Audiology and Speech Disorders Practice Questions

Q: Recruitment phenomenon is seen in:

Meniere's disease. ***Meniere's disease*** - The recruitment phenomenon, characterized by an abnormal increase in the perception of loudness for a given increase in sound intensity, is a classic finding in **cochlear hearing loss**, often seen in conditions like **Meniere's disease**. - This occurs due to damage to the **outer hair cells** in the cochlea, which normally compress the dynamic range of hearing. *Otitis media with effusion* - This condition involves **conductive hearing loss** due to fluid in the middle ear, and typically does not cause the recruitment phenomenon. - The problem lies in sound transmission, not in the processing of loudness within the cochlea. *Otosclerosis* - This condition causes **conductive hearing loss** due to abnormal bone growth around the stapes footplate, impeding sound transmission to the inner ear. - While it affects hearing, it does not directly lead to altered loudness perception or recruitment, as the cochlea itself is often intact. *Acoustic nerve schwannoma* - This tumor affects the **vestibulocochlear nerve (CN VIII)**, causing **sensorineural hearing loss** that is typically retrocochlear (beyond the cochlea). - While it causes hearing loss, recruitment is usually absent or minimal, as the pathology is neural, not cochlear.

Q: Carhart's notch in audiometry is seen in -

Otosclerosis. ***Otosclerosis*** - **Carhart's notch** is a characteristic dip in the **bone conduction threshold** at 2000 Hz, typically observed in patients with **otosclerosis**. - This phenomenon is believed to be due to an artifact caused by the **stapes fixation** interfering with the normal inertial and compressional bone conduction mechanisms. *Ossicular discontinuity* - While ossicular discontinuity causes a **conductive hearing loss**, it typically does not present with a specific notch at 2000 Hz in bone conduction. - The audiogram would show a significant **air-bone gap** but without the characteristic bone conduction dip. *Otomycosis* - **Otomycosis** is a fungal infection of the external auditory canal and can cause **conductive hearing loss** if there is significant debris or swelling. - It does not, however, lead to a Carhart's notch on the audiogram. *Haemotympanum* - **Haemotympanum**, or blood behind the tympanic membrane, causes a **conductive hearing loss** by dampening the movement of the tympanic membrane and ossicles. - This condition results in a **flat or low-frequency conductive hearing loss** without the specific audiometric feature of Carhart's notch.

Q: According to the WHO definition of hearing loss, what is the value to classify as profound hearing loss?

>91 dB. ***>91 dB*** - According to the **WHO classification of hearing loss**, a hearing threshold of **greater than 91 dB** in the better ear is defined as **profound hearing loss**. - Individuals with profound hearing loss typically have extreme difficulty hearing and understanding speech even with powerful hearing aids. *61-71 dB* - This range generally falls into the category of **severe hearing loss** (71-90 dB) or **moderately severe hearing loss** (61-70 dB) depending on the exact threshold, but not profound. - Severe hearing loss means hearing speech sounds at this level would be very difficult without amplification. *>101 dB* - While >101 dB is indeed profound hearing loss, the WHO definition for profound hearing loss starts at **>91 dB**. - This option specifies a threshold that is higher than the minimum for profound, making it less precise as the direct definition. *>81 dB* - This threshold falls within the range of **severe hearing loss**, which is defined by the WHO as a hearing threshold between **71 and 90 dB** in the better ear. - Severe hearing loss is distinct from profound hearing loss.

Q: Bilateral Rinne test +ve and Weber test lateralized to right with a shortened Schwabach test on left side suggests ?

Left inner ear pathology. ***Left inner ear pathology*** - A **bilateral positive Rinne test** indicates that **air conduction is better than bone conduction** in both ears, which is either normal or suggests **sensorineural hearing loss** (rules out conductive loss). - **Weber test lateralizing to the right** means sound is heard better in the right ear, indicating **left ear pathology**. Combined with positive Rinne bilaterally, this confirms **left sensorineural hearing loss**. - A **shortened Schwabach test on the left side** means **bone conduction duration is reduced** compared to normal, directly confirming **sensorineural hearing loss** in the left ear. *Right middle ear pathology* - A **conductive hearing loss** on the right would cause a **negative Rinne test** on the right side (bone conduction better than air conduction), contradicting the bilateral positive Rinne findings. - While **Weber would lateralize to the right** with right conductive loss, the **positive Rinne bilaterally** rules out any significant conductive pathology. *Right inner ear pathology* - A **sensorineural hearing loss** on the right would cause Weber test to **lateralize to the better (left) ear**, not to the right as described in the question. - The **shortened Schwabach test is on the left side**, not the right, indicating left ear pathology rather than right inner ear involvement. *Left middle ear pathology* - A **conductive hearing loss** in the left ear would cause a **negative Rinne test on the left side** (bone conduction better than air conduction), contradicting the bilateral positive findings. - **Weber test would lateralize to the left ear** (affected ear with conductive loss), not to the right as stated in the question.

Q: Which test is used to assess Neonatal hearing loss?

Otoacoustic emissions. ***Otoacoustic emissions*** - **Otoacoustic emissions (OAEs)** are sounds produced by the **cochlea** in response to auditory stimulation and are used for **newborn hearing screening**. - The presence of OAEs indicates normal function of the **outer hair cells** in the cochlea, suggesting adequate hearing sensitivity. *SISI* - The **Short Increment Sensitivity Index (SISI)** test assesses a patient's ability to detect small changes in the intensity of a tone. - This test is primarily used to differentiate between **normal hearing** and **cochlear hearing loss** in adults, and not for neonatal screening. *Rinne's Test* - **Rinne's test** compares **air conduction** and **bone conduction** of sound to evaluate for conductive or sensorineural hearing loss. - It involves placing a **tuning fork** on the mastoid bone and then next to the ear canal, and is typically performed on cooperative older children and adults. *Calorie Test* - The **caloric test** evaluates the function of the **vestibular system** by introducing warm or cold water/air into the ear canal to stimulate the horizontal semicircular canal. - It assesses **nystagmus** and is used to diagnose **vestibular disorders** and is not a test for hearing.

Q: Which is the investigation of choice in assessing hearing loss in neonates -

Brainstem Evoked Response Audiometry (BERA). ***Brainstem Evoked Response Audiometry (BERA)*** - **BERA** is the gold standard for assessing hearing loss in neonates because it measures the **brain's electrical activity** in response to sounds, making it objective and reliable in infants who cannot cooperate with behavioral tests. - It is crucial for **early detection** of hearing impairment, allowing for timely intervention to support language and developmental milestones. *Behavioral audiometry* - This method relies on the child's **behavioral responses** to sound, such as head turns or startling, which is not reliable or consistent for neonates. - It is typically used for older infants or children who can actively participate and respond to stimuli. *Impedance audiometry* - Measures the **middle ear function** (e.g., tympanometry, acoustic reflex), which can detect issues like fluid in the middle ear but does not directly assess the baby's ability to hear. - While useful for diagnosing **middle ear pathologies**, it is not a direct measure of hearing threshold. *Free field audiometry* - This technique involves presenting sounds through loudspeakers and observing the child's reaction in a **sound-attenuated room**. - Similar to other behavioral tests, its reliability is limited in neonates due to their inability to provide consistent and voluntary responses to sound.

Q: Trough-shaped curve in audiometry is seen in:

Congenital SNHL. ***Congenital SNHL*** - A **trough-shaped curve** (also known as a **'cookie-bite' audiogram**) is characteristic of congenital sensorineural hearing loss, particularly in some hereditary forms. - This pattern shows **greatest hearing loss in the mid-frequencies** (500 Hz to 2000 Hz) with better hearing in the low and high frequencies. *Otitis media* - Acute or chronic otitis media typically presents with a **conductive hearing loss** due to fluid in the middle ear. - The audiogram typically shows a **flat or upward-sloping bone conduction threshold** with an **air-bone gap**. *Acoustic neuroma* - An acoustic neuroma (vestibular schwannoma) usually causes **unilateral sensorineural hearing loss** that is often more pronounced in the **high frequencies**. - It does not typically produce a trough-shaped audiogram. *Otosclerosis* - Otosclerosis is a disease of the bony labyrinth causing **conductive hearing loss**, often with a characteristic **Carhart notch** (a dip in bone conduction thresholds, primarily at 2000 Hz). - This is distinct from a trough-shaped curve affecting mid-frequencies.

Q: Otoacoustic emission arises from?

Outer hair cell. ***Outer hair cell*** - **Otoacoustic emissions (OAEs)** are sounds generated by the **active electromotility** of outer hair cells in the cochlea - Outer hair cells function as **cochlear amplifiers**, contracting and expanding in response to sound, which produces measurable acoustic energy that travels back through the middle ear - OAEs are used clinically for **newborn hearing screening** and assessing cochlear function, as they are present in normal-hearing individuals and absent when outer hair cell damage occurs *Organ of otolith* - The **organs of otoliths** (utricle and saccule) are part of the **vestibular system**, detecting **linear acceleration** and **head position** relative to gravity - They contain hair cells embedded in a gelatinous layer with calcium carbonate crystals (otoconia), but these structures are involved in balance, not sound generation *Inner hair cell* - **Inner hair cells** are the **primary sensory receptors** for hearing, transducing mechanical vibrations into electrical signals transmitted via the auditory nerve to the brain - They receive amplified signals from outer hair cells but do not actively generate sound emissions themselves *Reissner's membrane* - **Reissner's membrane** (vestibular membrane) separates the **scala vestibuli** from the **scala media** in the cochlea - It maintains the **ionic gradient** between perilymph and endolymph, essential for hair cell function, but does not produce acoustic emissions

Q: In pure tone audiogram the symbol X is used to mark:

Air conduction in left ear. ***Air conduction in left ear*** - The symbol **X** is the standard notation in a pure tone audiogram to represent the **air conduction threshold for the left ear**. - This symbol indicates the softest sound level (in dB HL) at which a patient can hear a specific pure tone presented to their left ear via headphones. *Bone conduction in right ear* - **Bone conduction for the right ear** is typically marked with a **<** (unmasked) or **[** (masked) symbol. - This measures inner ear function, bypassing the outer and middle ear. *No response in air conduction in right ear* - A **no response** in air conduction for the right ear is often indicated by an **arrow pointing down from the O symbol** for the right ear. - This indicates that the patient did not respond to the maximum output of the audiometer for that frequency. *Air conduction in right ear* - **Air conduction in the right ear** is typically marked with a **O** symbol on the audiogram. - This symbol, usually plotted in red, represents the hearing threshold for the right ear when sound is delivered through headphones.

Q: Which intervention is best in patients operated for bilateral acoustic neuroma for hearing rehabilitation?

Auditory brainstem implant (ABI). ***Auditory brainstem implant (ABI)*** - Patients with bilateral acoustic neuromas often suffer damage to both **auditory nerves** during surgery, rendering cochlear implants ineffective. - The **ABI** bypasses the damaged auditory nerves and directly stimulates the **cochlear nucleus** in the brainstem, allowing for sound perception. *Bilateral cochlear implant* - This intervention is suitable when the **auditory nerve** remains intact and functional, which is typically not the case after bilateral acoustic neuroma surgery. - Cochlear implants depend on the integrity of the auditory nerve to transmit electrical signals to the brain. *Unilateral cochlear implant* - Similar to bilateral cochlear implants, a unilateral implant relies on a functional **auditory nerve** on the implanted side. - In bilateral acoustic neuroma, both auditory nerves are usually compromised or sacrificed, making a unilateral implant unsuitable for binaural hearing rehabilitation. *High power hearing aid* - Hearing aids only amplify sound and are effective for **sensorineural hearing loss** where the cochlea and auditory nerve are still functional. - They would not be beneficial in cases where the auditory nerve is damaged or absent, as occurs after bilateral acoustic neuroma removal.

Question 1

Recruitment phenomenon is seen in:

Accepted Answer

Meniere's disease

Answer

Otitis media with effusion

Answer

Otosclerosis

Answer

Acoustic nerve schwannoma

Question 2

Carhart's notch in audiometry is seen in -

Accepted Answer

Otosclerosis

Answer

Ossicular discontinuity

Answer

Otomycosis

Answer

Haemotympanum

Question 3

According to the WHO definition of hearing loss, what is the value to classify as profound hearing loss?

Accepted Answer

>91 dB

Answer

61-71 dB

Answer

>101 dB

Answer

>81 dB

Question 4

Bilateral Rinne test +ve and Weber test lateralized to right with a shortened Schwabach test on left side suggests ?

Accepted Answer

Left inner ear pathology

Answer

Right middle ear pathology

Answer

Right inner ear pathology

Answer

Left middle ear pathology

Question 5

Which test is used to assess Neonatal hearing loss?

Accepted Answer

Otoacoustic emissions

Answer

SISI

Answer

Rinne's Test

Answer

Calorie Test

Question 6

Which is the investigation of choice in assessing hearing loss in neonates -

Accepted Answer

Brainstem Evoked Response Audiometry (BERA)

Answer

Behavioral audiometry

Answer

Impedance audiometry

Answer

Free field audiometry

Question 7

Trough-shaped curve in audiometry is seen in:

Accepted Answer

Congenital SNHL

Answer

Acoustic neuroma

Answer

Otitis media

Answer

Otosclerosis

Question 8

Otoacoustic emission arises from?

Accepted Answer

Outer hair cell

Answer

Organ of otolith

Answer

Inner hair cell

Answer

Reissner's membrane

Question 9

In pure tone audiogram the symbol X is used to mark:

Accepted Answer

Air conduction in left ear

Answer

Bone conduction in right ear

Answer

No response in air conduction in right ear

Answer

Air conduction in right ear

Question 10

Which intervention is best in patients operated for bilateral acoustic neuroma for hearing rehabilitation?

Accepted Answer

Auditory brainstem implant (ABI)

Answer

Bilateral cochlear implant

Answer

Unilateral cochlear implant

Answer

High power hearing aid

Audiology and Speech Disorders — MCQs

Audiology and Speech Disorders — MCQs

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