IHS Audiometric Testing Procedures 5 — Questions and Answers
Question 1: What is a 'false positive' response during pure-tone audiometry?
- 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
- A patient correctly identifies tones on the first presentation
Correct answer: A patient responds when no tone was actually presented
A false positive occurs when the patient raises their hand or signals a response even though no tone was presented, indicating unreliable testing behavior.
Question 2: Which audiometric configuration is classically associated with noise-induced hearing loss (NIHL)?
- Rising configuration with better high-frequency thresholds
- Flat configuration across all frequencies
- Notch at 4,000 Hz with better thresholds at adjacent frequencies (Correct answer)
- Profound loss across all frequencies above 1,000 Hz
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 3: What is the recommended ambient noise level (in dB SPL) for audiometric testing in a test booth at 500 Hz according to ANSI standards?
- 11.5 dB SPL (Correct answer)
- 40 dB SPL
- 60 dB SPL
- 70 dB SPL
Correct answer: 11.5 dB SPL
ANSI S3.1 specifies maximum permissible ambient noise levels; at 500 Hz the limit is 11.5 dB SPL to allow valid threshold testing down to 0 dB HL.
Question 4: What audiometric finding distinguishes sensorineural hearing loss from conductive hearing loss?
- Air conduction thresholds are better than bone conduction thresholds
- Bone conduction thresholds are elevated and match air conduction thresholds (Correct answer)
- Air-bone gap exceeds 30 dB at all frequencies
- Speech recognition scores are always normal in sensorineural loss
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 5: What is the minimum air-bone gap (in dB) that is considered clinically significant for diagnosing conductive hearing loss?
- 5 dB
- 10 dB
- 15 dB (Correct answer)
- 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 6: Which condition would most likely produce a Type As (shallow) tympanogram?
- Perforated tympanic membrane
- Otitis media with effusion
- Otosclerosis or malleus fixation (Correct answer)
- Eustachian tube dysfunction
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 7: When should audiometric equipment be calibrated according to ASHA and ANSI guidelines?
- Only when the patient reports the equipment sounds different
- Daily listening checks with full electroacoustic calibration annually (Correct answer)
- Monthly listening checks with calibration every five years
- Every time a new audiologist uses the equipment
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.
IHS Audiometric Testing Procedures 5
What is a 'false positive' response during pure-tone audiometry?