IHS Auditory Assessment 4 — Questions and Answers
Question 1: Which of the following best describes the Stenger test and its primary application?
- Tests auditory processing using dichotic stimuli
- Identifies functional (non-organic) unilateral hearing loss (Correct answer)
- Measures cochlear reserve in otosclerosis
- Evaluates eustachian tube function
Correct answer: Identifies functional (non-organic) unilateral hearing loss
The Stenger test exploits the Stenger effect — when the same tone is presented to both ears simultaneously, only the louder one is perceived — to unmask feigned unilateral hearing loss.
Question 2: In pure-tone audiometry, the recommended test frequency sequence per ASHA guidelines begins with:
- 250 Hz
- 1000 Hz (Correct answer)
- 2000 Hz
- 4000 Hz
Correct answer: 1000 Hz
ASHA recommends starting pure-tone testing at 1000 Hz because it is in the most reliable portion of the audiogram and allows for a retest at 1000 Hz to check response reliability.
Question 3: A conductive hearing loss is confirmed on the audiogram when:
- Both air and bone conduction thresholds are elevated equally
- Air conduction thresholds are elevated but bone conduction thresholds are within normal limits (Correct answer)
- Bone conduction thresholds are elevated but air conduction is normal
- Both thresholds are within normal limits but the SRT is elevated
Correct answer: Air conduction thresholds are elevated but bone conduction thresholds are within normal limits
A conductive hearing loss is indicated by elevated air conduction thresholds with normal bone conduction thresholds, creating an air-bone gap of 10 dB or more.
Question 4: Which acoustic reflex pattern is most consistent with a unilateral acoustic neuroma on the right side?
- Absent ipsilateral right reflex only
- Absent contralateral reflexes with right probe only
- Absent all reflexes bilaterally
- Absent ipsilateral and contralateral reflexes with right probe and absent contralateral with left probe (Correct answer)
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 5: Otoacoustic emissions (OAEs) are generated by which cochlear structure?
- Inner hair cells
- Outer hair cells (Correct answer)
- Spiral ganglion neurons
- Basilar membrane stiffness only
Correct answer: Outer hair cells
OAEs are produced by the electromotile activity of outer hair cells (OHCs), which amplify basilar membrane motion and generate sounds that travel back through the middle ear.
Question 6: When masking is applied to the non-test ear during bone conduction audiometry, which type of noise is used?
- Narrow-band noise centered at the test frequency (Correct answer)
- Broadband white noise
- Speech-spectrum noise
- Sawtooth 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 7: The maximum comfortable loudness level (MCL) is typically measured during which type of audiometric procedure?
- Pure-tone air conduction testing
- Loudness discomfort level assessment and hearing aid fitting (Correct answer)
- Acoustic reflex threshold testing
- ABR threshold estimation
Correct answer: Loudness discomfort level assessment and hearing aid fitting
MCL is measured during loudness discomfort and dynamic range assessment, which is essential for hearing aid fitting to establish the patient's comfortable and tolerant listening range.
IHS Auditory Assessment 4
Which of the following best describes the Stenger test and its primary application?