NBC-HIS National Competency Exam — Questions and Answers

Question 1: A client with moderate hearing loss insists on the cheapest possible device against your clinical recommendation. What is the ethical response?

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

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 2: The most common cause of conductive hearing loss in adults in the United States is:

Otosclerosis
Cerumen impaction (Correct answer)
Cholesteatoma
Ossicular discontinuity from trauma

Correct answer: Cerumen impaction

Cerumen (earwax) impaction is the most prevalent cause of conductive hearing loss in adults and is easily corrected by removal.

Question 3: The COSI (Client Oriented Scale of Improvement) is used in rehabilitation to:

Identify patient-specific listening goals and track outcomes over time (Correct answer)
Determine candidacy for cochlear implant
Calculate the speech intelligibility index
Measure word recognition scores in quiet

Correct answer: Identify patient-specific listening goals and track outcomes over time

The COSI is a patient-centered outcome measure where individuals nominate their own goals and rate improvement after intervention.

Question 4: When a patient with a high-gain hearing aid reports persistent feedback even after earmold remake, the clinician should next consider:

Evaluating the acoustic vent size and considering a smaller or occluded vent (Correct answer)
Reducing the hearing aid gain
Switching to an in-the-canal style hearing aid
Increasing the canal length of the new earmold

Correct answer: Evaluating the acoustic vent size and considering a smaller or occluded vent

Acoustic vents can be a pathway for amplified sound to escape and re-enter the microphone; reducing vent size or occluding it eliminates this feedback path for high-gain fittings.

Question 5: The endocochlear potential (EP) in the scala media is approximately:

+10 mV
-40 mV
+80 mV (Correct answer)
-70 mV

Correct answer: +80 mV

The endocochlear potential is approximately +80 mV, created by the stria vascularis, and provides the driving force for K⁺ to enter hair cells during transduction.

Question 6: The tensor tympani muscle is innervated by which cranial nerve?

Facial nerve (CN VII)
Trigeminal nerve (CN V) (Correct answer)
Glossopharyngeal nerve (CN IX)
Vestibulocochlear nerve (CN VIII)

Correct answer: Trigeminal nerve (CN V)

The tensor tympani is innervated by the medial pterygoid nerve, a branch of the mandibular division (V3) of the trigeminal nerve (CN V).

Question 7: During a hearing aid fitting verification, the functional gain measurement is performed by comparing:

Audiogram and loudness scaling scores
Real-ear and 2-cc coupler responses
Aided and unaided soundfield thresholds (Correct answer)
REIG and REUG

Correct answer: Aided and unaided soundfield thresholds

Functional gain is the difference in dB between unaided and aided soundfield pure-tone thresholds, measuring how much audibility the hearing aid adds.

Question 8: 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?

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

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 9: What is the primary purpose of speech recognition threshold (SRT) testing?

To measure otoacoustic emissions during speech stimulation
To determine the highest intensity at which speech becomes uncomfortable
To confirm pure-tone average and assess functional hearing for speech (Correct answer)
To evaluate the patient's ability to discriminate between phonemes

Correct answer: To confirm pure-tone average and assess functional hearing for speech

The SRT validates the pure-tone average and establishes the softest level at which a patient can correctly repeat 50% of spondee words.

Question 10: Why is acoustic impedance clinically relevant in audiology?

It measures the loudness discomfort level of the patient
Impedance mismatches at the middle ear affect energy transfer and are evaluated via tympanometry (Correct answer)
It determines the maximum gain setting in a programmable hearing aid
It is used to calculate the signal-to-noise ratio inside a hearing aid

Correct answer: Impedance mismatches at the middle ear affect energy transfer and are evaluated via tympanometry

Acoustic impedance governs how efficiently sound energy is transferred between structures; tympanometry measures middle ear impedance to identify conditions such as otitis media with effusion or ossicular chain fixation.

Question 11: Which condition is associated with low-frequency sensorineural hearing loss, aural fullness, tinnitus, and episodic vertigo?

Acoustic neuroma
Ménière's disease (Correct answer)
Noise-induced hearing loss
Presbycusis

Correct answer: Ménière's disease

Ménière's disease classically presents with the triad of fluctuating low-frequency SNHL, episodic vertigo, and tinnitus, often accompanied by aural fullness.

Question 12: Which surgical technique repairs the tympanic membrane?

Cholesteaplasty
Myringoplasty (Correct answer)
Stapedectomy
Myringotomy

Correct answer: Myringoplasty

The surgical technique that repairs the tympanic membrane (eardrum) is called myringoplasty. This procedure involves repairing a perforation or hole in the tympanic membrane to restore its integrity and function. Myringotomy, on the other hand, is a surgical procedure that involves making a small incision in the eardrum to relieve pressure and drain fluid from the middle ear. Stapedectomy is a surgical procedure to treat otosclerosis by removing part or all of the stapes bone and replacing it with a prosthesis. Cholesteatoma refers to a type of benign cyst or growth in the middle ear that may require surgical removal, which can involve cholesteatoplasty.

Question 13: A patient's hearing aid produces an acoustic feedback whistle only when they cup their hand near the ear. The MOST likely cause is:

Earmold is too tight
Insufficient vent size
Battery voltage too low
Inadequate feedback suppression for reflected sound (Correct answer)

Correct answer: Inadequate feedback suppression for reflected sound

Cupping the hand reflects amplified sound back into the microphone; if feedback suppression cannot cancel this rapidly enough, oscillation occurs.

Question 14: Which of the following actions constitutes an unethical conflict of interest according to the IHS Code of Ethics?

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.
Accepting a commission structure that pays a higher percentage for the sale of premium-level devices over basic-level devices. (Correct answer)
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 15: When selecting an earmold material for a pediatric patient with a severe hearing loss, which material is generally preferred for safety and to ensure a good acoustic seal in a growing ear?

Polyethylene
Hard acrylic
Hard vinyl
Soft silicone (Correct answer)

Correct answer: Soft silicone

Soft, flexible materials like silicone are highly recommended for pediatric patients. They are gentle on sensitive, growing ears, reduce the risk of injury during physical activity, and provide an excellent acoustic seal, which is critical for high-gain fittings to prevent feedback. Hard materials are generally not recommended for children due to safety concerns.

Question 16: What is the IHS ethical standard regarding the use of before-and-after promotional testimonials?

Testimonials may be used freely as they are considered public speech
Only written testimonials require consent; verbal endorsements do not
Testimonials are prohibited entirely under IHS standards
Testimonials require the client's informed, written consent before use in any promotional material (Correct answer)

Correct answer: Testimonials require the client's informed, written consent before use in any promotional material

Using a client's personal experience in advertising requires their explicit informed consent to protect their privacy.

Question 17: During immittance testing, the probe tone frequency used in standard clinical tympanometry for adults is:

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

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 18: In audiometric testing, 'insert earphones' reduce the chance of collapsed ear canals and also provide greater attenuation of contralateral sound. Their typical inter-aural attenuation is approximately:

10–15 dB
70–80 dB (Correct answer)
40–50 dB
20–30 dB

Correct answer: 70–80 dB

Insert earphones provide approximately 70–80 dB of inter-aural attenuation, substantially more than supra-aural earphones (~40 dB), reducing the need for masking.

Question 19: An IHS member learns that a peer is practicing with a lapsed license. What is the ethical obligation?

Cover for the peer by providing their license number when needed
Ignore it since it is not their responsibility
Report the peer immediately to law enforcement without any discussion
Encourage the peer to renew their license and report continued unlicensed practice if it persists (Correct answer)

Correct answer: Encourage the peer to renew their license and report continued unlicensed practice if it persists

IHS ethics call for addressing unlicensed practice by first encouraging compliance, then reporting ongoing violations to protect the public.

Question 20: What do equal loudness contours (Fletcher-Munson curves) demonstrate about human hearing?

Louder sounds are always perceived as occurring at higher frequencies
Hearing loss affects all frequencies by the same number of decibels
The ear's perceived loudness varies with both frequency and sound intensity level (Correct answer)
The ear is equally sensitive to all frequencies at every intensity level

Correct answer: The ear's perceived loudness varies with both frequency and sound intensity level

Equal loudness contours show that the human ear's sensitivity is not flat; it is most sensitive around 1,000–4,000 Hz and requires substantially more intensity at very low and very high frequencies to achieve the same perceived loudness.

Question 21: Which of the following is a primary cause of a hearing aid cutting in and out intermittently, assuming the battery is fresh and the battery door is secure?

Dirty or corroded battery contacts. (Correct answer)
The hearing aid program has been accidentally changed.
The volume control is set too low.
The earmold tubing has developed a small crack.

Correct answer: Dirty or corroded battery contacts.

Dirty or corroded battery contacts can disrupt the consistent flow of power from the battery to the hearing aid's internal components. This poor electrical connection can cause the hearing aid to lose power intermittently, resulting in the sound cutting in and out. Cleaning the contacts often resolves this issue.

Question 22: A 1000 Hz probe tone is preferred over 226 Hz for tympanometry in which population?

Infants under 6 months of age (Correct answer)
Adults over 65 years
Patients with ossicular chain discontinuity
Patients with otosclerosis

Correct answer: Infants under 6 months of age

A 1000 Hz probe tone is recommended for infants under 6 months because their highly compliant ear canals and mobile middle ear systems are better assessed at higher probe tone frequencies.

Question 23: A patient's bone conduction thresholds and air conduction thresholds are both elevated by the same degree with no air-bone gap. This pattern is consistent with:

Mixed hearing loss
Functional hearing loss
Pure sensorineural hearing loss (Correct answer)
Pure conductive hearing loss

Correct answer: Pure sensorineural hearing loss

When air and bone conduction thresholds are equally elevated with no air-bone gap, the loss is entirely sensorineural, reflecting inner ear or auditory nerve dysfunction.

Question 24: What is the correct sequence of structures that auditory information passes through in the primary ascending auditory pathway after leaving the cochlear nerve?

Superior Olivary Complex, Cochlear Nucleus, Auditory Cortex, Medial Geniculate Body
Medial Geniculate Body, Auditory Cortex, Cochlear Nucleus, Inferior Colliculus
Cochlear Nucleus, Superior Olivary Complex, Inferior Colliculus, Medial Geniculate Body (Correct answer)
Inferior Colliculus, Medial Geniculate Body, Superior Olivary Complex, Auditory Cortex

Correct answer: Cochlear Nucleus, Superior Olivary Complex, Inferior Colliculus, Medial Geniculate Body

After the auditory nerve (cochlear nerve), the signal travels to the cochlear nucleus in the brainstem, then to the superior olivary complex (where information from both ears is first compared), up to the inferior colliculus, then to the medial geniculate body of the thalamus, and finally to the auditory cortex for conscious perception.

Question 25: 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:

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

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 26: Which frequency region is most critical for maximizing speech discrimination when fitting hearing aids?

2,000–4,000 Hz (high-frequency consonant region) (Correct answer)
125–500 Hz (low-frequency vowel energy region)
500–1,000 Hz (mid-frequency fundamental frequency region)
6,000–8,000 Hz (very high frequency region)

Correct answer: 2,000–4,000 Hz (high-frequency consonant region)

The 2,000–4,000 Hz region contains high-frequency consonants such as /s/, /sh/, /f/, and /th/, which carry the greatest phonemic information needed for distinguishing words from one another.

Question 27: When masking is applied to the non-test ear during bone conduction audiometry, which type of noise is used?

Sawtooth noise
Speech-spectrum noise
Narrow-band noise centered at the test frequency (Correct answer)
Broadband white noise

Correct answer: Narrow-band noise centered at the test frequency

Narrow-band noise centered at the test frequency is used during bone conduction masking to efficiently mask the non-test cochlea without over-masking.

Question 28: The degree of hearing loss classified as 'severe' corresponds to pure tone average thresholds in the range of:

71–90 dB HL (Correct answer)
56–70 dB HL
41–55 dB HL
26–40 dB HL

Correct answer: 71–90 dB HL

According to standard audiometric classification, severe hearing loss corresponds to pure tone averages between 71 and 90 dB HL.

Question 29: A client who works outdoors frequently complains that their hearing aids often stop working, especially in the summer. The issue often resolves after the aids sit out overnight. This problem is most characteristic of malfunction due to:

Earwax blocking the microphone ports.
Software corruption.
Battery drain from Bluetooth streaming.
Excessive moisture or perspiration. (Correct answer)

Correct answer: Excessive moisture or perspiration.

Intermittent failure, especially when related to environmental conditions like heat and humidity, is a classic sign of moisture affecting the electronic components. Perspiration or humidity can cause short circuits or interfere with the microphone and receiver. The fact that the problem resolves after the aids dry out overnight strongly points to moisture as the culprit. Regular use of a hearing aid dehumidifier is the recommended solution.

Question 30: A client asks a hearing instrument specialist to provide documentation that overstates their hearing loss to obtain greater insurance reimbursement. What must the specialist do?

Accommodate the request since the client will ultimately benefit
Refuse, as falsifying documentation constitutes fraud and violates IHS ethics and federal law (Correct answer)
Consult the insurance company's billing department before deciding
Document the findings in a way that could be interpreted as more severe without directly lying

Correct answer: Refuse, as falsifying documentation constitutes fraud and violates IHS ethics and federal law

Falsifying clinical documentation to inflate insurance reimbursement is insurance fraud and a serious violation of IHS ethics.

Question 31: The helicotrema is located:

At the round window membrane
Between the utricle and saccule
At the apex of the cochlea connecting the two scalae (Correct answer)
At the oval window where the stapes footplate sits

Correct answer: At the apex of the cochlea connecting the two scalae

The helicotrema is the small opening at the cochlear apex where the scala vestibuli and scala tympani communicate.

Question 32: When a hearing aid produces distorted sound even at low volumes and a new battery does not help, which component failure is most likely?

Receiver (speaker) damage (Correct answer)
Low-battery indicator activation
Excessive vent size
Incorrect NAL-NL2 target

Correct answer: Receiver (speaker) damage

A damaged or partially failed receiver produces distorted output across all volume levels because it can no longer accurately transduce the electrical signal.

Question 33: A telecoil (T-coil) in a hearing aid is designed to:

Enable Bluetooth streaming from smartphones
Improve battery life by switching to a lower-power mode
Reduce feedback when the hearing aid is near a telephone
Pick up electromagnetic signals from compatible telephones and hearing loop systems (Correct answer)

Correct answer: Pick up electromagnetic signals from compatible telephones and hearing loop systems

A telecoil is an induction coil inside a hearing aid that picks up electromagnetic signals generated by hearing loop (induction loop) systems and compatible telephones marked with the 'T' symbol. It provides a direct electromagnetic signal path that bypasses the hearing aid's microphone, reducing background noise. Bluetooth is a separate wireless technology; telecoils predate it.

Question 34: 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)
A significantly longer connection range, often exceeding 300 feet.
Universal compatibility with all electronic devices made before 2020.
Higher amplification levels for severe hearing losses.

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 35: Which of the following statements about over-the-counter (OTC) hearing aids, established under the 2022 FDA rule, is CORRECT?

OTC hearing aids are intended for adults with perceived mild-to-moderate hearing loss and can be purchased without a professional fitting (Correct answer)
OTC hearing aids are classified as Class III devices requiring premarket approval
OTC hearing aids require a hearing test by a licensed professional before purchase
OTC hearing aids are intended for people with moderate-to-severe hearing loss

Correct answer: OTC hearing aids are intended for adults with perceived mild-to-moderate hearing loss and can be purchased without a professional fitting

The 2022 FDA OTC hearing aid rule created a new regulatory category allowing adults 18+ with perceived mild-to-moderate hearing loss to purchase hearing aids directly without a prescription, exam, or professional fitting. They are Class II devices. They are NOT intended for severe or profound loss, and they are not suitable for children.

Question 36: Which ANSI standard governs the electroacoustic performance specifications of hearing aids tested in a 2 cc coupler?

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

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 37: What does the acronym WDRC refer to in hearing instrument signal processing?

Weighted Digital Response Calibration
Wide Dynamic Range Compression (Correct answer)
Wireless Digital Reception Circuit
Wide Directional Range Control

Correct answer: Wide Dynamic Range Compression

WDRC (Wide Dynamic Range Compression) amplifies soft sounds more than loud sounds to restore the compressed dynamic range typical of sensorineural hearing loss.

Question 38: Why should an audiology assistant recommend that clients/patients not pull their earmolds out of their ears by the tubing?

Doing so can tear the concha rim.
Doing so can damage the hearing aid.
Doing so will eventually pull the tube out of the earmold. (Correct answer)
Doing so causes the tubing to harden.

Correct answer: Doing so will eventually pull the tube out of the earmold.

An audiology assistant should recommend that clients/patients not pull their earmolds out of their ears by the tubing because doing so can damage the hearing aid. Pulling on the tubing can strain or break the delicate components inside the hearing aid, leading to malfunctions or costly repairs. Additionally, excessive pulling on the tubing can cause it to detach from the earmold, requiring replacement or repair. It's important to handle hearing aids and earmolds with care to ensure their longevity and optimal performance for the wearer.

Question 39: How should an IHS member respond if they realize they have made a clinical error that affected a client's care?

Correct the error quietly without disclosure to avoid damaging client trust
Disclose the error to the client, correct it where possible, and document the incident (Correct answer)
Document the error in their own records but do not inform the client
Consult an attorney before deciding whether to disclose the error

Correct answer: Disclose the error to the client, correct it where possible, and document the incident

IHS ethics require honest disclosure of errors to clients, corrective action, and thorough documentation.

Question 40: To reduce the occlusion effect without sacrificing low-frequency amplification for a patient with a sloping high-frequency loss, the best earmold modification is:

Add a longer canal portion
Reduce earmold thickness
Switch to a power earmold
Increase vent diameter (Correct answer)

Correct answer: Increase vent diameter

Increasing the vent diameter allows low-frequency bone-conducted sound to escape, reducing the hollow sensation without affecting amplification for patients who do not need low-frequency gain.

Question 41: A patient returns saying their hearing aid randomly reboots during the day. The battery checks out fine. What is the most probable cause?

Telecoil interference
Excessive compression limiting
Moisture or sweat infiltration causing intermittent short circuits (Correct answer)
Normal firmware update cycle

Correct answer: Moisture or sweat infiltration causing intermittent short circuits

Moisture ingress from sweat or humidity is a leading cause of random reboots and erratic behavior in hearing aids.

Question 42: During a hearing aid evaluation, a patient's aided word recognition score improves significantly compared to unaided scores. This finding MOST indicates:

An immediate cochlear implant referral is warranted
The patient is a good candidate who will likely achieve real-world benefit from amplification (Correct answer)
The hearing loss is conductive in nature
The patient does not require hearing aids

Correct answer: The patient is a good candidate who will likely achieve real-world benefit from amplification

Improved word recognition with amplification is a positive prognostic indicator that the patient will receive meaningful benefit from hearing instruments.

Question 43: Frequency lowering technology is MOST beneficial for patients with which audiometric profile?

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

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 44: Which of the following describes the function of a digital noise reduction (DNR) algorithm in hearing aids?

It filters out sounds louder than 85 dB SPL to prevent damage
It reduces gain in channels identified as containing primarily non-speech noise (Correct answer)
It eliminates all background sound signals below 1000 Hz
It removes electrical interference from nearby electronic devices

Correct answer: It reduces gain in channels identified as containing primarily non-speech noise

DNR algorithms detect channels with unfavorable speech-to-noise ratios and reduce gain in those channels to improve listening comfort, though they do not improve speech recognition scores.

Question 45: When performing speech-in-noise testing as part of hearing aid validation, which score would most strongly indicate that the current fitting is inadequate?

A QuickSIN score identical to the unaided performance
A QuickSIN score showing SNR loss of 3 dB
A QuickSIN score showing SNR loss of 15 dB with no improvement from unaided baseline (Correct answer)
A word recognition score of 80% in quiet

Correct answer: A QuickSIN score showing SNR loss of 15 dB with no improvement from unaided baseline

A large SNR loss on the QuickSIN with no aided improvement over unaided performance indicates the current fitting provides no meaningful benefit for speech understanding in noise.

Question 46: A client who frequently attends meetings in a large, reverberant conference room complains of difficulty understanding speakers, even with their new hearing aids. Which of the following technologies would be most beneficial for improving speech clarity in this specific situation?

Bluetooth streaming from a smartphone
Advanced feedback cancellation
Increased compression channels
A telecoil with a hearing loop system (Correct answer)

Correct answer: A telecoil with a hearing loop system

A telecoil receives electromagnetic signals from a hearing loop system, which can be connected to the room's microphone. This delivers the speaker's voice directly to the hearing aids, bypassing the effects of distance, background noise, and reverberation. While other features are useful, the telecoil directly addresses the primary challenges of this environment.

Question 47: A long-time BTE user complains of very weak volume. They have cleaned the earmold and replaced the battery. A visual inspection shows the tubing is clear. What is the practitioner's MOST logical next step to diagnose the problem in the office?

Use a listening stethoscope to check the aid's output directly. (Correct answer)
Immediately send the aid to the manufacturer for repair.
Increase the overall gain in the programming software.
Schedule the client for a new hearing test.

Correct answer: Use a listening stethoscope to check the aid's output directly.

Using a listening stethoscope is a fundamental in-office troubleshooting step. It allows the practitioner to listen directly to the sound coming from the earhook, objectively assessing the aid's quality and volume. This helps to confirm the client's complaint and isolate the issue (e.g., weak output, distortion) before attempting reprogramming or sending it for repair.

Question 48: 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
Reduce the MPO
Switch to a closed dome or custom earmold (Correct answer)
Increase compression attack time

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 49: 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 50: When fitting hearing instruments for a professional musician, which consideration is MOST critical during instrument selection?

Selecting the smallest instrument for stage appearance
Ensuring the instrument handles high SPL input without distortion and includes a music program (Correct answer)
Prioritizing maximum output power for loud venues
Choosing instruments with the longest battery life

Correct answer: Ensuring the instrument handles high SPL input without distortion and includes a music program

Musicians require instruments that process high sound pressure levels without distortion and benefit from dedicated music programs with different compression settings than speech programs.

Question 51: 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 52: A patient is unable to repeat spondee words to establish a Speech Recognition Threshold (SRT). Which test would be the most appropriate alternative to obtain information about their threshold for speech?

Word Recognition Score (WRS)
Speech Detection Threshold (SDT) / Speech Awareness Threshold (SAT) (Correct answer)
Uncomfortable Loudness Level (UCL)
Most Comfortable Loudness (MCL)

Correct answer: Speech Detection Threshold (SDT) / Speech Awareness Threshold (SAT)

The Speech Detection Threshold (SDT), also known as Speech Awareness Threshold (SAT), is the lowest level at which a patient can just detect the presence of speech 50% of the time, without needing to understand or repeat it. This makes it a suitable alternative when an SRT, which requires word repetition, cannot be obtained.

Question 53: An IHS member is asked by a marketing company to share client contact information for a promotional campaign. What should the specialist do?

Share only names and phone numbers, not full records
Share the data since it benefits the client with new products
Decline unless the client has provided explicit written consent (Correct answer)
Consult the marketing company's privacy policy before deciding

Correct answer: Decline unless the client has provided explicit written consent

Client information is confidential and may not be shared for marketing purposes without explicit client consent under HIPAA and IHS ethics.

Question 54: When performing tympanometry, a Type B tympanogram with a large ear canal volume most likely indicates:

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

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 55: Which test technique is used to determine the softest level at which a patient responds 50% of the time?

Modified Hughson-Westlake procedure (Correct answer)
Descending technique only
Ascending technique only
Loudness balance procedure

Correct answer: Modified Hughson-Westlake procedure

The modified Hughson-Westlake ascending technique systematically finds the threshold at which the patient correctly identifies the tone 50% of the time.

Question 56: Which type of words are standardly used in Speech Recognition Threshold (SRT) testing?

Monosyllabic CVC words
Spondee words (Correct answer)
Nonsense syllables
Sentences with contextual cues

Correct answer: Spondee words

Spondee words (two-syllable words with equal emphasis on each syllable, like 'baseball' or 'airplane') are used because they have predictable audibility.

Question 57: The primary purpose of maintaining accurate and comprehensive client records, as required by professional standards and regulations like HIPAA, is to:

Ensure continuity of care and provide a legal document of the services rendered. (Correct answer)
Justify billing codes to insurance companies.
Track sales statistics for business management.
Create a database for marketing and sending promotional materials.

Correct answer: Ensure continuity of care and provide a legal document of the services rendered.

While records are used for billing and business analysis, their foremost purpose is clinical and ethical. Complete records ensure that any practitioner can understand the client's history, the rationale for treatment, and the outcomes, thus ensuring high-quality continuity of care. They also serve as the official legal record of the client-practitioner relationship and the services provided.

Question 58: During pure-tone air conduction audiometry, what is the standard procedure for finding the threshold of hearing after a patient responds to a tone?

Move to the next frequency immediately.
Increase the intensity by 5 dB and present the tone again.
Present the tone at the same level to confirm the response.
Decrease the intensity by 10 dB and present the tone again. (Correct answer)

Correct answer: Decrease the intensity by 10 dB and present the tone again.

The modified Hughson-Westlake method, a standard procedure for threshold search audiometry, involves decreasing the intensity by 10 dB after a patient response ('down 10') and increasing it by 5 dB after a non-response ('up 5'). This bracketing technique helps to accurately pinpoint the softest level a person can hear approximately 50% of the time.

Question 59: At what interaural attenuation level should a hearing specialist typically apply masking for air conduction testing?

40 dB (Correct answer)
20 dB
60 dB
10 dB

Correct answer: 40 dB

Masking is generally applied when the air conduction signal in the test ear exceeds the bone conduction threshold of the non-test ear by 40 dB or more.

Question 60: Which of the following is considered a method of hearing aid validation, not verification?

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

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 61: Which action by a hearing instrument specialist would violate IHS standards related to scope of practice?

Diagnosing a medical condition such as Meniere's disease without a physician referral (Correct answer)
Performing audiometric testing within their licensed scope
Dispensing hearing instruments after completing a hearing evaluation
Referring a client to an audiologist for a cochlear implant evaluation

Correct answer: Diagnosing a medical condition such as Meniere's disease without a physician referral

Diagnosing medical conditions falls outside the scope of practice for hearing instrument specialists and violates professional standards.

Question 62: Which test provides frequency-specific threshold information using physiological measures without behavioral responses?

Auditory brainstem response (click ABR)
Acoustic reflex thresholds
Distortion product OAEs (DPOAEs)
Auditory steady-state response (ASSR) (Correct answer)

Correct answer: Auditory steady-state response (ASSR)

The auditory steady-state response (ASSR) uses modulated tones at specific frequencies to estimate frequency-specific hearing thresholds objectively without requiring behavioral responses.

Question 63: Which factor is MOST important when selecting a hearing instrument for a 3-year-old child?

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

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

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

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 65: Which of the following best defines 'auditory training' in the context of aural rehabilitation?

Structured listening practice designed to improve the auditory system's ability to interpret sound (Correct answer)
Teaching a patient to read lips without audio input
Measuring a patient's pure-tone thresholds over time
Fitting a patient with the most powerful hearing aid available

Correct answer: Structured listening practice designed to improve the auditory system's ability to interpret sound

Auditory training uses systematic listening exercises to strengthen the brain's ability to process and discriminate speech and environmental sounds.

Question 66: What is the minimum air-bone gap (in dB) that is considered clinically significant for diagnosing conductive hearing loss?

15 dB (Correct answer)
10 dB
5 dB
25 dB

Correct answer: 15 dB

An air-bone gap of 15 dB or greater at two or more frequencies is considered clinically significant and suggests conductive pathology in the outer or middle ear.

Question 67: A prospective client asks a hearing instrument specialist to guarantee that hearing aids will restore their hearing to normal. What is the ethical response?

Explain that hearing aids improve hearing but cannot restore normal hearing, and avoid making guarantees (Correct answer)
Refer the client to an audiologist who can provide such guarantees
Provide a conditional guarantee based on the device's published performance specs
Provide the guarantee to secure the sale and adjust expectations after fitting

Correct answer: Explain that hearing aids improve hearing but cannot restore normal hearing, and avoid making guarantees

Making false or misleading guarantees about treatment outcomes violates IHS honesty and advertising standards.

Question 68: 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?

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

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 69: 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 bone-anchored hearing aid on the left side
A traditional hearing aid on the right ear
Bilateral hearing aids
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 70: When reprogramming a repaired hearing aid, what does the audiology assistant do?

Start a new programming session. (Correct answer)
Set to best fit.
Set to the previous session.
Read the device.

Correct answer: Start a new programming session.

When reprogramming a repaired hearing aid, the audiology assistant typically starts a new programming session. This involves connecting the hearing aid to the programming equipment and setting up the software to communicate with the device. During this session, the assistant can adjust the settings of the hearing aid based on the patient's needs and audiogram results, ensuring the device is optimized for the individual's hearing requirements and preferences. Starting a new programming session allows for a fresh approach to programming and fine-tuning the hearing aid after it has been repaired.

Question 71: 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:

Activating the telecoil.
Lowering the overall volume of the device.
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 72: A tympanic membrane perforation may cause a:

Conductive loss. (Correct answer)
Degradation effect.
All of above.
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 73: A patient with bilateral hearing loss reports that their family frequently complains about the TV volume. Which counseling strategy best addresses this communication barrier?

Recommend a TV listening device and discuss volume compromise strategies (Correct answer)
Suggest the patient move closer to the TV
Advise the family to use written notes
Prescribe a second hearing aid only

Correct answer: Recommend a TV listening device and discuss volume compromise strategies

A TV listening device allows the patient to hear at their preferred volume while others listen at a normal level, directly resolving the conflict.

Question 74: What does 'WDRC' stand for in hearing aid signal processing?

Wideband Directional Receiver Circuit
Wireless Digital Radio Communication
Wide Dynamic Range Compression (Correct answer)
White-noise Distortion Reduction Control

Correct answer: Wide Dynamic Range Compression

Wide Dynamic Range Compression (WDRC) applies different amounts of gain across a range of input levels so that soft sounds are audible and loud sounds remain comfortable.

Question 75: 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 76: The 'open jaw' technique for ear impressions is recommended when fitting patients with:

In-the-canal aids where retention is the primary concern
Telecommunications devices that are worn only in quiet environments
Severe cerumen impaction
Behind-the-ear aids used for active individuals who talk frequently (Correct answer)

Correct answer: Behind-the-ear aids used for active individuals who talk frequently

Patients who talk or chew frequently cause significant TMJ-related ear canal shape changes; the open-jaw technique captures the ear canal in its most displaced state to prevent feedback and discomfort during use.

Question 77: When working with a professional sign language interpreter, the audiology assistant should:

face the interpreter.
face whoever is speaking or signing at the time.
minimize eye contact during interpretation.
face the client/patient. (Correct answer)

Correct answer: face the client/patient.

When working with a professional sign language interpreter, the audiology assistant should face the client/patient. This allows the client/patient to clearly see the assistant's facial expressions and any visual cues used during communication. It also helps to establish direct engagement and rapport with the client/patient, which is important for effective communication and ensuring that the client/patient feels respected and understood. The assistant should avoid facing the interpreter directly or minimizing eye contact during interpretation to maintain focus on the client/patient's needs and preferences.

Question 78: When using a syringe to inject impression material, the nozzle should be positioned:

Touching the otoblock before slowly withdrawing as the canal fills (Correct answer)
Against the ear canal wall to prevent air entrapment
At the entrance of the ear canal, pointing inward
In the concha bowl to allow gravity to fill the canal

Correct answer: Touching the otoblock before slowly withdrawing as the canal fills

Starting at the otoblock and withdrawing as the material fills prevents air pockets from being trapped behind the material as it is injected.

Question 79: 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?

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

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 80: A patient with severe hearing loss asks about devices that can alert them to sounds in their home environment, such as a doorbell or fire alarm. The specialist should recommend:

A higher-powered hearing aid with extended bandwidth
A personal FM system tuned to household frequencies
A cochlear implant referral only — no other options exist
Alerting and signaling assistive listening devices that use visual (flashing lights) or vibrotactile alerts (Correct answer)

Correct answer: Alerting and signaling assistive listening devices that use visual (flashing lights) or vibrotactile alerts

Alerting and signaling devices (visual alerting systems) use flashing lights, vibrating pagers, or bed shakers to notify individuals with hearing loss of environmental sounds like doorbells, telephone rings, baby cries, smoke alarms, or alarm clocks. These are an important category of hearing assistive technology (HAT) for people with severe-to-profound loss who may not benefit sufficiently from amplification alone.

Question 81: Which audiometric symbol is used to represent unmasked bone conduction thresholds for the left ear?

]
>
[ (Correct answer)
<

Correct answer: [

The bracket '[' pointing right represents unmasked bone conduction thresholds for the left ear on a standard audiogram.

Question 82: Presbycusis caused by degeneration of the stria vascularis is classified as which type?

Neural presbycusis
Mechanical presbycusis
Strial (metabolic) presbycusis (Correct answer)
Sensory presbycusis

Correct answer: Strial (metabolic) presbycusis

Strial or metabolic presbycusis results from atrophy of the stria vascularis, reducing the endocochlear potential and causing a relatively flat audiometric configuration.

Question 83: Harmonic distortion in a hearing aid occurs when the device produces:

Frequency-shifted versions of the input
Random noise unrelated to the input
A delayed echo of the input signal
Output frequencies that are integer multiples of the input frequency (Correct answer)

Correct answer: Output frequencies that are integer multiples of the input frequency

Harmonic distortion adds overtones at whole-number multiples (harmonics) of the input frequency, degrading sound quality.

Question 84: What is the purpose of the aided audiogram in hearing aid validation?

To assess whether amplified speech cues fall within the speech banana for patient counseling (Correct answer)
To determine the maximum output of the hearing aid
To replace real-ear measurements entirely
To calibrate the hearing aid programming software

Correct answer: To assess whether amplified speech cues fall within the speech banana for patient counseling

The aided audiogram shows which speech frequencies become audible with amplification, helping clinicians counsel patients and visually confirm benefit.

Question 85: 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 sharing records with the patient's employer at the employer's request
When coordinating treatment with another healthcare provider involved in the patient's care (Correct answer)
When posting a patient success story on the practice's social media

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 86: Which factor most significantly affects the difference between 2 cc coupler measurements and real-ear measurements?

The brand of hearing aid programming software
The patient's age alone
Battery type used in the hearing aid
Individual ear canal acoustics and residual ear canal volume (Correct answer)

Correct answer: Individual ear canal acoustics and residual ear canal volume

Each patient's ear canal has a unique shape, size, and resonance, creating differences between the standardized 2 cc coupler response and the actual in-situ sound pressure at the eardrum.

Question 87: A new hearing aid user complains that their own voice sounds loud and hollow, as if they are 'talking in a barrel.' This client has good low-frequency hearing. Which of the following is the MOST common and effective modification to alleviate this complaint?

Reducing high-frequency amplification.
Increasing the overall gain of the hearing aid.
Switching from a soft dome to a hard acrylic shell.
Increasing the size of the vent or adding a vent. (Correct answer)

Correct answer: Increasing the size of the vent or adding a vent.

The client is describing the occlusion effect, which is common in new users with good low-frequency hearing when their ear canal is blocked. The most effective way to reduce the occlusion effect is to increase venting. A larger vent allows the low-frequency, bone-conducted sounds of the user's own voice to escape the ear canal instead of being trapped and over-amplified.

Question 88: The round window membrane functions to:

Amplify incoming sound pressure
Allow perilymph displacement when the stapes moves (Correct answer)
Produce perilymph
Anchor the basilar membrane

Correct answer: Allow perilymph displacement when the stapes moves

The compliant round window membrane bulges outward into the middle ear when the stapes pushes inward, allowing cochlear fluid to move and the basilar membrane to vibrate.

Question 89: Which measurement best describes the subjective loudness level of a complex sound compared to a reference 1000 Hz pure tone?

Phon (Correct answer)
Decibel SPL
Neper
Sone

Correct answer: Phon

The phon is a unit of loudness level that equates any sound to the dB SPL of a 1000 Hz pure tone judged equally loud.

Question 90: 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 91: The acoustic reflex (stapedius reflex) serves primarily to:

Increase sensitivity to soft sounds
Enhance high-frequency hearing
Protect the cochlea from loud, low-frequency sounds (Correct answer)
Equalize pressure in the middle ear

Correct answer: Protect the cochlea from loud, low-frequency sounds

Contraction of the stapedius muscle stiffens the ossicular chain, attenuating the transmission of intense low-frequency sounds and offering some cochlear protection.

Question 92: Which of the following best describes 'informational counseling' in the context of hearing rehabilitation?

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

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 93: Which microphone technology automatically adjusts its focus to prioritize speech, regardless of which direction it is coming from, while simultaneously reducing background noise from other directions?

Fixed directional microphone
Analog microphone
Adaptive directional microphone (Correct answer)
Omnidirectional microphone

Correct answer: Adaptive directional microphone

Adaptive directional microphones are the most advanced type, automatically changing their directional focus based on the location of the primary speech signal and surrounding noise. This provides a more seamless listening experience in dynamic noise environments compared to fixed directional systems which only focus forward, or omnidirectional systems which pick up sound from all directions.

Question 94: The superior semicircular canal detects head movement in which plane?

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

Correct answer: Sagittal (pitch)

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

Question 95: What is a 'false positive' response during pure-tone audiometry?

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

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

Listing credentials and services accurately without unsubstantiated claims (Correct answer)
Claiming your devices are superior without comparative data
Advertising 'guaranteed hearing improvement' to attract clients
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 97: What does a Type C tympanogram indicate?

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

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 98: What is the purpose of otoscopic examination prior to audiometric testing?

To visually inspect the ear canal and tympanic membrane for conditions that may affect testing (Correct answer)
To measure middle ear pressure
To screen for sensorineural hearing loss
To determine the correct masking level

Correct answer: To visually inspect the ear canal and tympanic membrane for conditions that may affect testing

Otoscopic examination allows the hearing specialist to identify cerumen impaction, perforations, or other conditions that could influence audiometric results.

Question 99: Under IHS ethical guidelines, which practice constitutes fee splitting?

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

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

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

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 101: When assessing a patient for hearing loss, which case history question is most directly relevant to identifying occupational noise exposure?

Do you have a family history of hearing loss?
Have you ever worked in environments requiring hearing protection? (Correct answer)
Do you have diabetes?
Do you experience balance problems?

Correct answer: Have you ever worked in environments requiring hearing protection?

Asking about occupational noise exposure directly identifies one of the most preventable causes of acquired sensorineural hearing loss.

Question 102: Which step should a hearing healthcare professional take after performing a 2cc coupler hearing aid test on a repaired BTE hearing instrument?

retube the BTE instrument with #13HW tubing
compare 2cc data to original specifications (Correct answer)
recalibrate the test equipment
print out the data for the patient/client

Correct answer: compare 2cc data to original specifications

After performing a 2cc coupler hearing aid test on a repaired BTE (Behind-the-Ear) hearing instrument, the next step for a hearing healthcare professional should be to compare the 2cc data to the original specifications. This comparison is essential to ensure that the repaired hearing instrument meets the manufacturer's specifications and functions correctly after repair. It helps in verifying the effectiveness of the repair and ensuring that the device provides the appropriate amplification according to the prescribed settings. Comparing the test results to the original specifications helps in determining if further adjustments or calibrations are necessary.

Question 103: When evaluating hearing aid benefit during a rehabilitation follow-up, the HHIE (Hearing Handicap Inventory for the Elderly) measures:

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

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 104: An IHS member is approached by a client who is also a close personal friend. What ethical consideration is most important?

Dual relationships automatically create a conflict of interest requiring referral
Personal relationships disqualify specialists from providing care entirely
The specialist must maintain the same professional and ethical standards as with any other client (Correct answer)
Friends may be offered discounts but must receive the same clinical standard of care

Correct answer: The specialist must maintain the same professional and ethical standards as with any other client

IHS ethics require consistent professional conduct regardless of the personal relationship between specialist and client.

Question 105: Which tympanogram type suggests excessive mobility of the tympanic membrane, possibly due to ossicular discontinuity or a monomeric membrane?

Type B
Type As (shallow/low compliance)
Type A
Type Ad (deep/high compliance) (Correct answer)

Correct answer: Type Ad (deep/high compliance)

Type Ad (Ad = deep) tympanogram shows abnormally high compliance, indicating hypermobility of the tympanic membrane, seen with ossicular discontinuity or healed perforations.

Question 106: Absent distortion product OAEs (DPOAEs) with normal ABR thresholds most likely suggests:

Malingering
Auditory neuropathy spectrum disorder
Outer hair cell dysfunction with intact auditory nerve function (Correct answer)
Middle ear pathology only

Correct answer: Outer hair cell dysfunction with intact auditory nerve function

Absent DPOAEs indicate outer hair cell dysfunction, while a normal ABR confirms that the auditory nerve and brainstem pathways are intact, suggesting isolated OHC damage.

Question 107: A primary goal of the initial needs assessment, using tools like the Client Oriented Scale of Improvement (COSI), before selecting a hearing instrument is to:

Identify and prioritize the client's specific listening goals and difficulties. (Correct answer)
Measure the real-ear-to-coupler difference (RECD).
Determine the exact make and model of the hearing aid.
Objectively verify the hearing aid's electroacoustic performance.

Correct answer: Identify and prioritize the client's specific listening goals and difficulties.

The initial needs assessment is a crucial part of the selection process focused on the patient's subjective experience. Tools like the COSI are used to quantify and prioritize the client's specific communication problems and listening goals, which then guide the selection of appropriate technology and features.

Question 108: When counseling a patient who refuses to wear their hearing aids due to stigma, the hearing care professional should FIRST:

Contact family members without the patient's consent
Recommend cochlear implant evaluation
Explore the patient's specific concerns and provide factual perspective on modern hearing aid design (Correct answer)
Document refusal and discontinue services

Correct answer: Explore the patient's specific concerns and provide factual perspective on modern hearing aid design

Addressing stigma requires understanding the patient's personal concerns before providing education about discreet modern devices and the social cost of untreated hearing loss.

Question 109: A patient complains that their hearing aid sounds 'tinny' or too sharp after a programming adjustment. Which parameter was most likely increased excessively?

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

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 110: Which patient characteristic MOST strongly indicates the need for a custom earmold over a standard dome with a RIC instrument?

Active lifestyle including jogging
Severe hearing loss requiring high gain (Correct answer)
Preference for Bluetooth streaming
Prior hearing aid experience

Correct answer: Severe hearing loss requiring high gain

Severe hearing loss requiring high gain makes a sealed custom earmold necessary to prevent feedback and ensure adequate low-frequency amplification.

Question 111: When fitting a patient with a steeply sloping high-frequency hearing loss, which gain prescription approach is MOST appropriate?

Flat gain across all frequencies
Equal gain across low and high frequencies regardless of audiogram shape
Substantially increased high-frequency gain with minimal low-frequency amplification (Correct answer)
Maximum output at all frequencies equally

Correct answer: Substantially increased high-frequency gain with minimal low-frequency amplification

A steeply sloping loss requires significantly more gain in the high frequencies where the loss is greatest while avoiding over-amplification of low frequencies where hearing may be near normal.

Question 112: Which type of vent has the greatest effect on reducing the occlusion effect while minimizing feedback risk?

A pressure vent (pinhole vent) (Correct answer)
An external vent groove
Select-a-vent (SAV) with a large diameter insert
A diagonal vent

Correct answer: A pressure vent (pinhole vent)

A pressure vent (pinhole vent, ~0.8 mm) is small enough to reduce feedback risk but still allows canal pressure equalization, providing occlusion relief without compromising acoustic seal significantly.

Question 113: What is the reference standard level for 0 dB Hearing Level (HL) based on?

The detection limit of a standard sound level meter
Absolute silence in an anechoic chamber
The threshold of a single calibrated audiometer
The average threshold of young adults with normal hearing (Correct answer)

Correct answer: The average threshold of young adults with normal hearing

0 dB HL is defined by audiometric standards (ANSI/ISO) as the average minimum audible sound level for a population of young, otologically normal adults.

Question 114: Which acoustic reflex pattern is most consistent with a unilateral acoustic neuroma on the right side?

Absent ipsilateral and contralateral reflexes with right probe and absent contralateral with left probe (Correct answer)
Absent ipsilateral right reflex only
Absent contralateral reflexes with right probe only
Absent all reflexes bilaterally

Correct answer: Absent ipsilateral and contralateral reflexes with right probe and absent contralateral with left probe

An acoustic neuroma on the right (CN VIII) disrupts the afferent arc, causing absent reflexes when the right ear is stimulated (both ipsi and contra right-probe) and absent contralateral reflex when the left ear is stimulated.

Question 115: A patient reports their hearing aid whistles whenever someone gives them a close hug. This is MOST likely due to:

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

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.

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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