintaining secure, confidential records for the period required by state law, typically 5–10 years

State laws vary but generally require patient records to be retained for a minimum of 5–10 years (longer for minors). Records must be stored securely to protect PHI under HIPAA. Premature destruction of records or unsecured storage violates both state regulations and federal HIPAA requirements.

Question 100: What is the acceptable agreement range between the pure-tone average (PTA) and the speech recognition threshold (SRT)?

Within 20 dB
Within 10 dB (Correct answer)
Within 15 dB
Within 5 dB

Correct answer: Within 10 dB

The SRT should agree within 10 dB of the three-frequency pure-tone average; a larger discrepancy suggests test reliability concerns.

Question 101: A patient experiencing hearing aid feedback (whistling) when hugging family members should first be counseled to:

Increase the volume to override the feedback
Return the hearing aid immediately for replacement
Switch to a completely-in-canal style
Cup their hand over the ear during hugs or remove the aid briefly (Correct answer)

Correct answer: Cup their hand over the ear during hugs or remove the aid briefly

Feedback during close contact is normal; counseling the patient on simple behavioral strategies prevents unnecessary frustration.

Question 102: What is the commonly cited threshold of pain for sound pressure level in humans?

85 dB SPL
100 dB SPL
120 dB SPL
140 dB SPL (Correct answer)

Correct answer: 140 dB SPL

The threshold of pain is approximately 140 dB SPL, the level at which sound causes immediate discomfort or pain and can result in acute hearing damage.

Question 103: A patient's ITE hearing aid produces intermittent sound that cuts in and out. After ruling out battery and wax blockage, what is the next most likely cause?

Defective volume control or loose internal connection (Correct answer)
Incorrect frequency response
Normal BILL processing
Improper gain setting

Correct answer: Defective volume control or loose internal connection

Intermittent sound after ruling out battery and wax typically indicates a faulty potentiometer, cracked solder joint, or loose internal connection.

Question 104: What is a 'false positive' response during pure-tone audiometry?

A patient fails to respond when a tone is presented
A patient hears a tone at a level below their true threshold
A patient responds when no tone was actually presented (Correct answer)
A patient correctly identifies tones on the first presentation

Correct answer: A patient responds when no tone was actually presented

A false positive occurs when the patient raises their hand or signals a response even though no tone was presented, indicating unreliable testing behavior.

Question 105: The Americans with Disabilities Act (ADA) requires hearing instrument dispensing offices to:

Offer only digital hearing aids to comply with modern accessibility standards
Provide hearing aids free of charge to patients who cannot afford them
Provide effective communication accommodations and accessible facilities for patients with disabilities (Correct answer)
Employ at least one audiologist alongside the hearing instrument specialist

Correct answer: Provide effective communication accommodations and accessible facilities for patients with disabilities

The ADA requires places of public accommodation — including hearing aid dispensing offices — to provide effective communication for patients with disabilities and to ensure physical accessibility. This includes things like written materials, captioning, or accessible entrances. It does not mandate free products or staffing requirements.

Question 106: The superior semicircular canal detects head movement in which plane?

Horizontal (yaw)
All planes simultaneously
Sagittal (pitch) (Correct answer)
Coronal (roll)

Correct answer: Sagittal (pitch)

The superior (anterior) semicircular canal is oriented to detect pitch movements (nodding the head forward and backward).

Question 107: A hearing instrument with multiple memory programs is MOST useful for which type of patient?

A patient who regularly moves between quiet, noisy, music, and telephone listening situations (Correct answer)
A patient with unilateral hearing loss
A patient who prefers a fully automatic single-program instrument
A patient with stable hearing loss and a single daily listening environment

Correct answer: A patient who regularly moves between quiet, noisy, music, and telephone listening situations

Multiple memories allow optimized settings for distinct acoustic environments, enabling the patient or automatic switching to match the current listening situation.

Question 108: A patient with severe arthritis reports difficulty manipulating small controls. Which hearing aid feature MOST addresses this limitation?

Multiple manual push-button programs
Automatic volume and program adjustment without manual controls (Correct answer)
Size 10 zinc-air battery
Smaller battery door for cosmetic discreteness

Correct answer: Automatic volume and program adjustment without manual controls

Automatic adjustment eliminates fine motor manipulation, making the instrument manageable for patients with reduced dexterity.

Question 109: What is the primary cause of acoustic feedback in hearing instruments?

A loose or corroded battery contact
Excessive cerumen blocking the microphone port
A depleted battery causing voltage fluctuations
Amplified sound from the receiver leaking back into the microphone and being re-amplified (Correct answer)

Correct answer: Amplified sound from the receiver leaking back into the microphone and being re-amplified

Acoustic feedback is a closed loop where amplified sound from the receiver (speaker) escapes and re-enters the microphone, is amplified again, and creates the characteristic whistle or squeal.

Question 110: The Client Oriented Scale of Improvement (COSI) is a validation tool used to measure a patient's progress with hearing aids. What is the primary characteristic that makes the COSI a patient-centered measure?

It uses a standardized list of 25 common listening situations to ensure all areas are covered.
It relies solely on objective real-ear measurement data to determine the final outcome.
It compares the patient's performance to a normative database of other hearing aid users.
The patient identifies and prioritizes their own specific listening goals, which are then used to measure success. (Correct answer)

Correct answer: The patient identifies and prioritizes their own specific listening goals, which are then used to measure success.

The COSI is a highly patient-centered validation tool because it begins with the patient identifying up to five specific listening situations where they want to see improvement. The success of the hearing aid fitting is then evaluated based on their self-perceived progress in those personally relevant situations, rather than on a generic set of questions or objective data alone.

Question 111: In acoustics, what does one octave represent?

A doubling of frequency (Correct answer)
An increase of exactly 1,000 Hz between two tones
A fixed interval of 8 semitones used only in audiometric testing
A tenfold increase in sound intensity

Correct answer: A doubling of frequency

One octave equals a doubling of frequency; for example, 500 Hz to 1,000 Hz is one octave, and 1,000 Hz to 2,000 Hz is the next octave.

Question 112: A colleague asks you to sign off on a hearing evaluation you did not personally conduct. What is the correct action?

Sign and note that it was performed by a colleague
Refuse, as signing documentation for evaluations you did not perform is fraudulent (Correct answer)
Sign if you trust the colleague's competence
Sign only if the results appear clinically reasonable

Correct answer: Refuse, as signing documentation for evaluations you did not perform is fraudulent

Signing evaluation records you did not personally conduct constitutes fraud and violates IHS professional standards.

Question 113: A client with mild high-frequency hearing loss reports that their primary complaint is bothersome tinnitus, which is especially noticeable in quiet environments. They are anxious and ask what can be done. Which of the following is the most appropriate initial counseling and management strategy?

Explain the link between hearing loss and tinnitus, and discuss how sound therapy via hearing aids or other sources can reduce its perception. (Correct answer)
Immediately refer them for an MRI to rule out an acoustic neuroma.
Tell them that tinnitus is incurable and they will simply have to learn to live with it.
Recommend they see a psychiatrist for anti-anxiety medication.

Correct answer: Explain the link between hearing loss and tinnitus, and discuss how sound therapy via hearing aids or other sources can reduce its perception.

The most common and effective initial approach for tinnitus management, especially when hearing loss is present, is sound therapy. Counseling should focus on educating the patient that enriching the sound environment with soft, ambient noise can make the tinnitus less noticeable and reduce the associated anxiety. This is an evidence-based strategy within the scope of a hearing professional.

Question 114: Silicone impression material is generally preferred over powder-and-liquid acrylic for ear impressions because silicone:

Is less expensive and more widely available
Sets faster and requires less skill
Produces a harder impression for better lab processing
Is more dimensionally stable and flexible for easier removal (Correct answer)

Correct answer: Is more dimensionally stable and flexible for easier removal

Silicone impression materials exhibit excellent dimensional stability after setting and their flexibility allows for easier, safer removal from the ear canal.

Question 115: A patient complains that their new earmold causes a 'plugged up' or occlusion effect when chewing or speaking. The most appropriate first modification would be to:

Remake the earmold in a harder acrylic material
Add or enlarge a vent in the earmold (Correct answer)
Polish the surface of the earmold canal portion
Reduce the overall length of the canal tip

Correct answer: Add or enlarge a vent in the earmold

The occlusion effect is caused by bone-conducted sound being trapped in a sealed ear canal, and adding or enlarging a vent allows this energy to escape.

NBC-HIS National Competency Exam

The NBC-HIS National Competency Examination (NCE) certifies hearing instrument specialists, assessing their competency across five domains essential to fitting and dispensing hearing instruments.

115

Questions

120 min

Time Limit

70%

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Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

ihsinfo.org — Time limit, test delivery, eligibility, fees, retake policy · verified Oct 2026
myhome.ihsinfo.org — Passing score, retake fee · verified Oct 2026