IHS Auditory Assessment 5 — Questions and Answers
Question 1: A patient presents with normal hearing thresholds but reports difficulty understanding speech in noise. Which test battery is most appropriate to investigate auditory processing?
- Tympanometry and acoustic reflexes
- Dichotic listening, temporal processing, and binaural interaction tests (Correct answer)
- ABR and ASSR
- OAEs and word recognition in quiet
Correct answer: Dichotic listening, temporal processing, and binaural interaction tests
Central auditory processing disorders (CAPD) are evaluated with dichotic listening tasks, temporal processing measures (e.g., gaps-in-noise), and binaural interaction tests, as peripheral hearing is typically normal.
Question 2: Which condition is characterized by a low-frequency sensorineural hearing loss that fluctuates, accompanied by aural fullness, tinnitus, and vertigo?
- Otosclerosis
- Presbycusis
- Ménière's disease (Correct answer)
- Noise-induced hearing loss
Correct answer: Ménière's disease
Ménière's disease presents with the classic tetrad of fluctuating low-frequency SNHL, episodic vertigo, tinnitus, and aural fullness due to endolymphatic hydrops.
Question 3: The 'shadow curve' during pure-tone audiometry occurs when:
- The patient guesses on thresholds
- The test signal crosses over to the non-test ear and produces a response (Correct answer)
- Calibration error affects low-frequency responses
- The audiometer generates harmonic distortion
Correct answer: The test signal crosses over to the non-test ear and produces a response
A shadow curve appears when sound from the test ear crosses over (via bone conduction) to the better non-test ear, creating the false impression that the poorer ear has some residual hearing.
Question 4: In the modified Hughson-Westlake procedure, a threshold is defined as the lowest level at which a patient correctly responds in:
- 3 out of 3 ascending presentations
- 2 out of 3 ascending presentations at the same level (Correct answer)
- 1 out of 5 presentations at any intensity
- 50% of descending presentations
Correct answer: 2 out of 3 ascending presentations at the same level
Using the modified Hughson-Westlake method, threshold is the lowest hearing level at which the patient responds correctly to at least 2 out of 3 ascending presentations.
Question 5: Absent distortion product OAEs (DPOAEs) with normal ABR thresholds most likely suggests:
- Auditory neuropathy spectrum disorder
- Outer hair cell dysfunction with intact auditory nerve function (Correct answer)
- Middle ear pathology only
- Malingering
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 6: Which finding on ABR is the hallmark of auditory neuropathy spectrum disorder (ANSD)?
- Prolonged absolute latency of Wave I only
- Absent or severely abnormal ABR with present OAEs (Correct answer)
- Absent Wave V with normal Waves I through IV
- Normal ABR with absent acoustic reflexes
Correct answer: Absent or severely abnormal ABR with present OAEs
ANSD is characterized by absent or grossly abnormal ABR waveforms co-existing with present OAEs, indicating intact outer hair cell function but disrupted neural synchrony.
Question 7: During hearing screening at 1000, 2000, and 4000 Hz at 25 dB HL, a patient fails to respond at 4000 Hz in the right ear only. The recommended next step is:
- Refer immediately for medical evaluation
- Rescreen within the same session or within two weeks (Correct answer)
- Fit with amplification immediately
- No action needed if the patient reports no complaints
Correct answer: Rescreen within the same session or within two weeks
A single failed screening result warrants rescreening within the same session or within two weeks before making a referral, to rule out temporary threshold shifts or testing artifacts.
IHS Auditory Assessment 5
A patient presents with normal hearing thresholds but reports difficulty understanding speech in noise.
Which test battery is most appropriate to investigate auditory processing?