Audiology and Speech Disorders — MCQs

Audiology and Speech Disorders Indian Medical PG Practice Questions and MCQs

Question 121: A patient with hearing loss of 70 dB is LEAST likely to hear which of the following sounds?

A. Noisy street at night
B. Rustling of leaves (Correct Answer)
C. Sound of Niagara falls
D. Start of car engine at 10 feet

Explanation: ***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.

Question 122: 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?

A. 0.45
B. 0.2
C. 0.3 (Correct Answer)
D. 0.4

Explanation: ### **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.

Question 123: 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 124: The "O" sign in a pure tone audiogram indicates -

A. Air conduction of left ear
B. Bone conduction of left ear
C. Bone conduction of right ear
D. Air conduction of right ear (Correct Answer)

Explanation: ***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.

Question 125: 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 126: 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 127: Pure tone audiometry in presbycusis shows?

A. Conductive hearing loss
B. Normal study
C. Mixed hearing loss
D. Sensorineural hearing loss (Correct Answer)

Explanation: ***Sensorineural hearing loss*** - **Presbycusis** is age-related hearing loss that primarily affects the **inner ear**, specifically the cochlea and auditory nerve - Pure tone audiometry typically shows **bilateral, symmetrical high-frequency sensorineural hearing loss** that progresses over time - This is the characteristic audiometric pattern in presbycusis *Conductive hearing loss* - This type involves problems in the **outer or middle ear**, preventing sound from reaching the inner ear - Conditions like **otitis media** or **otosclerosis** cause conductive hearing loss - Not characteristic of presbycusis, which is an inner ear disorder *Normal study* - Would indicate no hearing impairment, inconsistent with the definition of **presbycusis** as age-related hearing loss - Presbycusis is a progressive condition with demonstrable hearing deficits on audiometry *Mixed hearing loss* - Involves components of both **conductive** and **sensorineural hearing loss** - While an older adult could have both types, the primary and defining characteristic of **presbycusis** is sensorineural damage, not mixed presentation

Question 128: Impedance audiometry is primarily used to assess?

A. Meniere's disease
B. Cholesteatoma
C. Pressure changes in middle ear (Correct Answer)
D. Otomycosis

Explanation: ***Pressure changes in middle ear*** - Impedance audiometry, particularly **tympanometry**, directly assesses the **compliance and pressure of the middle ear**, making it ideal for detecting changes due to fluid or Eustachian tube dysfunction. - It works by varying air pressure in the ear canal and measuring how much sound energy is reflected from the tympanic membrane, providing a graph (tympanogram) indicative of middle ear status. *Meniere's disease* - This condition involves **endolymphatic hydrops** within the inner ear, leading to fluctuating hearing loss, tinnitus, vertigo, and aural fullness. - While an audiogram would show a **low-frequency sensorineural hearing loss**, impedance audiometry typically shows a **normal tympanogram** unless there is a co-existing middle ear pathology. *Cholesteatoma* - A cholesteatoma is a **destructive, expanding growth** in the middle ear or mastoid, often presenting with chronic ear discharge and conductive hearing loss. - While it can lead to ossicular chain disruption or perforation, the primary diagnostic tools are **otoscope examination** and **CT scan**, with impedance audiometry showing a type B or C tympanogram if there's a perforation or ossicular discontinuity, but not as the primary diagnostic for the growth itself. *Otomycosis* - This is a **fungal infection of the external ear canal**, causing itching, pain, and a feeling of fullness, often visible on otoscopic examination. - Impedance audiometry would typically yield a **normal tympanogram** in otomycosis, as the middle ear is unaffected.

Question 129: 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 130: High-frequency audiometry is used in

A. Otosclerosis
B. Non-organic hearing loss
C. Ototoxicity (Correct Answer)
D. Meniere disease

Explanation: ***Ototoxicity*** - **High-frequency audiometry** is particularly sensitive to early detection of **ototoxicity** because many ototoxic drugs, such as aminoglycoside antibiotics and chemotherapeutic agents, damage the **outer hair cells** in the basal turn of the cochlea, which are responsible for high-frequency hearing. - This specialized audiometry can detect cochlear damage at frequencies above the conventional audiometric range (typically 8000 Hz), allowing for intervention before significant hearing loss occurs in the conventional frequency range. - Early detection enables dose modification or drug discontinuation to prevent irreversible hearing damage. *Otosclerosis* - Otosclerosis primarily involves **conductive hearing loss** due to fixation of the stapes, which is best evaluated by conventional audiometry showing an **air-bone gap** and often a **Carhart notch** around 2000 Hz. - While it can sometimes have sensorineural components, high-frequency audiometry is not its primary diagnostic tool. *Non-organic hearing loss* - **Non-organic hearing loss** (or functional hearing loss) refers to hearing loss that is not due to organic pathology and is often identified by inconsistencies in conventional audiometric tests, such as discrepancies between pure-tone thresholds and speech reception thresholds, or inconsistent responses during repeated testing. - High-frequency audiometry has no specific role in diagnosing this condition. *Meniere disease* - Meniere's disease is characterized by fluctuating **sensorineural hearing loss**, vertigo, tinnitus, and aural fullness, typically affecting the **lower frequencies** initially. - High-frequency audiometry is not routinely used for its diagnosis, as the characteristic hearing loss pattern is usually observed in the low to mid-frequency range.

Practice by Chapter

Hearing Assessment Techniques

Practice Questions

Tympanometry and Acoustic Reflexes

Practice Questions

Otoacoustic Emissions

Practice Questions

Auditory Brainstem Response

Practice Questions

Hearing Aids

Practice Questions

Cochlear Implants

Practice Questions

Bone-Anchored Hearing Devices

Practice Questions

Speech and Language Development

Practice Questions

Articulation Disorders

Practice Questions

Stuttering

Practice Questions

Dysphonia

Practice Questions

Rehabilitation of Hearing-Impaired Children

Practice Questions

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