IHS Instrument Selection 5 — Questions and Answers
Question 1: When fitting a patient with a steeply sloping high-frequency hearing loss, which gain prescription approach is MOST appropriate?
- Flat gain across all frequencies
- Substantially increased high-frequency gain with minimal low-frequency amplification (Correct answer)
- Maximum output at all frequencies equally
- Equal gain across low and high frequencies regardless of audiogram shape
Correct answer: Substantially increased high-frequency gain with minimal low-frequency amplification
A steeply sloping loss requires significantly more gain in the high frequencies where the loss is greatest while avoiding over-amplification of low frequencies where hearing may be near normal.
Question 2: During a hearing aid evaluation, a patient's aided word recognition score improves significantly compared to unaided scores. This finding MOST indicates:
- The patient does not require hearing aids
- The patient is a good candidate who will likely achieve real-world benefit from amplification (Correct answer)
- An immediate cochlear implant referral is warranted
- The hearing loss is conductive in nature
Correct answer: The patient is a good candidate who will likely achieve real-world benefit from amplification
Improved word recognition with amplification is a positive prognostic indicator that the patient will receive meaningful benefit from hearing instruments.
Question 3: Which patient would receive the LEAST benefit from a directional microphone system?
- A patient who frequently dines in restaurants
- A patient who is primarily homebound and watches television in a quiet room (Correct answer)
- A patient who attends regular business meetings
- A patient who struggles at cocktail parties
Correct answer: A patient who is primarily homebound and watches television in a quiet room
A primarily homebound patient in a controlled quiet environment rarely faces competing noise from behind, making directional microphone benefit minimal in their daily life.
Question 4: The occlusion effect is MOST commonly reported by which patient group?
- Patients with severe-to-profound loss using power instruments
- Patients with good low-frequency hearing wearing occluding earmolds (Correct answer)
- Patients with high-frequency loss using open-fit instruments
- Patients with unilateral loss using CROS systems
Correct answer: Patients with good low-frequency hearing wearing occluding earmolds
Patients with intact low-frequency hearing who wear occluding earmolds perceive their own voice as hollow because bone-conducted vocal energy cannot escape the sealed canal.
Question 5: In which listening environment is a telecoil MOST beneficial?
- Outdoor settings with significant wind noise
- Venues with installed hearing loop (induction loop) systems such as theaters or churches (Correct answer)
- Noisy restaurants without assistive listening infrastructure
- Quiet one-on-one conversations at home
Correct answer: Venues with installed hearing loop (induction loop) systems such as theaters or churches
Telecoils pick up electromagnetic signals from installed hearing loop systems, delivering a direct clean signal that bypasses environmental background noise.
Question 6: A patient has asymmetrical hearing loss with word recognition of 20% in one ear. How should this affect the bilateral instrument selection strategy?
- The poor ear should not receive any amplification
- The poor ear may require a different fitting target and BiCROS routing should be considered (Correct answer)
- Both ears should receive identical instrument settings
- Only the better ear should be fitted
Correct answer: The poor ear may require a different fitting target and BiCROS routing should be considered
A poor word recognition score predicts limited benefit from conventional amplification in that ear, potentially making BiCROS routing or a specialized fitting approach more appropriate.
Question 7: Which audiometric finding MOST strongly indicates a physician referral BEFORE proceeding with instrument selection?
- Bilateral symmetrical high-frequency sensorineural hearing loss in a 70-year-old
- Unilateral sudden sensorineural hearing loss of 50 dB occurring within 72 hours (Correct answer)
- Gradual bilateral progressive hearing loss over 10 years
- Mild bilateral hearing loss with excellent word recognition scores
Correct answer: Unilateral sudden sensorineural hearing loss of 50 dB occurring within 72 hours
Sudden sensorineural hearing loss is a medical emergency requiring immediate physician referral for possible corticosteroid treatment to maximize hearing recovery.
IHS Instrument Selection 5
When fitting a patient with a steeply sloping high-frequency hearing loss, which gain prescription approach is MOST appropriate?