AUDIOLOGY - EVALUATION ALL TESTS (AB)

Question 1

Which aspects should be inspected first during an ear examination?

Answer 1

Changes in auricle shape, surgical scars, crusting, discharge (cerumen, mucus, pus, blood, CSF), redness, and swelling.

Question 2

What are the tools for hearing evaluation?

Answer 2

Tuning fork test, pure tone audiometry, speech audiometry, tympanometry, brainstem-evoked response audiometry (BERA - gold standard).

Question 3

What are the degrees of hearing loss?

Answer 3

Mild, moderate, severe.

Question 4

What are the reference comparisons in a tuning fork test?

Answer 4

Examiner’s ear (standard/golden ear), patient’s normal ear (for unilateral hearing loss), third person with normal hearing acuity.

Question 5

What is measured in a tuning fork test?

Answer 5

Threshold of hearing by comparing when the patient and examiner stop hearing the sound.

Question 6

What is the Weber’s test used for?

Answer 6

Determining lateralization of hearing loss.

Question 7

How is Weber’s test performed?

Answer 7

A vibrating tuning fork is placed on the midline of the forehead, vertex of the skull, or incisors, and the patient is asked where they hear the sound best.

Question 8

What does lateralization to the poorer ear in Weber’s test indicate?

Answer 8

Conductive hearing loss (attenuation of background noise and prevention of energy loss from the external auditory canal).

Question 9

What does lateralization to the better ear in Weber’s test indicate?

Answer 9

Sensorineural hearing loss (or normal hearing in both ears/equal conductive hearing loss).

Question 10

What does the Rinne’s test compare?

Answer 10

Bone conduction (BC) vs air conduction (AC).

Question 11

How is Rinne’s test performed?

Answer 11

A vibrating tuning fork is placed on the mastoid process until the sound is no longer heard, then moved near the external auditory canal.

Question 12

What is a positive Rinne’s test?

Answer 12

AC > BC, indicating normal hearing or sensorineural impairment.

Question 13

What is a negative Rinne’s test?

Answer 13

AC < BC, indicating conductive hearing loss.

Question 14

Why is masking necessary in Rinne’s test?

Answer 14

To prevent the opposite ear from detecting sound through bone conduction, avoiding false-negative results.

Question 15

What is the Schwabach’s test used for?

Answer 15

Comparing the patient’s bone conduction against a normal reference.

Question 16

How is Schwabach’s test performed?

Answer 16

A vibrating tuning fork is placed on the mastoid process of the patient until inaudible, then applied to a normal reference ear.

Question 17

What does a prolonged Schwabach’s test result indicate?

Answer 17

Conductive hearing loss (EAC/ME pathology).

Question 18

What does a diminished Schwabach’s test result indicate?

Answer 18

Sensorineural hearing loss (cochlear/retrocochlear pathology).

Question 19

What is the Bing’s test used for?

Answer 19

Assessing the occlusion effect.

Question 20

How is Bing’s test performed?

Answer 20

A vibrating tuning fork is placed on the mastoid while the examiner alternately occludes and opens the external auditory canal by pressing on the tragus.

Question 21

What is a positive Bing’s test?

Answer 21

Increase in loudness when ear is covered and decrease when opened, indicating normal or sensorineural hearing loss.

Question 22

What is a negative Bing’s test?

Answer 22

No change in loudness, indicating conductive hearing loss.

Question 23

What are the limitations of tuning fork tests?

Answer 23

Subjectivity in detecting inaudibility, difficulty in reproducibility, background noise interference, and skull vibration stimulating both cochleae.

Question 24

Why is the 256 Hz tuning fork preferred?

Answer 24

It is the most accurate for detecting slight conductive hearing loss.

Question 25

Why is the 512 Hz tuning fork preferred?

Answer 25

It is more useful for Bing’s test.

Question 26

Why can tuning fork tests produce false results?

Answer 26

Bone conduction vibrates the entire skull, allowing sound to be heard in both ears, leading to false positives/negatives.

Question 27

Why is it recommended to use multiple tuning fork tests?

Answer 27

To improve accuracy by cross-checking results due to the unreliability of single tests.

Question 28

What technological advancement in the early 1920s made pure tone audiometry possible?

Answer 28

The invention of vacuum tubes to produce electronic tones.

Question 29

Which frequencies are sampled in pure tone audiometry that represent the spectrum of human hearing capability?

Answer 29

125, 250, 500, 1000, 2000, 4000, and 8000 Hz.

Question 30

What are the half-octave interval frequencies provided in pure tone audiometry?

Answer 30

750, 1500, 3000, and 6000 Hz.

Question 31

What is the advantage of pure tone audiometry regarding tonal intensity?

Answer 31

Tonal intensity can be maintained at a fixed level or interrupted at will at fixed intervals.

Question 32

Name the three essential parts of pure tone audiometry (PTA).

Answer 32

1. Variable frequency oscillator, 2. Attenuator, 3. Transducer.

Question 33

What is the function of a variable frequency oscillator in PTA?

Answer 33

To produce sounds with changeable frequencies.

Question 34

What role does the attenuator play in PTA?

Answer 34

It changes the volume to permit variations in intensity of the sound.

Question 35

What is the purpose of a transducer in PTA?

Answer 35

To convert electrical energy to acoustic energy using devices like earphones, bone vibrators, or loudspeakers.

Question 36

What is an audiogram?

Answer 36

A graph of the patient’s hearing sensitivity for various frequencies.

Question 37

How are measures recorded on an audiogram?

Answer 37

Separately for each ear, with frequency on the x-axis (abscissa) and intensity on the y-axis (ordinate).

Question 38

Define 'threshold' in the context of audiometry.

Answer 38

The lowest intensity level in dB that can be heard for each frequency.

Question 39

What is 'Audiometric Zero (ANSI)'?

Answer 39

The median average threshold of a large sample of young adults with no hearing complaints, representing 0 dB HL.

Question 40

What does it indicate when bone conduction thresholds are better than air conduction by 10 dB or more and are normal?

Answer 40

The hearing loss is conductive.

Question 41

What type of hearing loss is indicated when bone conduction thresholds are the same as air conduction and neither is normal?

Answer 41

Sensorineural hearing loss.

Question 42

If bone conduction thresholds are reduced but still better than air conduction by 10 dB or more, what type of hearing loss is this?

Answer 42

Mixed or combined hearing loss.

Question 43

What does the horizontal axis on an audiogram represent?

Answer 43

Frequencies (Hz), ranging from 250 to 8000 Hz.

Question 44

What does the vertical axis on an audiogram represent?

Answer 44

Intensity of the sounds (dB).

Question 45

What is considered a normal hearing threshold in dB?

Answer 45

0-20 dB is considered normal; clinically, up to 25 dB is acceptable.

Question 46

What dB range indicates mild hearing loss?

Answer 46

20-40 dB.

Question 47

What dB range indicates moderate hearing loss?

Answer 47

40-60 dB.

Question 48

What dB range indicates severe hearing loss?

Answer 48

60-80 dB.

Question 49

What dB range indicates profound hearing loss?

Answer 49

80-100 dB.

Question 50

In audiogram color coding, which color represents the right ear?

Answer 50

Red.

Question 51

In audiogram color coding, which color represents the left ear?

Answer 51

Blue.

Question 52

What symbol is typically used to represent air conduction in the right ear on an audiogram?

Answer 52

A circle (O).

Question 53

What symbol is typically used to represent air conduction in the left ear on an audiogram?

Answer 53

An 'X'.

Question 54

What does a 'Carhart’s notch' at 2000 Hz on an audiogram suggest?

Answer 54

It is a signature for otosclerosis.

Question 55

What does a notch at 4000 Hz on an audiogram typically indicate?

Answer 55

Noise-induced hearing loss.

Question 56

What does pure tone audiometry (PTA) measure?

Answer 56

The ability to hear various tones, typically beeps or warbles, across different frequencies.

Question 57

Why is speech audiometry important in hearing assessments?

Answer 57

It evaluates the ability to understand speech, which is crucial for effective communication.

Question 58

What is the purpose of masking the non-test ear during speech audiometry?

Answer 58

To prevent crossover hearing, ensuring accurate assessment of each ear individually.

Question 59

How does Speech Reception Threshold (SRT) differ from Pure Tone Audiometry (PTA)?

Answer 59

SRT measures sensitivity using words, while PTA uses tones; SRT assesses the lowest level at which speech can be recognized 50% of the time.

Question 60

What type of words are used in determining the Speech Reception Threshold?

Answer 60

Spondee words, which are two-syllable words with equal stress on each syllable.

Question 61

How is the Spondee Threshold defined?

Answer 61

The faintest presentation level in dB at which the patient correctly identifies 50% of the test words.

Question 62

Which pure tone frequencies does the Spondee Threshold closely agree with?

Answer 62

500, 1000, and 2000 Hz, as these frequencies are commonly used in human speech.

Question 63

What might a difference of 15 dB or more between the Spondee Threshold and Pure Tone Average indicate?

Answer 63

Possible equipment calibration error, patient misunderstanding, lack of cooperation, or malingering.

Question 64

What does Speech Discrimination Testing assess?

Answer 64

The patient's ability to understand speech, aiding in diagnosing the site of lesion and planning rehabilitation.

Question 65

What type of word lists are used in Speech Discrimination Testing?

Answer 65

Phonetically balanced, single-syllable word lists that reflect the relative incidence of various speech sounds in the chosen language.

Question 66

At what level are words presented during Speech Discrimination Testing?

Answer 66

20 to 40 dB above the Speech Reception Threshold or at the patient's most comfortable level.

Question 67

What is considered a normal score in Speech Discrimination Testing?

Answer 67

94-100% correct word recognition.

Question 68

What does Tympanometry measure?

Answer 68

The compliance (mobility) of the tympanic membrane and ossicular chain system under varying air pressures, assessing middle ear function.

Question 69

What does a Type A tympanogram indicate?

Answer 69

Normal middle ear pressure with maximum compliance near ambient air pressure.

Question 70

What condition might a Type AS tympanogram suggest?

Answer 70

Fixation or stiffening of the ossicular system, as it shows normal pressure but reduced compliance.

Question 71

What does a Type AD tympanogram signify?

Answer 71

Very high compliance at ambient pressure, possibly indicating ossicular discontinuity or a monomeric tympanic membrane.

Question 72

What does a Type B tympanogram typically indicate?

Answer 72

A flat curve suggesting middle ear fluid, a thickened drum, or impacted cerumen.

Question 73

What might a Type C tympanogram reveal?

Answer 73

Maximum compliance at negative pressure, often associated with a retracted tympanic membrane or Eustachian tube dysfunction.