Audiology and Speech Disorders Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Audiology and Speech Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Audiology and Speech Disorders Indian Medical PG Question 1: A 45-year-old gentleman reports decreased hearing in the right ear for the last two years. On testing with a 512 Hz tuning fork, the Rinne's test without masking is negative on the right ear and positive on the left ear. With the Weber's test, the tone is perceived as louder in the left ear. Patient most likely has -
- A. Right conductive hearing loss (Correct Answer)
- B. Right sensorineural hearing loss
- C. Left sensorineural hearing loss
- D. Left conductive hearing loss
Audiology and Speech Disorders Explanation: ***Right conductive hearing loss***
- A **negative Rinne's test** (bone conduction louder than air conduction) in the right ear indicates **conductive hearing loss** on that side
- However, in true conductive hearing loss, **Weber should lateralize to the affected (right) ear** due to the occlusion effect, not to the left ear
- The Weber lateralizing to the left ear with a negative Rinne on the right suggests this may be a **false negative Rinne** due to lack of masking, where sound crosses over to the better left ear
- This combination is atypical for pure conductive loss and requires repeat testing with proper masking
*Right sensorineural hearing loss*
- In **sensorineural hearing loss**, Rinne's test should be **positive** (air conduction > bone conduction) on both sides, though both may be reduced on the affected side
- **Weber lateralizes to the unaffected (left) ear**, which matches the given finding
- The **negative Rinne on the right ear without masking** is likely a **false negative** due to sound crossing over to the better left ear during bone conduction testing
- This is the **most consistent interpretation** when Rinne testing is done without masking, but traditionally the question frame suggests conductive loss
*Left sensorineural hearing loss*
- Would show **positive Rinne bilaterally** with reduced hearing on the left
- **Weber would lateralize to the right ear** (the better ear), contradicting the given findings
- This option is clearly inconsistent with the clinical findings
*Left conductive hearing loss*
- Would show **negative Rinne on the left** and positive on the right
- Weber would lateralize to the left ear (affected side in conductive loss)
- The **Rinne findings contradict this**, as the right ear shows negative Rinne, not the left
Audiology and Speech Disorders Indian Medical PG Question 2: 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
Audiology and Speech Disorders 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**.
Audiology and Speech Disorders Indian Medical PG Question 3: A pure tone audiogram showing a bone conduction dip (Carhart notch) at 2000 Hz is characteristic of-
- A. Otosclerosis (Correct Answer)
- B. Presbyacusis
- C. Ototoxicity
- D. Noise induced hearing loss
Audiology and Speech Disorders Explanation: ***Otosclerosis***
- A **Carhart notch** is a characteristic feature on a pure tone audiogram in otosclerosis, specifically a **bone conduction dip at 2000 Hz**.
- This notch is believed to be an **artifact of cochlear mechanics** caused by the fixation of the stapes in the oval window.
*Presbyacusis*
- Characterized by a **bilateral, symmetrical, high-frequency sensorineural hearing loss** that gradually worsens with age.
- It does not present with a specific bone conduction dip like the Carhart notch.
*Ototoxicity*
- Hearing loss induced by ototoxic drugs (e.g., aminoglycosides, loop diuretics) typically causes **bilateral, progressive, high-frequency sensorineural hearing loss**.
- A Carhart notch is not a typical finding in ototoxicity.
*Noise induced hearing loss*
- Often presents with a **sensorineural hearing loss notch at 4000 Hz** (or sometimes 3000 Hz or 6000 Hz) on the audiogram.
- This pattern is distinct from the 2000 Hz bone conduction dip seen in a Carhart notch.
Audiology and Speech Disorders Indian Medical PG Question 4: Progressive loss of hearing, tinnitus and ataxia are commonly seen in a case of -
- A. Acoustic neuroma (Correct Answer)
- B. Otitis media
- C. Ependymoma
- D. Cerebral glioma
Audiology and Speech Disorders Explanation: ***Acoustic neuroma***
- This benign tumor arises from the **vestibulocochlear nerve (cranial nerve VIII)**, leading to **progressive unilateral hearing loss**, **tinnitus**, and **ataxia** as it compresses the adjacent cerebellum [1].
- The symptoms are progressive and often insidious, reflecting the slow growth of the tumor, and are highly characteristic for this condition [1].
*Otitis media*
- **Otitis media** is an **inflammation/infection of the middle ear**, primarily causing ear pain, ear discharge, and conductive hearing loss.
- While it causes hearing loss, it typically presents with acute symptoms and does not typically cause **tinnitus** or **ataxia** unless there are severe complications affecting the inner ear or brain.
*Ependymoma*
- **Ependymomas** are tumors originating from the **ependymal cells** lining the ventricles and spinal cord, often causing symptoms related to increased intracranial pressure (headache, nausea) or spinal cord compression.
- They do not typically present with the specific triad of **progressive hearing loss**, **tinnitus**, and **ataxia** characteristic of acoustic neuroma.
*Cerebral glioma*
- **Cerebral gliomas** are brain tumors that arise from glial cells and present with a wide range of neurological symptoms depending on their location, such as **seizures**, **weakness**, or **cognitive changes**.
- They are unlikely to present with the specific combination of **progressive hearing loss**, **tinnitus**, and **ataxia** unless located in the brainstem or cerebellum in a way that specifically compresses the eighth cranial nerve and cerebellar pathways, which is less common than for an acoustic neuroma.
Audiology and Speech Disorders Indian Medical PG Question 5: Which intervention is best in patients operated for bilateral acoustic neuroma for hearing rehabilitation?
- A. Bilateral cochlear implant
- B. Auditory brainstem implant (ABI) (Correct Answer)
- C. Unilateral cochlear implant
- D. High power hearing aid
Audiology and Speech Disorders Explanation: ***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.
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