Hearing Assessment Techniques — MCQs
To distinguish between cochlear and post-cochlear damage, which test is done?
Which of the following is used for initial screening of auditory function in a neonate?
Rinne's test was negative in the right ear. What is the possible diagnosis?
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?
Which of the following tests assesses resistance in the middle ear?
Dip at 4000 Hz in pure tone audiometry indicates:
Tests of SNHL are characterized by all EXCEPT
What is the primary purpose of the Bing test in audiology?
Which of the following is not a function of the instrument given below?
Hearing Assessment Techniques Indian Medical PG Practice Questions and MCQs
Question 1: To distinguish between cochlear and post-cochlear damage, which test is done?
- A. Auditory brainstem response (ABR) (Correct Answer)
- B. Impedance audiometry
- C. Pure tone audiometry
- D. Electrocochleography (ECochG)
Explanation: ***Auditory brainstem response (ABR)*** - This test evaluates the integrity of the **auditory pathway from the cochlea through the brainstem**, making it excellent for differentiating between cochlear (sensory) and post-cochlear (retrocochlear/neural) lesions. - Abnormalities in wave latencies or interpeak intervals suggest **retrocochlear pathology** (e.g., acoustic neuroma), while normal ABR responses despite hearing loss point towards cochlear damage. - ABR records **five characteristic waves (I-V)** representing neural transmission from the auditory nerve through the brainstem. *Impedance audiometry* - Primarily assesses the **middle ear function**, including the eardrum and ossicles, by measuring **tympanic membrane compliance** and **acoustic reflexes**. - It does not directly evaluate the function of the **cochlea or the retrocochlear pathways**, making it unsuitable for this differentiation. *Pure tone audiometry* - Measures a person's **hearing sensitivity** at different frequencies and provides information on the **degree and type of hearing loss (conductive, sensorineural, or mixed)**. - While it identifies sensorineural hearing loss, it cannot pinpoint whether the damage is **cochlear or retrocochlear** within the sensorineural category. *Electrocochleography (ECochG)* - Records **electrical potentials generated by the cochlea and auditory nerve** in response to sound, including **cochlear microphonics, summating potentials, and compound action potentials**. - While it evaluates cochlear function and is useful in diagnosing **Meniere's disease** and **auditory neuropathy**, it does not adequately assess the **integrity of the brainstem auditory pathways** needed to differentiate retrocochlear lesions.
Question 2: Which of the following is used for initial screening of auditory function in a neonate?
- A. Otoacoustic emission (OAE) (Correct Answer)
- B. Auditory brainstem response (ABR)
- C. Pure tone audiometry (PTA)
- D. Free field audiometry
Explanation: ***Otoacoustic emission (OAE)*** - **OAE** is the **gold standard for universal newborn hearing screening (UNHS)** programs worldwide due to its **non-invasive nature**, speed, and cost-effectiveness. - The test measures **sound waves produced by the outer hair cells of the cochlea** in response to auditory stimuli, indicating normal cochlear function. - **Quick to perform (2-3 minutes)**, requires minimal cooperation, and can be done while the infant is sleeping. *Auditory brainstem response (ABR)* - While **ABR** is a definitive diagnostic test for hearing loss, it is typically used as a **second-stage test** if an OAE screening fails, rather than the initial screening tool. - ABR measures the **brain's response to sound**, providing information about the neural pathway from the cochlea to the brainstem. - More **time-consuming and expensive** than OAE, making it less suitable for mass screening. *Pure tone audiometry (PTA)* - **PTA** requires active participation and understanding of instructions, making it **unsuitable for neonates** and young children. - This test is primarily used for **older children (typically >4 years) and adults** to determine hearing thresholds across various frequencies. *Free field audiometry* - **Free field audiometry** involves presenting sounds through loudspeakers to assess hearing, but it is **not suitable for precise threshold determination** in neonates due to their inability to localize sounds reliably or respond consistently. - It's mainly used for behavioral observation audiometry in older infants (6-24 months), but **not as a primary screening method** for neonates.
Question 3: Rinne's test was negative in the right ear. What is the possible diagnosis?
- A. Profound hearing loss right ear, left ear normal
- B. 40 dB CHL in both ears
- C. 40 dB SNHL in left ear, right ear normal
- D. 40 dB CHL right ear, left normal (Correct Answer)
Explanation: ***40 dB CHL right ear, left normal*** - A **negative Rinne's test** indicates that **bone conduction is better than air conduction**, which is characteristic of a **conductive hearing loss (CHL)** in the tested ear. - For Rinne's test to be negative, the conductive hearing loss usually needs to be at least **25-30 dB**, making **40 dB CHL** a plausible diagnosis. - This correctly identifies the **right ear** as the affected ear with conductive pathology. *40 dB SNHL in left ear, right ear normal* - A **negative Rinne's test** in the **right ear** means the issue is in the right ear, not the left. - **Sensorineural hearing loss (SNHL)** typically results in a **positive Rinne's test** (air conduction better than bone conduction) as both air and bone conduction are equally reduced. - This option incorrectly identifies the left ear and wrong type of hearing loss. *40 dB CHL in both ears* - While a negative Rinne's test indicates CHL, it specifically points to the ear being tested (the **right ear** in this case). - There is no information from a unilateral Rinne's test to suggest CHL in the **left ear** as well. - This represents over-interpretation of a unilateral test finding. *Profound hearing loss right ear, left ear normal* - A **profound hearing loss** (particularly severe SNHL) in the right ear could result in a false-negative Rinne's test where bone conduction is picked up by the contralateral ear. - However, a negative Rinne's test without additional context more specifically indicates **moderate conductive hearing loss (40 dB CHL)** rather than profound loss. - The term "profound" is also imprecise without specifying the type of hearing loss.
Question 4: 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 5: 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 6: Which of the following tests assesses resistance in the middle ear?
- A. Pure tone audiometry
- B. Caloric test
- C. BERA (Brainstem evoked response audiometry)
- D. Impedance audiometry (Correct Answer)
Explanation: ***Impedance audiometry*** - This test measures the **impedance** (resistance) of the middle ear and the mobility of the **tympanic membrane** and **ossicular chain** - It also assesses the **acoustic reflex**, which is the contraction of the middle ear muscles in response to loud sound, providing information about the middle ear and auditory pathways *Pure tone audiometry* - This test measures an individual's **hearing sensitivity** across different frequencies - It assesses the **thresholds of hearing** for air conduction and bone conduction, but does not directly measure middle ear resistance *Caloric test* - The caloric test evaluates the function of the **vestibular system** and the **horizontal semicircular canal** - It involves introducing warm or cold water/air into the ear canal to induce nystagmus, but does not assess middle ear resistance *BERA (Brainstem evoked response audiometry)* - BERA measures the **electrical activity** in the auditory pathway from the cochlea to the brainstem in response to auditory stimuli - It is used to assess hearing in infants, differentiate between **sensory** and **neural hearing loss**, and detect neurological disorders, but does not measure middle ear impedance
Question 7: Dip at 4000 Hz in pure tone audiometry indicates:
- A. Meniere's disease
- B. Age related hearing loss
- C. Otosclerosis
- D. Noise induced hearing loss (Correct Answer)
Explanation: ***Noise induced hearing loss*** - A characteristic **"4 kHz Notch"** or dip in the audiogram is a hallmark of **noise-induced hearing loss**, resulting from damage to the **cochlear hair cells** in this frequency range. - This specific frequency is most susceptible to damage from loud noise exposure due to the physical properties of the **basilar membrane**. *Meniere's disease* - Typically presents with **low-frequency hearing loss**, often fluctuating, along with **tinnitus**, **vertigo**, and a feeling of **aural fullness**. - A dip at 4000 Hz is not a characteristic audiometric finding for **Meniere's disease**. *Age related hearing loss* - Also known as **presbycusis**, it is typically a **symmetrical, progressive, sensorineural hearing loss** that primarily affects **higher frequencies**, but it usually presents as a more gradual slope rather than a sharp dip at a specific frequency like 4 kHz. - While high frequencies are affected, the pattern is usually a broader high-frequency loss, not an isolated notch. *Otosclerosis* - This condition is a form of **conductive hearing loss** (though it can have a sensorineural component in advanced stages) due to abnormal bone growth around the **stapes footplate**. - Its classic audiometric finding is a **Carhart notch** around 2000 Hz, with a conductive hearing loss pattern, rather than a sensorineural dip at 4000 Hz.
Question 8: 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 9: What is the primary purpose of the Bing test in audiology?
- A. Assessing overall hearing ability through audiometry
- B. Evaluating sound conduction through air
- C. A general term for various hearing assessments
- D. Determining the effect of ear canal occlusion on sound conduction (Correct Answer)
Explanation: ***Determining the effect of ear canal occlusion on sound conduction*** - The Bing test specifically assesses how **occluding the ear canal** (using a finger or probe) affects the perception of **bone-conducted sound** from a tuning fork placed on the mastoid. - This test evaluates the **occlusion effect**, which is the increase in loudness of bone-conducted sound when the ear canal is occluded. - In **normal hearing** or **sensorineural hearing loss**, occluding the ear canal makes the bone-conducted sound louder (positive Bing test). - In **conductive hearing loss**, there is no change or the sound becomes softer (negative Bing test), as the conductive pathology already creates an occlusion-like effect. - This helps differentiate between **conductive** and **sensorineural hearing loss**. *Assessing overall hearing ability through audiometry* - **Audiometry** is a broad term encompassing various tests to quantify hearing sensitivity across different frequencies. - While the Bing test is part of audiological assessment, its primary purpose is not to determine overall hearing ability but rather to assess the occlusion effect. *Evaluating sound conduction through air* - Tests like **air conduction audiometry** directly evaluate the transmission of sound through the outer and middle ear via air. - The Bing test primarily focuses on **bone conduction** using a tuning fork on the mastoid, not air conduction. *A general term for various hearing assessments* - This statement describes a category of tests rather than the specific function of the Bing test. - The Bing test is a **specific diagnostic tuning fork test** with a defined purpose, not a general umbrella term.
Question 10: 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.
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