IHS Hearing Loss Assessment 5 — Questions and Answers
Question 1: During case history intake, a patient reports sudden hearing loss in one ear upon waking that morning. The hearing instrument specialist should:
- Schedule a hearing aid evaluation for the following week
- Refer the patient to a physician immediately as this is a medical emergency (Correct answer)
- Perform audiometry and fit a CROS hearing aid
- Advise the patient to return if symptoms worsen in two weeks
Correct answer: Refer the patient to a physician immediately as this is a medical emergency
Sudden sensorineural hearing loss is a medical emergency requiring urgent physician evaluation and possible steroid treatment within 72 hours for best prognosis.
Question 2: Which tympanogram type suggests excessive mobility of the tympanic membrane, possibly due to ossicular discontinuity or a monomeric membrane?
- Type A
- Type Ad (deep/high compliance) (Correct answer)
- Type As (shallow/low compliance)
- Type B
Correct answer: Type Ad (deep/high compliance)
Type Ad (Ad = deep) tympanogram shows abnormally high compliance, indicating hypermobility of the tympanic membrane, seen with ossicular discontinuity or healed perforations.
Question 3: The degree of hearing loss classified as 'severe' corresponds to pure tone average thresholds in the range of:
- 26–40 dB HL
- 41–55 dB HL
- 56–70 dB HL
- 71–90 dB HL (Correct answer)
Correct answer: 71–90 dB HL
According to standard audiometric classification, severe hearing loss corresponds to pure tone averages between 71 and 90 dB HL.
Question 4: A patient with normal audiometric thresholds but significant complaints of difficulty understanding speech in noise most likely warrants referral for evaluation of:
- Retrocochlear pathology via ABR
- Central auditory processing disorder (CAPD) (Correct answer)
- Otosclerosis
- Ménière's disease
Correct answer: Central auditory processing disorder (CAPD)
Normal thresholds with poor speech-in-noise performance is a hallmark of central auditory processing disorder, which affects higher-level auditory analysis rather than peripheral sensitivity.
Question 5: What is the primary reason bone conduction testing bypasses the outer and middle ear?
- Bone conduction tones are louder than air conduction tones
- Vibration transmitted through the skull directly stimulates the cochlea without passing through the outer or middle ear (Correct answer)
- Bone conduction uses lower frequencies that travel farther
- The mastoid bone amplifies sound before it reaches the cochlea
Correct answer: Vibration transmitted through the skull directly stimulates the cochlea without passing through the outer or middle ear
Bone conduction vibrations travel through the skull and directly set the cochlear fluids into motion, bypassing the outer and middle ear entirely.
Question 6: A patient presents with asymmetric sensorineural hearing loss (right worse than left) and unilateral tinnitus. The most important referral concern is:
- Noise-induced hearing loss from asymmetric occupational exposure
- Acoustic neuroma (vestibular schwannoma) on the right side (Correct answer)
- Presbycusis progressing faster in one ear
- Autoimmune inner ear disease
Correct answer: Acoustic neuroma (vestibular schwannoma) on the right side
Unilateral or significantly asymmetric SNHL with ipsilateral tinnitus is a red flag for acoustic neuroma and requires imaging referral to rule out a retrocochlear mass.
Question 7: Which measure best represents a patient's overall ability to hear conversational speech in the speech frequency range (500, 1000, 2000 Hz)?
- High-frequency pure tone average (HFPTA)
- Pure tone average (PTA) of 500, 1000, and 2000 Hz (Correct answer)
- Speech detection threshold (SDT)
- Uncomfortable loudness level (UCL)
Correct answer: Pure tone average (PTA) of 500, 1000, and 2000 Hz
The pure tone average (PTA) of 500, 1000, and 2000 Hz encompasses the primary speech frequencies and is the standard estimate of functional hearing for conversational speech.
IHS Hearing Loss Assessment 5
During case history intake, a patient reports sudden hearing loss in one ear upon waking that morning.
The hearing instrument specialist should: