IHS Hearing Loss Assessment 3 — Questions and Answers
Question 1: A patient's audiogram shows bilateral symmetric hearing loss with thresholds of 25 dB at 500 Hz, 35 dB at 1000 Hz, 55 dB at 2000 Hz, and 70 dB at 4000 Hz. This pattern is most consistent with:
- Conductive hearing loss
- Noise-induced hearing loss
- Presbycusis (age-related hearing loss) (Correct answer)
- Sudden sensorineural hearing loss
Correct answer: Presbycusis (age-related hearing loss)
Presbycusis typically presents as bilateral, symmetric, gradually sloping high-frequency sensorineural hearing loss that worsens progressively with age.
Question 2: What is the significance of a 4000 Hz notch on an audiogram?
- Indicates Ménière's disease
- Suggests noise-induced hearing loss from chronic loud sound exposure (Correct answer)
- Is a normal variant requiring no follow-up
- Points to otosclerosis
Correct answer: Suggests noise-induced hearing loss from chronic loud sound exposure
A 4000 Hz notch is the characteristic audiometric signature of noise-induced hearing loss, reflecting the frequency region most susceptible to acoustic trauma.
Question 3: Which masking condition is most critical during bone conduction audiometry?
- Masking is never needed for bone conduction
- Masking is needed when the air-bone gap exceeds 40 dB in the test ear
- Masking is needed in the non-test ear whenever testing bone conduction (Correct answer)
- Masking is only needed for frequencies above 4000 Hz
Correct answer: Masking is needed in the non-test ear whenever testing bone conduction
Because bone-conducted sound travels bilaterally with minimal interaural attenuation, the non-test ear must almost always be masked during bone conduction testing to prevent it from responding.
Question 4: The most common cause of conductive hearing loss in adults in the United States is:
- Otosclerosis
- Cholesteatoma
- Cerumen impaction (Correct answer)
- 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 5: A hearing instrument specialist performs otoscopy and observes a pearly white mass behind the tympanic membrane. The appropriate next step is:
- Proceed with hearing aid fitting
- Perform tympanometry to quantify the mass
- Refer the patient to an otolaryngologist immediately (Correct answer)
- Recheck in six months
Correct answer: Refer the patient to an otolaryngologist immediately
A pearly white mass behind the tympanic membrane is the classic appearance of a cholesteatoma, which requires prompt medical/surgical evaluation and management.
Question 6: In pure tone audiometry, 'threshold' is defined as the lowest hearing level at which a patient correctly detects a tone in what percentage of ascending trials?
- 25%
- 50% (Correct answer)
- 75%
- 100%
Correct answer: 50%
Audiometric threshold is conventionally defined as the lowest dB HL at which the patient correctly responds to at least 50% of ascending presentations.
Question 7: Which type of audiogram configuration is described as a 'reverse slope' or 'rising' configuration?
- Thresholds worse in high frequencies
- Thresholds worse in low frequencies (Correct answer)
- Thresholds equally poor at all frequencies (flat)
- Thresholds poor only in the mid-frequencies (cookie-bite)
Correct answer: Thresholds worse in low frequencies
A rising or reverse-slope audiogram shows poorer thresholds in the low frequencies that improve toward the high frequencies, associated with conditions like Ménière's disease.
IHS Hearing Loss Assessment 3
A patient's audiogram shows bilateral symmetric hearing loss with thresholds of 25 dB at 500 Hz, 35 dB at 1000 Hz, 55 dB at 2000 Hz, and 70 dB at 4000 Hz.
This pattern is most consistent with: