Audiology and Speech Disorders Practice Questions

Q: A patient with hearing loss of 70 dB is LEAST likely to hear which of the following sounds?

Rustling of leaves. ***Rustling of leaves*** - A hearing loss of 70 dB indicates **severe hearing impairment**, meaning the patient cannot hear sounds quieter than 70 dB. - The **rustling of leaves** produces sound at approximately **10-20 dB**, which is **50-60 dB below the patient's hearing threshold**. - This makes it **completely inaudible** to the patient and the least likely sound to be heard. *Noisy street at night* - A noisy street at night typically produces sounds in the range of **50-70 dB**. - This is **at or below the hearing threshold**, making it difficult or impossible to hear. - However, it is louder than rustling leaves and closer to the threshold. *Sound of Niagara Falls* - The sound of Niagara Falls is extremely loud, typically **90-100 dB**. - This is **20-30 dB above the patient's hearing threshold**, making it **clearly audible**. *Start of car engine at 10 feet* - A car engine starting at 10 feet produces sound at approximately **70-80 dB**. - This is **at or slightly above the hearing threshold**, making it **potentially audible**, though possibly perceived as quiet.

Q: Positive Rinne test is seen in -

Presbycusis. ***Presbycusis*** - A **positive Rinne test** indicates that **air conduction is better than bone conduction (AC > BC)**, which is normal. - In presbycusis, which is a **sensorineural hearing loss**, the inner ear is affected. While hearing is impaired, the *relationship between air and bone conduction remains normal*, thus a positive Rinne test is maintained. *Wax impacted ear* - This causes a **conductive hearing loss** by obstructing the ear canal. - In conductive hearing loss, **bone conduction is better than air conduction (BC > AC)**, resulting in a **negative Rinne test**. *CSOM* - **Chronic Suppurative Otitis Media (CSOM)** involves infection and perforation of the tympanic membrane and/or damage to ossicles. - This leads to **conductive hearing loss**, where **bone conduction is better than air conduction**, resulting in a **negative Rinne test**. *Otosclerosis* - This condition involves **abnormal bone growth** in the middle ear, particularly around the stapes footplate, leading to fixation. - It causes a **conductive hearing loss**, characterized by **bone conduction being better than air conduction**, meaning a **negative Rinne test**.

Q: Average hearing at 500, 1000, 2000 Hz is 45 dB in the left ear. What is the percentage hearing loss in the left ear, when 25 dB loss is considered normal?

0.3. ### **0.3** * To calculate the percentage of hearing loss, subtract the **normal hearing threshold** (25 dB) from the **average hearing loss** (45 dB): 45 dB - 25 dB = 20 dB. * This **20 dB excess loss** is then divided by the total range for calculating percentage, which is typically 60 dB. Thus, 20 dB / 60 dB = **0.33** or 30%, which is closest to 0.3. ### *0.45* * This value incorrectly uses the absolute average hearing loss (45 dB) without adjusting for the **normal hearing threshold** (25 dB). * The calculation of percentage hearing loss requires considering the amount of hearing loss *above* the normal threshold, not the total average hearing. ### *0.2* * This response potentially arises from an incorrect assumption about the **normal hearing threshold** or the total range used in the calculation. * It does not correctly account for the 25 dB considered normal hearing, or it applies an incorrect denominator for the percentage calculation. ### *0.4* * This result might stem from a miscalculation of the **excess hearing loss** or an incorrect **denominator** for normalizing the percentage. * It does not accurately reflect the difference between the observed hearing loss and the normal threshold, nor the standard range for calculating percentage hearing impairment.

Q: Which of the following is not a function of the instrument given below?

To measure the threshold of hearing by bone conduction only. ***To measure the threshold of hearing by bone conduction only*** - This instrument, an **audiometer**, measures hearing thresholds for both **air conduction and bone conduction**, not exclusively bone conduction. - Measurement of both pathways is crucial to differentiate between **conductive, sensorineural, and mixed hearing loss**. *To predict speech reception threshold* - An audiometer can generate pure tones and speech stimuli, which are essential for determining the **Speech Reception Threshold (SRT)**. - SRT is a key measure in audiology to predict a person's ability to **understand speech**. *To find degree of handicap* - While not directly measuring a "handicap," the **audiogram** produced by this instrument, along with other audiometric tests, helps in assessing the **functional impact of hearing loss**. - This information contributes to understanding the overall **degree of impairment** and guiding rehabilitation. *Records can be kept for future reference* - Modern audiometers like the one pictured typically have internal memory or can be connected to computers to **store and retrieve patient data**. - This feature is vital for **monitoring hearing changes over time**, evaluating treatment efficacy, and legal or insurance purposes.

Q: The "O" sign in a pure tone audiogram indicates -

Air conduction of right ear. ***Air conduction of right ear*** - The "O" symbol is the standard graphical representation for **air conduction thresholds** in the **right ear** on a pure tone audiogram. - It indicates the softest sound intensity (in dB HL) at which a patient can detect a pure tone when sound is delivered through headphones. *Air conduction of left ear* - Air conduction thresholds for the left ear are typically represented by an **"X" symbol** on a pure tone audiogram. - This symbol, along with "O," helps differentiate hearing levels between the two ears for air conduction. *Bone conduction of left ear* - Bone conduction thresholds for the left ear are usually represented by a **">" symbol** (unmasked) or a **"]" symbol** (masked) on a pure tone audiogram. - These symbols show how well the inner ear responds to sound vibrations transmitted directly through the skull, bypassing the middle ear. *Bone conduction of right ear* - Bone conduction thresholds for the right ear are commonly represented by a **"<" symbol** (unmasked) or a **"[" symbol** (masked) on a pure tone audiogram. - These symbols are crucial for determining the type of hearing loss (e.g., conductive, sensorineural, or mixed) by comparing them with air conduction thresholds.

Q: Tuning fork of 512 Hz is used to test the hearing because it is -

Better heard. ***Better heard*** - A 512 Hz tuning fork produces a frequency that falls within the range of **optimal human hearing sensitivity** (around 500 Hz to 4000 Hz), making it clearly perceptible for hearing tests. - **Key clinical advantage**: 512 Hz minimizes **tactile bone vibration** compared to lower frequencies (128 Hz or 256 Hz), which are "better felt" than heard, making 512 Hz more specific for testing actual auditory perception. - This frequency allows for accurate assessment of **conductive** and **sensorineural hearing loss** using Rinne and Weber tests. - It produces fewer **overtones** compared to higher frequencies, ensuring a clear fundamental tone for testing. *Produces overtones* - While all tuning forks produce some **overtones** (harmonics), 512 Hz produces relatively fewer overtones compared to higher frequencies. - The primary reason for choosing 512 Hz is **not** its overtone production but rather its clear fundamental tone and optimal audibility. - Excessive overtones can interfere with the clarity of hearing assessment. *Better felt* - This describes **lower frequency tuning forks** (128 Hz, 256 Hz), which produce more **bone vibration** that can be felt tactilely. - 512 Hz is specifically chosen because it minimizes this tactile sensation, making it a **better auditory test** rather than a vibration test. - The goal of hearing tests is to assess **auditory perception**, not tactile sensation. *Not heard* - This statement is incorrect; a 512 Hz tuning fork is specifically chosen because its frequency is **well within the human auditory range** and is easily heard. - If a patient cannot hear this frequency, it indicates potential **hearing impairment**, which is the goal of the test to identify.

Q: According to WHO classification, severe degree of hearing impairment occurs at -

71-90 dB. ***71-90 dB*** - According to the **WHO classification** of hearing impairment, a hearing loss in the range of **71-90 dB** is categorized as **severe hearing impairment**. - Individuals with severe hearing impairment typically require **hearing aids** or other assistive listening devices, and may struggle to follow conversational speech even with amplification. *41-55 dB* - This range corresponds to **moderate hearing loss** according to the WHO classification. - Individuals may have difficulty understanding normal speech, especially in noisy environments, but can often communicate with amplification. *56-70 dB* - This range is classified as **moderately severe hearing loss** by the WHO. - Speech understanding is significantly impaired, and individuals typically rely heavily on amplification. *26-40 dB* - This range is considered **mild hearing loss** by the WHO. - Individuals may have difficulty hearing faint speech or speech in background noise, but usually manage well in quiet settings.

Q: Carhart's notch in audiogram is seen at which frequency?

2 KHz. ***2 KHz*** - **Carhart's notch** is a characteristic **ipsilateral bone conduction threshold elevation** observed in patients with **otosclerosis** at **2000 Hz (2 KHz)**. - This notch disappears after successful **stapedectomy**, indicating its origin in the **ossicular chain fixation**. *4 KHz* - A **notch at 4 KHz** is typically seen in **noise-induced hearing loss (NIHL)**, not otosclerosis, and reflects damage to the **cochlear hair cells**. - This type of notch is associated with **sensorineural hearing loss**, whereas Carhart's notch is a feature of **conductive hearing loss** with a specific bone conduction anomaly. *8 KHz* - Hearing loss at **8 KHz** often indicates **presbycusis** (age-related hearing loss) or other forms of **high-frequency sensorineural hearing loss**. - It is not a characteristic feature of **Carhart's notch** or **otosclerosis**. *0.5 KHz* - Hearing loss at **0.5 KHz (500 Hz)** is common in various conditions causing **low-frequency conductive hearing loss**, such as **otitis media with effusion**. - While otosclerosis can cause low-frequency hearing loss, the specific **Carhart's notch** is observed at **2 KHz**, not 0.5 KHz.

Q: All are tuning fork test except-

Pure tone audiometry. ***Pure tone audiometry*** - This is an **objective test** that uses an audiometer to measure hearing thresholds at various frequencies, determining the degree and type of hearing loss. - It does not involve the use of a **tuning fork** but rather headphones or bone oscillators connected to specialized equipment. *Rinne's test* - This is a **tuning fork test** that compares **air conduction** and **bone conduction** in one ear. - A tuning fork is first placed on the mastoid process and then held near the ear canal to determine which sound is heard longer. *Schwabach test* - The Schwabach test is a **tuning fork test** that compares the **bone conduction** of the patient with that of the examiner. - It assesses the duration of sound perception via bone conduction for both the patient and a normal hearing individual. *Weber's test* - This is a **tuning fork test** that assesses **lateralization of sound** when the tuning fork is placed on the middle of the forehead. - It helps distinguish between conductive and sensorineural hearing loss by indicating which ear hears the sound louder or if it's heard equally in both ears.

Q: Tests of SNHL are characterized by all EXCEPT

Speech discrimination is good. ***Speech discrimination is good*** - In **sensorineural hearing loss (SNHL)**, damage to the cochlea or auditory nerve specifically impairs the processing of complex sound signals. - This typically leads to **poor speech discrimination**, particularly in noisy environments, making it difficult to understand spoken words even when the volume is adequate. - **This is NOT characteristic of SNHL**, making it the correct answer to this EXCEPT question. ***Positive Rinne test*** - A **positive Rinne test** (air conduction > bone conduction) **is characteristic of SNHL**. - In SNHL, both air and bone conduction are reduced equally, but air conduction remains better than bone conduction, maintaining the positive Rinne pattern. - There is **no air-bone gap** in SNHL (unlike conductive hearing loss where Rinne becomes negative). ***Weber lateralised to better ear*** - In **unilateral SNHL**, the **Weber test lateralizes to the better-hearing ear** because the healthy cochlea perceives the sound vibration more strongly. - The damaged ear is less able to detect the bone-conducted sound, causing the perception that the sound is louder in the unaffected ear. - **This is characteristic of SNHL**. ***More often involving high frequencies*** - **SNHL often affects high frequencies first** due to specific vulnerabilities of the **basal turn of the cochlea** to age-related degeneration, noise exposure, and ototoxic drugs. - This pattern of hearing loss is common in **presbycusis** and noise-induced hearing loss. - **This is characteristic of SNHL**.

Question 1

A patient with hearing loss of 70 dB is LEAST likely to hear which of the following sounds?

Accepted Answer

Rustling of leaves

Answer

Noisy street at night

Answer

Sound of Niagara falls

Answer

Start of car engine at 10 feet

Question 2

Positive Rinne test is seen in -

Accepted Answer

Presbycusis

Answer

Wax impacted ear

Answer

CSOM

Answer

Otosclerosis

Question 3

Average hearing at 500, 1000, 2000 Hz is 45 dB in the left ear. What is the percentage hearing loss in the left ear, when 25 dB loss is considered normal?

Accepted Answer

0.3

Answer

0.45

Answer

0.2

Answer

0.4

Question 4

Which of the following is not a function of the instrument given below?

Accepted Answer

To measure the threshold of hearing by bone conduction only

Answer

To predict speech reception threshold

Answer

To find degree of handicap

Answer

Records can be kept for future reference

Question 5

The "O" sign in a pure tone audiogram indicates -

Accepted Answer

Air conduction of right ear

Answer

Air conduction of left ear

Answer

Bone conduction of left ear

Answer

Bone conduction of right ear

Question 6

Tuning fork of 512 Hz is used to test the hearing because it is -

Accepted Answer

Better heard

Answer

Produces overtones

Answer

Better felt

Answer

Not heard

Question 7

According to WHO classification, severe degree of hearing impairment occurs at -

Accepted Answer

71-90 dB

Answer

41-55 dB

Answer

56-70 dB

Answer

26-40 dB

Question 8

Carhart's notch in audiogram is seen at which frequency?

Accepted Answer

2 KHz

Answer

4 KHz

Answer

8 KHz

Answer

0.5 KHz

Question 9

All are tuning fork test except-

Accepted Answer

Pure tone audiometry

Answer

Rinne's test

Answer

Schwabach test

Answer

Weber's test

Question 10

Tests of SNHL are characterized by all EXCEPT

Accepted Answer

Speech discrimination is good

Answer

Positive Rinne test

Answer

Weber lateralised to better ear

Answer

More often involving high frequencies

Audiology and Speech Disorders — MCQs

Audiology and Speech Disorders — MCQs

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