Hearing Aids — MCQs
Which of the following is not a function of the instrument given below?
According to WHO classification, severe degree of hearing impairment occurs at -
Which of the following statements about Bone Anchored Hearing Aids (BAHA) is true?
Tests of SNHL are characterized by all EXCEPT
Cochlear implants are primarily indicated for which of the following conditions?
Hearing loss of 65dB, what is the grade of deafness?
Which of the following tests is used to differentiate between cochlear and retrocochlear hearing loss?
A child aged 3 yrs, presented with severe sensorineural deafness was prescribed hearing aids, but showed no improvement. What is the next line of management:
Hearing loss at 65 dB HL, what will be the grade of deafness?
Which of the following interventions is least appropriate for an 8-year-old boy with bilateral sensorineural hearing loss?
Hearing Aids Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is not a function of the instrument given below?
- A. To predict speech reception threshold
- B. To find degree of handicap
- C. To measure the threshold of hearing by bone conduction only (Correct Answer)
- D. Records can be kept for future reference
Explanation: ***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.
Question 2: According to WHO classification, severe degree of hearing impairment occurs at -
- A. 41-55 dB
- B. 56-70 dB
- C. 26-40 dB
- D. 71-90 dB (Correct Answer)
Explanation: ***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.
Question 3: Which of the following statements about Bone Anchored Hearing Aids (BAHA) is true?
- A. It transmits sound through air conduction, making it ideal for sensorineural hearing loss.
- B. It is useful in patients with canal atresia and microtia. (Correct Answer)
- C. It is used after surgery for acoustic neuroma in neurofibromatosis type 2.
- D. It is beneficial for patients with bilateral severe sensorineural hearing loss.
Explanation: ***It is useful in patients with canal atresia and microtia.*** - BAHA operates by **bone conduction**, bypassing the external auditory canal and middle ear structures. - This makes it an ideal solution for conductive hearing loss caused by malformations like **canal atresia** and **microtia**, where air conduction is impaired. - BAHA is particularly effective when the cochlea is functional but sound cannot reach it via normal air conduction pathways. *It transmits sound through air conduction, making it ideal for sensorineural hearing loss.* - This statement is incorrect on both counts. - BAHA uses **bone conduction**, not air conduction. - BAHA is primarily indicated for **conductive or mixed hearing loss**, not sensorineural hearing loss, as it requires a functional cochlea. *It is used after surgery for acoustic neuroma in neurofibromatosis type 2.* - After acoustic neuroma surgery, especially in Neurofibromatosis type 2, the primary concern is often **unilateral sensorineural hearing loss** or **single-sided deafness**. - While BAHA can be used for single-sided deafness, the first-line option for single-sided deafness is **Cochlear Implants (CIs)** or contralateral routing of signal (CROS) hearing aids. *It is beneficial for patients with bilateral severe sensorineural hearing loss.* - For **bilateral severe sensorineural hearing loss**, the primary intervention is typically **cochlear implantation**, not BAHA. - BAHA is less effective for severe sensorineural loss because it still relies on a functional cochlea to convert bone-conducted vibrations into neural signals.
Question 4: Tests of SNHL are characterized by all EXCEPT
- A. Positive Rinne test
- B. Speech discrimination is good (Correct Answer)
- C. Weber lateralised to better ear
- D. More often involving high frequencies
Explanation: ***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 5: Cochlear implants are primarily indicated for which of the following conditions?
- A. Sensorineural deafness (Correct Answer)
- B. Conductive deafness
- C. Mixed deafness
- D. Absent pinna
Explanation: ***Sensorineural deafness*** - **Cochlear implants** are prosthetic devices that electrically stimulate the **auditory nerve**, bypassing damaged hair cells in the **cochlea**. - They are primarily indicated for individuals with **severe to profound sensorineural hearing loss** who do not benefit adequately from conventional hearing aids. - This is the gold standard indication for cochlear implantation in both adults and children. *Conductive deafness* - **Conductive hearing loss** occurs when sound waves cannot reach the inner ear due to problems in the outer or middle ear (e.g., **otosclerosis**, **perforated eardrum**). - This type of hearing loss is typically treatable with **hearing aids**, surgery, or bone-anchored hearing systems, as the inner ear and auditory nerve are still functional. *Mixed deafness* - **Mixed hearing loss** involves elements of both **conductive** and **sensorineural hearing loss**. - While a profound sensorineural component might eventually warrant a cochlear implant, initial treatment often focuses on addressing the conductive component first, or using hearing aids for both aspects. - Not the **primary** indication for cochlear implants. *Absent pinna* - An **absent pinna** (microtia or anotia) represents a developmental anomaly of the external ear, primarily affecting **cosmetics** and potentially causing **conductive hearing loss** if the ear canal or middle ear structures are also affected. - It does not indicate the need for a **cochlear implant**, as the inner ear and auditory nerve may be perfectly healthy.
Question 6: Hearing loss of 65dB, what is the grade of deafness?
- A. Mild
- B. Moderate
- C. Severe
- D. Moderately severe (Correct Answer)
Explanation: ***Moderately severe*** - A hearing loss of **65 dB** falls within the range defined as moderately severe. - The moderately severe range typically spans from **56 dB to 70 dB** in conventional audiometric classifications. *Mild* - **Mild hearing loss** is characterized by a threshold between **26 dB and 40 dB**. - Individuals with mild hearing loss may struggle with soft sounds or speech in noisy environments. *Moderate* - **Moderate hearing loss** is defined by a threshold between **41 dB and 55 dB**. - This level of loss causes difficulty understanding normal conversation without amplification. *Severe* - **Severe hearing loss** is characterized by a threshold between **71 dB and 90 dB**. - Individuals with severe hearing loss often require powerful hearing aids or other assistive listening devices.
Question 7: Which of the following tests is used to differentiate between cochlear and retrocochlear hearing loss?
- A. Recruitment
- B. Threshold tone decay test
- C. Evoked response audiometry (Correct Answer)
- D. SISI test
Explanation: **Evoked response audiometry** - **Evoked response audiometry (ERA)**, specifically **Auditory Brainstem Response (ABR)** or **Brainstem Evoked Response Audiometry (BERA)**, is the gold standard for differentiating between cochlear and retrocochlear hearing loss. - ABR measures electrical activity from the auditory nerve and brainstem in response to sound, allowing for differentiation between **cochlear pathology** (normal ABR latencies with hearing loss) and **retrocochlear pathology** (prolonged interpeak latencies, absent waves, or abnormal waveform morphology suggestive of auditory nerve or brainstem lesion). - Classic findings in retrocochlear lesions include prolonged I-V interpeak latency or absent Wave V. *SISI test* - The **Short Increment Sensitivity Index (SISI) test** assesses the ability to detect small (1 dB) increments in sound intensity superimposed on a continuous tone. - A **high SISI score (>70%)** indicates **cochlear dysfunction** due to recruitment phenomenon, while a **low score (<20%)** may suggest retrocochlear pathology. - However, it does not directly differentiate between cochlear and retrocochlear lesions with the same specificity and sensitivity as ABR. *Threshold tone decay test* - The **Tone Decay Test (TDT)** measures the ability to sustain the perception of a continuous pure tone presented at or near threshold level. - **Significant tone decay (>30 dB in 60 seconds)** suggests **retrocochlear pathology** due to auditory nerve fatigue, making it useful for screening. - While helpful, it is less precise, sensitive, and specific than ABR for definitive differentiation and may have false positives. *Recruitment* - **Recruitment** is an abnormal growth in the perception of loudness, where a small increase in sound intensity leads to a disproportionately large increase in perceived loudness. - It is a classic sign of **cochlear hearing loss**, particularly associated with outer hair cell damage (sensory hearing loss). - Its presence confirms cochlear pathology but its absence does not confirm retrocochlear lesions, making it less reliable as a differentiating test compared to ABR.
Question 8: A child aged 3 yrs, presented with severe sensorineural deafness was prescribed hearing aids, but showed no improvement. What is the next line of management:
- A. Conservative
- B. Fenestration surgery
- C. Stapes mobilisation
- D. Cochlear implant (Correct Answer)
Explanation: ***Cochlear implant*** - For **severe sensorineural deafness** where conventional hearing aids provide no benefit, a cochlear implant is the most effective next step for restoring hearing. - A cochlear implant directly stimulates the **auditory nerve**, bypassing damaged hair cells in the cochlea, which is crucial for severe sensorineural hearing loss. - In children aged **12 months to 5 years**, early cochlear implantation is critical for optimal **speech and language development**. *Conservative* - This typically refers to observation or non-invasive treatments like hearing aids, which have already failed in this case. - Continuing a conservative approach would delay effective intervention for severe deafness, potentially impacting the child's **speech and language development**. *Fenestration surgery* - This is a surgical procedure primarily used for some types of **conductive hearing loss**, especially **otosclerosis**, by creating an opening in the bony labyrinth. - It is not indicated for **sensorineural deafness**, as the problem lies with the inner ear or auditory nerve, not the sound conduction pathway. *Stapes mobilisation* - This procedure aims to restore mobility to the **stapes bone** in cases of **otosclerosis**, a form of conductive hearing loss where the stapes becomes fixed. - It is not appropriate for **sensorineural hearing loss**, where the primary issue is damage to the inner ear's sensory cells or the auditory nerve.
Question 9: Hearing loss at 65 dB HL, what will be the grade of deafness?
- A. Mild
- B. Moderately severe
- C. Severe (Correct Answer)
- D. Moderate
Explanation: ***Severe*** - A hearing loss at **65 dB HL** falls within the range classified as **severe hearing loss** according to the **WHO classification**. - The WHO classification defines **severe hearing loss** as **61-80 dB HL**, making 65 dB a clear fit. - This is the most widely accepted international standard and commonly used in Indian medical education. *Mild* - **Mild hearing loss** is characterized by hearing thresholds between **26-40 dB HL**. - A 65 dB loss significantly exceeds this range, indicating much more pronounced impairment. *Moderate* - **Moderate hearing loss** is defined by hearing thresholds between **41-60 dB HL** (WHO classification). - Since 65 dB exceeds 60 dB, it does not meet the criteria for moderate hearing loss. *Moderately severe* - This category exists in some classification systems (ASHA: 56-70 dB) but is **not part of the WHO classification**. - The WHO classification, which is the **international standard**, uses: Mild (26-40), Moderate (41-60), Severe (61-80), and Profound (>80 dB HL). - For standardized medical exams, the WHO classification is preferred.
Question 10: Which of the following interventions is least appropriate for an 8-year-old boy with bilateral sensorineural hearing loss?
- A. Adenoidectomy with grommet insertion (Correct Answer)
- B. Hearing aid
- C. Cochlear implant
- D. Preferential sitting in the classroom
Explanation: ***Adenoidectomy with grommet insertion*** - This procedure addresses **conductive hearing loss** (e.g., due to **otitis media with effusion**), while the boy has **sensorineural hearing loss (SNHL)**. - **Grommet insertion** (tympanostomy tubes) is used to improve middle ear ventilation and drain fluid, which is irrelevant for SNHL. *Hearing aid* - A **hearing aid** amplifies sound and is a common and appropriate intervention for **sensorineural hearing loss**, especially for mild to severe cases. - It can significantly improve a child's ability to hear and develop speech. *Cochlear implant* - A **cochlear implant** is appropriate for children with **severe to profound sensorineural hearing loss** who do not benefit sufficiently from hearing aids. - It directly stimulates the auditory nerve, bypassing damaged parts of the inner ear. *Preferential sitting in the classroom* - This is a simple and effective **accommodative strategy** to improve a child's listening environment and is appropriate for any degree of hearing loss. - It helps the child to better hear the teacher and participate in classroom discussions.
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