NBC-HIS National Competency Exam — Questions and Answers

Question 1: When should audiometric equipment be calibrated according to ASHA and ANSI guidelines?

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

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

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

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 3: 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)
A standard power BTE on the impaired side
Binaural RIC instruments
A high-power ITE 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 4: At what frequency is the acoustic reflex most commonly elicited in clinical testing?

1,000 Hz (Correct answer)
250 Hz
500 Hz
4,000 Hz

Correct answer: 1,000 Hz

The acoustic reflex is most reliably elicited at 1,000 Hz, which is the standard test frequency used in clinical tympanometry.

Question 5: What audiometric finding distinguishes sensorineural hearing loss from conductive hearing loss?

Speech recognition scores are always normal in sensorineural loss
Air conduction thresholds are better than bone conduction thresholds
Air-bone gap exceeds 30 dB at all frequencies
Bone conduction thresholds are elevated and match air conduction thresholds (Correct answer)

Correct answer: Bone conduction thresholds are elevated and match air conduction thresholds

In sensorineural hearing loss, both air and bone conduction thresholds are elevated with no significant air-bone gap, indicating inner ear or neural involvement.

Question 6: Which hearing aid style is typically recommended for patients with severe-to-profound hearing loss who require maximum power output?

Completely-in-canal (CIC)
Receiver-in-canal (RIC) with open dome
Behind-the-ear (BTE) with custom earmold (Correct answer)
In-the-canal (ITC)

Correct answer: Behind-the-ear (BTE) with custom earmold

BTE instruments with custom earmolds provide the highest power output and are best suited for severe-to-profound hearing losses.

Question 7: When validating a pediatric hearing aid fitting using the Desired Sensation Level (DSL) method, which speech level is typically used for verification targets?

55 dB SPL conversational speech
45 dB SPL soft speech only
65 dB SPL conversational speech (Correct answer)
75 dB SPL loud speech only

Correct answer: 65 dB SPL conversational speech

DSL targets are typically verified at 65 dB SPL to represent average conversational speech levels for fitting children.

Question 8: Which term describes the maximum output of a hearing aid regardless of input level?

OSPL90 (Correct answer)
Saturation SPL
AGC threshold
MPO target

Correct answer: OSPL90

OSPL90 (Output Sound Pressure Level at 90 dB input) is the standardized measure of a hearing aid's maximum output.

Question 9: Which phenomenon describes the bending of sound waves around obstacles or through openings?

Refraction
Diffraction (Correct answer)
Reflection
Absorption

Correct answer: Diffraction

Diffraction is the bending of sound waves around corners or through openings, allowing sound to be heard around barriers.

Question 10: How many correct responses out of how many presentations are typically required to establish a threshold in the ascending technique?

2 out of 4
3 out of 5
2 out of 3 (Correct answer)
1 out of 2

Correct answer: 2 out of 3

Threshold is established when the patient responds correctly to 2 out of 3 presentations at the same level using the ascending approach.

Question 11: A receiver-in-canal (RIC) hearing aid differs from a traditional BTE primarily in that:

It only amplifies high frequencies
It uses analog signal processing
The receiver is placed in the ear canal rather than in the housing (Correct answer)
It requires no ear mold

Correct answer: The receiver is placed in the ear canal rather than in the housing

In RIC aids, the receiver (speaker) is moved from the BTE housing into the ear canal, connected by a thin electrical wire, reducing size and improving sound quality.

Question 12: What is a characteristic of a sensorineural loss?

-Loud talker -Difficulty understanding high frequency consonants sounds -Recruitment -Tinnitus often preceeds it. (Correct answer)
-A hearing level dial -An attenuator dial
Greater for the low frequencies than for the higher frequencies.
high frequency average saturation sound pressure level with a 90 dB SPL input.

Correct answer: -Loud talker -Difficulty understanding high frequency consonants sounds -Recruitment -Tinnitus often preceeds it.

A characteristic of sensorineural hearing loss is that it typically affects higher frequencies more than lower frequencies. This means there is greater loss for high-frequency sounds, such as consonant sounds like "s," "f," and "th," compared to low-frequency sounds. This can result in difficulty understanding speech, especially in noisy environments, and may lead to the perception that others are speaking softly or mumbling (hence the "loud talker" impression).

Question 13: What does a 'shadow curve' on an audiogram indicate?

Calibration error in the audiometer
The non-test ear responding to stimuli meant for the test ear (Correct answer)
Presence of a conductive hearing loss
Normal hearing in both ears

Correct answer: The non-test ear responding to stimuli meant for the test ear

A shadow curve appears when the non-test ear responds to cross-heard signals, mimicking the test ear's response and giving falsely better thresholds.

Question 14: 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:

Replace the need for hearing aids while at work
Improve speech understanding with coworkers
Prevent further noise-induced hearing loss from occurring (Correct answer)
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 15: During a hearing aid evaluation, a patient's aided word recognition score improves significantly compared to unaided scores. This finding MOST indicates:

The patient does not require hearing aids
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

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 16: When inspecting a completed ear impression, an air bubble or void in the canal portion indicates:

The impression should be accepted as-is if the void is small
A potential fit problem and the impression should be retaken (Correct answer)
The patient moved their jaw during the impression
The material set too slowly

Correct answer: A potential fit problem and the impression should be retaken

Voids in the canal portion of an impression will translate to bumps or gaps in the finished earmold, causing a poor fit and possible feedback.

Question 17: A 'skeleton' earmold differs from a 'semi-skeleton' earmold primarily in that the skeleton style:

Retains more of the concha bowl material for a solid rim
Has material only in the helix and anti-helix area with an open concha bowl (Correct answer)
Has a larger canal portion
Is made exclusively from soft silicone material

Correct answer: Has material only in the helix and anti-helix area with an open concha bowl

A skeleton earmold has a rim of material following the helix and anti-helix contours but leaves the center of the concha bowl open, while a semi-skeleton retains part of the bowl.

Question 18: A tympanic membrane perforation may cause a:

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

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

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

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

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

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 21: 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 posting a patient success story on the practice's social media
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)

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

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 23: What is the purpose of masking during pure-tone audiometry?

To reduce ambient noise in the test booth
To prevent the non-test ear from responding to cross-heard signals (Correct answer)
To amplify the test signal in the test ear
To calibrate the audiometer before testing

Correct answer: To prevent the non-test ear from responding to cross-heard signals

Masking introduces narrow-band noise to the non-test ear to prevent it from detecting signals intended for the test ear via cross-hearing.

Question 24: What advantage does the NAL-NL2 prescriptive formula have over NAL-NL1?

NAL-NL2 incorporates research on binaural fittings, gender, and acclimatization effects (Correct answer)
NAL-NL2 is designed only for children
NAL-NL2 targets only high-frequency amplification
NAL-NL2 eliminates the need for real-ear verification

Correct answer: NAL-NL2 incorporates research on binaural fittings, gender, and acclimatization effects

NAL-NL2 updated NAL-NL1 by incorporating data on binaural summation, gender differences, hearing aid experience, and acclimatization into gain prescriptions.

Question 25: Tinnitus is MOST accurately defined as:

Fluid accumulation in the middle ear producing a rushing sound
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

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 26: Which assistive listening system is most commonly installed in theaters, houses of worship, and conference rooms to benefit hearing aid users with telecoils?

Hearing loop (audio induction loop) system (Correct answer)
Infrared (IR) listening system
Personal FM system
Bluetooth multipoint system

Correct answer: Hearing loop (audio induction loop) system

Hearing loop (induction loop) systems use a wire loop installed around a room's perimeter to transmit magnetic signals from the venue's audio system directly to hearing aids with active telecoils. They are widely used in public venues because they require no receiver equipment — users simply switch to the T-coil setting. IR systems also work in venues but require a receiver; FM systems are more commonly portable.

Question 27: A patient reports their rechargeable hearing aid's battery life has decreased from 18 hours to 6 hours over several months. The charging contacts are clean. What is most likely?

Bluetooth pairing issue
The hearing aid volume has been turned up
Telecoil constant activation draining power
Battery cell degradation from charge cycles reducing capacity (Correct answer)

Correct answer: Battery cell degradation from charge cycles reducing capacity

Rechargeable lithium-ion cells degrade over hundreds of charge cycles, permanently losing capacity and resulting in shorter daily runtime.

Question 28: What is the primary purpose of a hearing aid orientation (HAO) session?

To select the best hearing aid model for the patient
To ensure the patient can manage and benefit from their new hearing aids (Correct answer)
To measure real-ear gain
To conduct a follow-up audiogram

Correct answer: To ensure the patient can manage and benefit from their new hearing aids

HAO sessions teach device care, insertion/removal, battery management, and realistic expectations to maximize successful hearing aid use.

Question 29: The critical band concept in psychoacoustics refers to:

The frequency range of normal speech
The bandwidth of a hearing aid receiver
The audiometric test frequency range
A frequency range within which two tones interact and mask each other (Correct answer)

Correct answer: A frequency range within which two tones interact and mask each other

A critical band is a frequency region of the cochlear basilar membrane within which stimuli interact, causing masking and affecting loudness perception.

Question 30: A patient reports their BTE hearing aid produces a loud, continuous squeal only when their hand is placed near the ear. What is the most likely cause?

Acoustic feedback due to a loose earmold fit (Correct answer)
Receiver failure
Blocked microphone port
Dead battery

Correct answer: Acoustic feedback due to a loose earmold fit

A loose or improperly fitted earmold allows amplified sound to escape and re-enter the microphone, causing feedback squealing.

Question 31: A patient with moderate sensorineural hearing loss struggles in reverberant restaurant environments even with well-fitted hearing aids. The BEST supplemental recommendation is:

Avoid restaurants entirely
Reprogram the hearing aid to maximum gain
Schedule additional audiometric testing
Use a remote microphone system worn by a dining companion (Correct answer)

Correct answer: Use a remote microphone system worn by a dining companion

Remote microphone systems place the microphone near the talker, dramatically improving signal-to-noise ratio in noisy, reverberant spaces.

Question 32: Which infection control practice is MOST important when handling hearing aids that have been worn by a patient?

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

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 33: What is the primary goal of formal auditory training programs, such as LACE (Listening and Communication Enhancement), as part of a comprehensive aural rehabilitation plan?

To improve the brain's ability to process and comprehend speech, especially in challenging listening environments. (Correct answer)
To teach the client how to properly clean and maintain their hearing instruments.
To reverse the physiological damage to the cochlear hair cells.
To measure the remaining amount of residual hearing in a client.

Correct answer: To improve the brain's ability to process and comprehend speech, especially in challenging listening environments.

Formal auditory training programs are designed to address the central auditory processing aspect of hearing loss. The goal is not to change the ear itself, but to train the brain to become a more effective listener. These programs often target skills like understanding rapid speech, comprehending speech in noise, and improving auditory memory.

Question 34: When fitting hearing instruments for a professional musician, which consideration is MOST critical during instrument selection?

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

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 35: 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.
Accepting a commission structure that pays a higher percentage for the sale of premium-level devices over basic-level devices. (Correct answer)
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 36: Which of the following is the BEST practice for maintaining patient records in a hearing instrument dispensing practice?

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

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 37: What does a 'rollover' phenomenon in word recognition testing suggest?

Normal cochlear function
Conductive hearing loss
Retrocochlear pathology such as acoustic neuroma (Correct answer)
Noise-induced hearing loss

Correct answer: Retrocochlear pathology such as acoustic neuroma

Rollover occurs when word recognition scores decrease at higher intensity levels, which is a hallmark sign of retrocochlear (neural) pathology.

Question 38: What does the acronym WDRC refer to in hearing instrument signal processing?

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

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 39: A patient with severe hearing loss who relies heavily on lipreading should be counseled that lipreading alone provides approximately what percentage of speech intelligibility?

5–10%
25–30% (Correct answer)
85–95%
60–70%

Correct answer: 25–30%

Visual speech cues alone yield only about 25–30% intelligibility because many phonemes look identical on the lips (visemes); auditory input is essential for accurate speech understanding.

Question 40: Which factor will affect a patient's/client's acceptance and use of hearing instruments?

cause of the hearing loss
frequency and duration of hearing instrument use
patient's/client's dominant hand
patient's/client's cosmetic preferences (Correct answer)

Correct answer: patient's/client's cosmetic preferences

The factor that will affect a patient's/client's acceptance and use of hearing instruments includes their cosmetic preferences. Patients or clients may have specific preferences regarding the appearance of the hearing instrument, such as its size, color, or visibility when worn. These preferences can significantly influence whether they are willing to accept and regularly use the hearing device. Therefore, addressing cosmetic concerns and offering options that align with the patient's preferences can enhance their acceptance and adherence to using the hearing instrument.

Question 41: 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 92000–92999 (special otorhinolaryngologic services)
ICD-10 codes only — CPT codes do not apply to hearing aids
CPT V codes (vision services)
CPT V5000–V5999 series (hearing services) (Correct answer)

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 42: A patient understands speech well in quiet but struggles in restaurants. Which technology feature should be PRIORITIZED during instrument selection?

Extended low-frequency amplification
Telecoil for induction loop systems
Directional microphone system with digital noise reduction (Correct answer)
Increased maximum output (MPO)

Correct answer: Directional microphone system with digital noise reduction

Directional microphones and noise reduction algorithms specifically target improving the speech-to-noise ratio in environments like restaurants.

Question 43: When performing tympanometry, a Type B tympanogram with a large ear canal volume most likely indicates:

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

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 44: Hair cell stereocilia are connected at their tips by structures called:

Lateral links
Tight junctions
Gap junctions
Tip links (Correct answer)

Correct answer: Tip links

Tip links are fine filaments connecting the tip of each shorter stereocilium to the side of the adjacent taller one, gating mechanosensitive ion channels upon deflection.

Question 45: 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?

Hard vinyl
Hard acrylic
Soft silicone (Correct answer)
Polyethylene

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 46: Under FDA regulations, which of the following is required before dispensing a hearing aid to an adult patient?

A mandatory 90-day trial period for the instrument
A medical evaluation by a licensed physician or a signed waiver (Correct answer)
Proof of health insurance coverage for the device
A prescription from a licensed audiologist

Correct answer: A medical evaluation by a licensed physician or a signed waiver

FDA regulations require that adults receive a medical evaluation by a licensed physician within six months prior to purchasing a hearing aid, OR sign a written waiver indicating they are aware of this recommendation but choose to waive the medical examination. Adults (18+) may waive this; the waiver option does not apply to children under 18.

Question 47: Which outcome measure is considered most useful for capturing the real-world hearing aid benefit perceived by the patient?

Uncomfortable loudness level (UCL)
Pure tone average (PTA)
Real-ear insertion gain (REIG)
Abbreviated Profile of Hearing Aid Benefit (APHAB) (Correct answer)

Correct answer: Abbreviated Profile of Hearing Aid Benefit (APHAB)

The APHAB is a validated self-report questionnaire measuring perceived hearing aid benefit across communication situations, background noise, reverberation, and aversiveness.

Question 48: A patient with tinnitus reports that it is most bothersome at bedtime in a quiet room. The MOST appropriate rehabilitation recommendation is:

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

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

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

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 50: A hearing professional posts a photo on their personal, private social media account. The photo shows them celebrating a successful fitting with a client, whose back is to the camera but whose distinctive tattoo is visible. The post text says, 'So happy for my client who can hear his grandkids clearly now!' This action is:

Acceptable, because the client's face is not visible and the account is private.
Acceptable, as it is considered positive marketing for the practice.
Unethical only if another user recognizes the client from the tattoo and comments on the post.
Unethical, because it shares a client's story without express written consent, which is a breach of confidentiality. (Correct answer)

Correct answer: Unethical, because it shares a client's story without express written consent, which is a breach of confidentiality.

Under HIPAA and professional ethics codes, any information that can potentially identify a patient is considered Protected Health Information (PHI). A distinctive tattoo, combined with the context of the post, could lead to identification. Sharing any client information or images on social media without explicit, written authorization is a serious breach of confidentiality, regardless of privacy settings or whether a name is used.

Question 51: Which patient characteristic MOST strongly indicates the need for a custom earmold over a standard dome with a RIC instrument?

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

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

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

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 53: A patient with bilateral hearing loss reports that their family frequently complains about the TV volume. Which counseling strategy best addresses this communication barrier?

Suggest the patient move closer to the TV
Recommend a TV listening device and discuss volume compromise strategies (Correct answer)
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 54: A 78-year-old patient with cognitive decline has difficulty remembering hearing aid battery changes. The MOST appropriate counseling solution is:

Recommend rechargeable hearing aids and involve a family caregiver in the routine (Correct answer)
Schedule weekly clinic visits for battery replacement
Discontinue hearing aid use until cognition improves
Prescribe a more powerful behind-the-ear aid

Correct answer: Recommend rechargeable hearing aids and involve a family caregiver in the routine

Rechargeable hearing aids eliminate the need to manage small batteries, and caregiver involvement compensates for the patient's memory challenges.

Question 55: An IHS member is asked by a marketing company to share client contact information for a promotional campaign. What should the specialist do?

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

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 56: A client presents for an earmold impression. The otoscopic exam reveals a significant amount of cerumen completely blocking the view of the ear canal beyond the first bend. Which of the following is the correct procedure?

Proceed with the impression but inform the lab about the wax.
Place the otoblock just in front of the wax blockage.
Use a high-viscosity material to push the wax against the otoblock.
Postpone the impression until the cerumen can be safely removed according to your scope of practice or by a medical professional. (Correct answer)

Correct answer: Postpone the impression until the cerumen can be safely removed according to your scope of practice or by a medical professional.

Taking an ear impression is contraindicated when impacted or excessive cerumen is present in the ear canal. Proceeding could push the wax further down, causing impaction or injury. The correct action is to delay the impression until the ear canal is clear, either through removal by the practitioner (if within their scope of practice) or by referring the client for medical removal.

Question 57: The Americans with Disabilities Act (ADA) requires hearing instrument dispensing offices to:

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

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

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

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

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 60: During a tinnitus assessment, a specialist uses a procedure called tinnitus pitch matching. The purpose of this procedure is to:

Evaluate the patient's psychological distress caused by tinnitus
Measure the loudness of tinnitus in decibels SPL
Assess whether the tinnitus can be masked by white noise
Determine the frequency or pitch the patient perceives for their tinnitus (Correct answer)

Correct answer: Determine the frequency or pitch the patient perceives for their tinnitus

Tinnitus pitch matching involves presenting pure tones or narrowband noises to the patient and asking them to identify which frequency most closely matches their perceived tinnitus. This helps characterize the tinnitus and can guide sound therapy or masking choices. Loudness matching is a separate, complementary procedure.

Question 61: 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
Refuse to fit the client with an inadequate device
Fully inform the client of the clinical limitations and document their informed decision (Correct answer)

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 62: The acoustic reflex threshold (ART) is typically how many dB above the pure-tone threshold in a normal ear?

30–40 dB SL
5–10 dB SL
70–100 dB SL (Correct answer)
10–20 dB SL

Correct answer: 70–100 dB SL

In normal-hearing ears, the acoustic reflex is elicited at approximately 70–100 dB above the pure-tone threshold (sensation level).

Question 63: Which prescriptive formula is specifically designed and validated for fitting infants and young children?

NAL-NL2
POGO II
DSL v5.0 (Correct answer)
Berger method

Correct answer: DSL v5.0

DSL (Desired Sensation Level) v5.0 was developed and validated specifically for pediatric populations, accounting for smaller ear canal volumes and developmental needs.

Question 64: A hearing instrument specialist is required to keep patient records for a minimum period under most state laws. Which record is MOST critical to retain in the patient file?

The manufacturer's warranty card for the hearing aid
The original purchase receipt from the device manufacturer
A copy of the signed medical waiver or physician's clearance (Correct answer)
The patient's insurance card

Correct answer: A copy of the signed medical waiver or physician's clearance

A signed medical waiver (or documentation of physician clearance) is a regulatory requirement under FDA rules and is the most legally critical document in the patient file. Without it, dispensing a hearing aid to an adult who did not receive a medical evaluation constitutes a violation of federal law.

Question 65: According to FTC regulations, what is the MINIMUM trial period a hearing aid dispenser must offer to consumers?

30 days (Correct answer)
15 days
45 days
60 days

Correct answer: 30 days

The FTC's Cooling-Off Rule, as applied to hearing aid sales, and many state laws require a minimum 30-day trial (return) period. During this period, consumers may return the hearing aid for a refund, though dispensers may deduct a specified restocking or fitting fee.

Question 66: What does total harmonic distortion (THD) measure in hearing instrument performance?

The overall gain of the hearing instrument in dB
The ratio of unwanted harmonic energy to the fundamental frequency energy, expressed as a percentage (Correct answer)
The full frequency range of the amplification channels
The maximum output level of the hearing aid in dB SPL

Correct answer: The ratio of unwanted harmonic energy to the fundamental frequency energy, expressed as a percentage

THD quantifies the distortion introduced by a hearing aid by measuring energy in harmonic frequencies relative to the intended fundamental, with lower percentages indicating cleaner, higher-quality amplification.

Question 67: A telecoil (T-coil) in a hearing aid is designed to:

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

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

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

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 69: What should the audiology assistant check while performing a listening check?

the response button
availability of inserts
cords and connections (Correct answer)
sound booth seal

Correct answer: cords and connections

During a listening check, the audiology assistant should check the cords and connections of the hearing aid. This involves inspecting the physical connections between the hearing aid components, such as the microphone, receiver, and battery compartment, to ensure that they are properly connected and functioning correctly. Any loose or faulty connections could affect the performance of the hearing aid, leading to issues with sound quality or amplification. Checking the cords and connections is an essential step in verifying that the hearing aid is operating as intended before fitting it to the patient.

Question 70: When using a Knowles Electronic Manikin for Acoustic Research (KEMAR), the hearing aid fitting professional can:

Test only ITE hearing aids
Measure tympanometry results
Simulate real-ear measurements on a standardized head and ear canal (Correct answer)
Calibrate audiometers

Correct answer: Simulate real-ear measurements on a standardized head and ear canal

KEMAR is an acoustic manikin that allows real-ear simulation measurements in a controlled, repeatable environment.

Question 71: 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?

Gradual, bilateral high-frequency hearing loss
Visible evidence of significant cerumen accumulation (Correct answer)
Recruitment and difficulty hearing in noise
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 72: The primary purpose of using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire is to:

Screen for 'red flag' conditions that require medical referral before a fitting.
Determine the specific listening situations that are most important to an individual client.
Quantify the amount of difficulty a patient experiences in various listening situations, comparing their performance with and without hearing aids. (Correct answer)
Measure the electroacoustic characteristics of the hearing aid in a test box.

Correct answer: Quantify the amount of difficulty a patient experiences in various listening situations, comparing their performance with and without hearing aids.

The APHAB is specifically designed to be administered before a fitting (unaided) and after a period of use (aided). By comparing the scores, it quantifies the reduction in perceived hearing difficulty across different domains (e.g., Ease of Communication, Background Noise), thereby measuring hearing aid benefit. The COSI is better for identifying specific client-chosen situations (A).

Question 73: Which hearing aid coupling style BEST preserves the natural pinna effect and localization cues?

Body-worn hearing aid
BTE with a standard occluding earmold
Full-shell in-the-ear (ITE)
Open-fit receiver-in-canal (RIC) (Correct answer)

Correct answer: Open-fit receiver-in-canal (RIC)

Open-fit RIC instruments leave the ear canal largely unoccluded, allowing the pinna to collect sound naturally and preserve directional cues.

Question 74: Which patient would receive the LEAST benefit from a directional microphone system?

A patient who struggles at cocktail parties
A patient who frequently dines in restaurants
A patient who is primarily homebound and watches television in a quiet room (Correct answer)
A patient who attends regular business meetings

Correct answer: A patient who is primarily homebound and watches television in a quiet room

A primarily homebound patient in a controlled quiet environment rarely faces competing noise from behind, making directional microphone benefit minimal in their daily life.

Question 75: The most common cause of chronic subjective tinnitus is:

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

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 76: 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:

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

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

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

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: A patient with a flat 50 dB HL hearing loss consistently rejects hearing aids because loud sounds are uncomfortable. The fitting adjustment MOST likely needed is:

Increase attack time
Increase compression threshold
Lower the MPO/OSPL90 setting (Correct answer)
Add a larger vent to the earmold

Correct answer: Lower the MPO/OSPL90 setting

Reducing the maximum power output (MPO) prevents the hearing aid from reaching uncomfortable loudness levels for the patient.

Question 79: 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:

Reduce the MPO
Increase compression attack time
Increase low-frequency gain
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 80: What is the purpose of the aided audiogram in hearing aid validation?

To replace real-ear measurements entirely
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 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 81: What is the recommended counseling approach for a patient who is in the 'pre-contemplation' stage of readiness to change regarding hearing aid use?

Immediately fit hearing aids and schedule follow-up
Discharge the patient and reappoint in six months
Raise awareness of the impact of hearing loss without pressuring action (Correct answer)
Refer for psychological evaluation

Correct answer: Raise awareness of the impact of hearing loss without pressuring action

In pre-contemplation, patients are not yet aware of or concerned about their problem; motivational interviewing techniques raise awareness without creating resistance.

Question 82: Which type of microphone configuration in a hearing aid provides the greatest directional benefit in a noisy restaurant?

T-coil input
Omnidirectional microphone
Adaptive directional microphone (Correct answer)
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 83: Which frequency range is most critical for speech intelligibility?

125–500 Hz
4,000–8,000 Hz
8,000–12,000 Hz
500–4,000 Hz (Correct answer)

Correct answer: 500–4,000 Hz

The 500–4,000 Hz range contains the most important frequencies for speech intelligibility, encompassing the primary energy of most vowels and consonants.

Question 84: Which tympanogram type is most associated with otitis media with effusion (fluid in the middle ear)?

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

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 85: What is the standard unit used to measure sound frequency?

Decibel (dB)
Pascal (Pa)
Hertz (Hz) (Correct answer)
Watt (W)

Correct answer: Hertz (Hz)

Hertz (Hz) measures the number of complete sound wave cycles per second and is the universally accepted unit for sound frequency.

Question 86: What type of screening assessment would need to be scheduled prior to a procedure for pressure equalization tubes?

immitance screening (Correct answer)
otoacoustic emission screening
newborn hearing 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 87: A patient has asymmetrical hearing loss with word recognition of 20% in one ear. How should this affect the bilateral instrument selection strategy?

The poor ear may require a different fitting target and BiCROS routing should be considered (Correct answer)
Only the better ear should be fitted
The poor ear should not receive any amplification
Both ears should receive identical instrument settings

Correct answer: The poor ear may require a different fitting target and BiCROS routing should be considered

A poor word recognition score predicts limited benefit from conventional amplification in that ear, potentially making BiCROS routing or a specialized fitting approach more appropriate.

Question 88: What is the fundamental difference between analog and digital signal processing in hearing aids?

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

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 89: 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?

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

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 90: A new hearing professional is taking their first independent ear impression. To ensure all critical anatomical landmarks are captured for a full-shell ITE hearing aid, which of the following must be completely filled with impression material?

The ear canal up to the first bend only
The concha bowl (cavum and cymba), helix, tragus, and anti-tragus (Correct answer)
The cymba concha, external auditory meatus, and incisura intertragica
The earlobe and mastoid process

Correct answer: The concha bowl (cavum and cymba), helix, tragus, and anti-tragus

A successful ear impression for a custom hearing aid must be a complete and accurate reproduction of the outer ear's anatomy. This includes filling the entire concha bowl (both cavum and cymba), the helix curl, and capturing the tragus and anti-tragus landmarks to ensure proper fit, retention, and placement of components like microphones.

Question 91: A client reports that their hearing aid produces sound that is 'scratchy and garbled,' particularly at louder volumes. A fresh battery does not solve the problem, and a listening check confirms the distortion. Which component is the most probable source of this issue?

A damaged or failing receiver (speaker). (Correct answer)
A blocked earmold vent.
A malfunctioning telecoil.
An over-aggressive noise reduction feature.

Correct answer: A damaged or failing receiver (speaker).

A damaged receiver is a common cause of sound distortion, often described as scratchy, fuzzy, or garbled. This can occur due to moisture exposure, physical shock, or simply component failure over time. The distortion is often more noticeable at higher output levels when the receiver is being driven harder.

Question 92: What does the IHS Code of Ethics require regarding a member's obligation to keep professional knowledge current?

Members have an ongoing duty to maintain and improve their professional competence through continuing education (Correct answer)
Competence is assessed only at the time of initial certification
Continuing education is optional once initial licensure is obtained
Members must complete at least one continuing education course per decade

Correct answer: Members have an ongoing duty to maintain and improve their professional competence through continuing education

IHS ethics mandate ongoing professional development to ensure members provide competent, up-to-date care.

Question 93: The tonotopic organization of the cochlea refers to the specific arrangement of hair cells along the basilar membrane. Where are high-frequency sounds processed?

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

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 94: Insertion Loss occurs when;

presenting a tone that is only inaudible without the instruments on.
Bone conduction testing causing thresholds to shift due to headphones being placed over the ear.
the instrument feeds back only when the coupler is removed.
The level in the ear canal with a hearing aid inserted is less than the input level. (Correct answer)

Correct answer: The level in the ear canal with a hearing aid inserted is less than the input level.

Insertion Loss occurs when the level in the ear canal with a hearing aid inserted is less than the input level. This term refers to the reduction in sound level that occurs when a hearing aid is placed in the ear canal. It's a measure of how much sound the hearing aid attenuates or reduces before reaching the eardrum. The goal is to minimize insertion loss to ensure that the wearer receives the appropriate amplification for their hearing needs.

Question 95: What is the commonly cited threshold of pain for sound pressure level in humans?

100 dB SPL
120 dB SPL
85 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 96: What is the PRIMARY purpose of a feedback cancellation algorithm in a digital hearing aid?

Reduce the instrument's maximum output level
Detect and suppress acoustic feedback whistling before it becomes audible (Correct answer)
Improve battery efficiency
Enhance directional microphone polar pattern

Correct answer: Detect and suppress acoustic feedback whistling before it becomes audible

Feedback cancellation continuously monitors for feedback and applies an inverse signal to cancel the whistle before the patient or listener hears it.

Question 97: 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:

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

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

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

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 99: The occlusion effect is MOST commonly reported by which patient group?

Patients with severe-to-profound loss using power instruments
Patients with high-frequency loss using open-fit instruments
Patients with unilateral loss using CROS systems
Patients with good low-frequency hearing wearing occluding earmolds (Correct answer)

Correct answer: Patients with good low-frequency hearing wearing occluding earmolds

Patients with intact low-frequency hearing who wear occluding earmolds perceive their own voice as hollow because bone-conducted vocal energy cannot escape the sealed canal.

Question 100: Compared to a 0 dB SPL reference, a 20 dB SPL sound is how many times more intense?

1,000 times
10 times
100 times (Correct answer)
2 times

Correct answer: 100 times

The decibel scale is logarithmic; each 10 dB increase represents a tenfold increase in intensity, so 20 dB equals 100 times the intensity of the reference level.

Question 101: Damage to which nerve is responsible for sensorineural hearing loss in acoustic neuroma?

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

Correct answer: Vestibulocochlear nerve (CN VIII)

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

Question 102: A hearing instrument with multiple memory programs is MOST useful for which type of patient?

A patient who prefers a fully automatic single-program instrument
A patient who regularly moves between quiet, noisy, music, and telephone listening situations (Correct answer)
A patient with unilateral hearing loss
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 103: 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)
Measuring Real Ear Insertion Gain (REIG).
Test box analysis against manufacturer specifications.

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 104: A patient has a severe-to-profound high-frequency sensorineural hearing loss, making it difficult to hear sibilant sounds like /s/ and /f/. Simply amplifying these frequencies is ineffective due to cochlear dead regions. Which technology is specifically designed to address this problem?

Noise reduction algorithms
Frequency lowering (Correct answer)
Wide Dynamic Range Compression (WDRC)
Directional microphones

Correct answer: Frequency lowering

Frequency lowering technology, through methods like frequency compression or transposition, shifts high-frequency sounds that the user cannot hear into a lower frequency range where their hearing is better. This makes previously inaudible speech cues, like high-frequency consonants, accessible to the listener.

Question 105: Which hearing aid style is most appropriate for a patient with severe-to-profound hearing loss who also has chronic ear drainage?

Completely-in-canal (CIC)
In-the-canal (ITC)
Behind-the-ear (BTE) with earmold (Correct answer)
In-the-ear (ITE)

Correct answer: Behind-the-ear (BTE) with earmold

BTE with earmold keeps the electronics away from the moist ear environment, making it suitable for patients with ear drainage.

Question 106: The occlusion effect is most significant at which frequencies?

Ultra-high frequencies above 6000 Hz
Low frequencies (250–500 Hz) (Correct answer)
Mid frequencies (1000 Hz)
High frequencies (2000–4000 Hz)

Correct answer: Low frequencies (250–500 Hz)

The occlusion effect predominantly enhances bone-conduction thresholds at low frequencies (250–500 Hz) by increasing the sound pressure in the occluded ear canal.

Question 107: During earmold impression taking, the cotton or foam dam is placed in the ear canal to:

Improve acoustics of the impression
Reduce patient discomfort
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 108: How does a higher signal-to-noise ratio (SNR) affect speech intelligibility for hearing aid users?

It reduces speech clarity by masking critical frequencies
It increases reverberation in the listening environment
It improves speech intelligibility by making the signal stronger relative to background noise (Correct answer)
It has no measurable effect on speech understanding

Correct answer: It improves speech intelligibility by making the signal stronger relative to background noise

A higher SNR means the desired speech signal is substantially louder than background noise, directly improving the listener's ability to understand speech, especially for those with hearing loss.

Question 109: 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
Polish the surface of the earmold canal portion
Reduce the overall length of the canal tip
Add or enlarge a vent in the earmold (Correct answer)

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.

Question 110: The FDA classifies hearing aids as which type of medical device?

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

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 111: What is the mathematical relationship between the frequency and wavelength of a sound wave?

Inversely proportional (Correct answer)
Independent of each other
Directly proportional
Exponentially proportional

Correct answer: Inversely proportional

Frequency and wavelength are inversely proportional; as frequency increases, wavelength decreases, governed by the formula: wavelength = speed of sound ÷ frequency.

Question 112: Which condition would most likely produce a Type As (shallow) tympanogram?

Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis or malleus fixation (Correct answer)
Otitis media with effusion

Correct answer: Otosclerosis or malleus fixation

A Type As tympanogram shows a peak at normal pressure but with reduced compliance (shallow peak), characteristic of stiffness-related conditions like otosclerosis.

Question 113: When counseling a patient who refuses to wear their hearing aids due to stigma, the hearing care professional should FIRST:

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

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 114: 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.
Increasing the size of the vent or adding a vent. (Correct answer)
Switching from a soft dome to a hard acrylic shell.

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 115: 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
Hearing aids will restore hearing to normal
An adaptation period of several weeks is normal and hearing will not sound exactly like pre-loss hearing (Correct answer)
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.

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%

To Pass

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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