IHS Hearing Loss Assessment 4 — Questions and Answers
Question 1: When assessing a patient for hearing loss, which case history question is most directly relevant to identifying occupational noise exposure?
- Do you have diabetes?
- Have you ever worked in environments requiring hearing protection? (Correct answer)
- Do you have a family history of hearing loss?
- Do you experience balance problems?
Correct answer: Have you ever worked in environments requiring hearing protection?
Asking about occupational noise exposure directly identifies one of the most preventable causes of acquired sensorineural hearing loss.
Question 2: A patient's Most Comfortable Loudness (MCL) level is notably close to their Uncomfortable Loudness Level (UCL), indicating a narrow dynamic range. This finding suggests:
- Pseudohypacusis
- Recruitment, often associated with cochlear hearing loss (Correct answer)
- Retrocochlear pathology
- Normal loudness growth
Correct answer: Recruitment, often associated with cochlear hearing loss
Recruitment is the abnormally rapid growth of loudness in damaged cochleae, narrowing the range between threshold and discomfort, and is characteristic of cochlear (sensorineural) hearing loss.
Question 3: What is the interaural attenuation (IA) for supra-aural earphones at most frequencies?
- 0 dB
- 40 dB (Correct answer)
- 60 dB
- 80 dB
Correct answer: 40 dB
Interaural attenuation for supra-aural earphones is approximately 40 dB, meaning the non-test ear may be stimulated when the presented signal exceeds the test ear threshold by 40 dB.
Question 4: A Stenger test is used to identify:
- Recruitment in cochlear hearing loss
- Unilateral functional (non-organic) hearing loss (Correct answer)
- Retrocochlear pathology
- Central auditory processing disorders
Correct answer: Unilateral functional (non-organic) hearing loss
The Stenger test exploits the physiological principle that only the louder of two simultaneous tones presented to both ears is perceived, revealing feigned unilateral hearing loss.
Question 5: What is the reference standard level for 0 dB Hearing Level (HL) based on?
- The average threshold of young adults with normal hearing (Correct answer)
- The threshold of a single calibrated audiometer
- The detection limit of a standard sound level meter
- Absolute silence in an anechoic chamber
Correct answer: The average threshold of young adults with normal hearing
0 dB HL is defined by audiometric standards (ANSI/ISO) as the average minimum audible sound level for a population of young, otologically normal adults.
Question 6: Which condition involves progressive conductive hearing loss due to abnormal bone remodeling that fixes the stapes footplate in the oval window?
- Presbycusis
- Otosclerosis (Correct answer)
- Cholesteatoma
- Ménière's disease
Correct answer: Otosclerosis
Otosclerosis is a hereditary condition causing abnormal bone remodeling around the stapes, progressively fixing it and reducing sound transmission into the inner ear.
Question 7: A patient's bone conduction thresholds and air conduction thresholds are both elevated by the same degree with no air-bone gap. This pattern is consistent with:
- Pure conductive hearing loss
- Pure sensorineural hearing loss (Correct answer)
- Mixed hearing loss
- Functional hearing loss
Correct answer: Pure sensorineural hearing loss
When air and bone conduction thresholds are equally elevated with no air-bone gap, the loss is entirely sensorineural, reflecting inner ear or auditory nerve dysfunction.
IHS Hearing Loss Assessment 4
When assessing a patient for hearing loss, which case history question is most directly relevant to identifying occupational noise exposure?