Midterm Questions

Question 1

Which of the following statements best describes the primary advantages of percutaneous implantable bone conduction devices?
They require minimal wound care and offer improved aesthetics
They provide direct sound transmission for optimal signal delivery and secure retention, especially for active users
They allow easier attachment and removal, with less risk of trauma to the implant
They are associated with fewer complications around the surgical site

Answer 1

They provide direct sound transmission for optimal signal delivery and secure retention, especially for active users

Question 2

All of the following practices may lead to inappropriate recommendations regarding Cl candidacy, potentially resulting in either under- or over-qualifying patients, EXCEPT for:
Using 70 dBA as the presentation level for speech testing
Conducting aided speech testing in the soundfield without audiometer output calibration
Conducting aided speech assessment without hearing aid verifications
Isolating the test ear during assessment in the soundfield

Answer 2

Isolating the test ear during assessment in the soundfield

Question 3

Which of the following patients would be considered an appropriate candidate for a bone-anchored hearing device due to SSD?
A patient with profound SNHL in the poorer ear and moderate SNHL in the better ear
A patient with profound SNHL in the poorer ear and mixed hearing loss not greater than 50 dB in the better ear
A patient with severe MHL in the poorer ear and PTA ≤ 20 dB HL in the better ear
A patient with profound SNHL in the poorer ear and PTA ≤ 20 dB HL in the better ear

Answer 3

A patient with profound SNHL in the poorer ear and PTA ≤ 20 dB HL in the better ear

Question 4

Sam is a three-year-old boy diagnosed with congenital SSD due to auditory nerve aplasia in the left ear. His right ear has normal hearing sensitivity. Which of the following is the most appropriate intervention to recommend to his parents?
Baha Softband (Baha Start)
Envoy Esteem
Baha Attract
Cochlear implant

Answer 4

Baha Softband (Baha Start)

Question 5

A family brings their 14-month-old daughter to your clinic for a routine follow-up. They report that Sarah failed her newborn hearing screening and was diagnosed with severe to profound bilateral SNHL. She received a Cl at 12 months of age and is currently enrolled in early intervention.
Her parents note that she is beginning to respond to sounds at home. To help monitor her progress over time, which of the following questionnaires would be most appropriate for tracking her auditory skill development?
APHAB
IT-MAIS
SSO12
COSI

Answer 5

IT MAIS

Question 6

CT or MRI imaging are a crucial step in determining Cl candidacy. What is the primary purpose of this imaging?
Assessing mastoid pneumatization, the course of the facial nerve, facial recess anatomy, and round window patency
Identifying bony anomalies such as displaced facial nerves, aberrant vasculature, or signs of chronic infection
Identifying inner ear malformations such as enlarged vestibular aqueducts, cochlear aperture stenosis, or labyrinthine abnormalities
All of the above

Answer 6

ALL

Question 7

Which FDA center is responsible for overseeing cochlear implant devices?
Center for Biologics Evaluation and Research
Center for Devices and Radiological Health
Office of Regulatory Affairs
Center for Drug Evaluation and Research

Answer 7

Center for Devices and Radiological Health

Question 8

What is the current FDA-approved minimum age for cochlear implantation in children?
6 months
9 months
12 months
18 months

Answer 8

9 mos

Question 9

Mr. Jones is a 53-year-old with moderate SNHL. He wears hearing aids consistently and reports substantial benefits in everyday situations.
However, as a triathlete who regularly competes in swimming events, he is frustrated that he cannot wear his hearing aids in the water, which limits his ability to hear during training and races. Which of the following device options may best address his concerns and fit his lifestyle?
Esteem middle ear implant
Vibrant Soundbridge
Cochlear implants
Vibrant Bonebridge

Answer 9

esteem

Question 10

Which audiometric measure is most important for determining candidacy and selecting the appropriate sound processor for bone-anchored hearing devices (such as Ponto, Baha 6 Max, or Baha 5 SuperPower)?
Word recognition score
Air conduction thresholds
Bone conduction thresholds
Both air and bone conduction thresholds

Answer 10

bone conduction thresholds

Question 11

The Vibrant Soundbridge is a type of middle ear implant. What is the name of the component that directly vibrates the middle ear structures?
Floating Mass Transducer
Piezoelectric transducer
Receiver coil
Driver

Answer 11

FMT

Question 12

Bone conduction hearing solutions are generally most effective for patients with CHL or MHL when the air-bone gap is at least:
10 dB
20 dB
30 dB
40 dB

Answer 12

30

Question 13

An 87-year-old woman with progressive SNHL presents for a cochlear implant evaluation. She has worn hearing aids for over 20 years but reports that they no longer provide sufficient benefit. Her current devices are 7 years old, full-shell style, and are managed by a dispensing audiologist in the community. Real ear measurements reveal that her hearing aids are significantly under-amplifying for her hearing loss. What is the most appropriate next step in proceeding with her cochlear implant candidacy evaluation?
Proceed with the Cl evaluation using her current hearing aid settings
Fit and program demo hearing aids to match her current hearing thresholds and real ear targets, then perform the Cl evaluation
Reprogram her personal hearing aids to match her current thresholds and targets, then proceed with the evaluation
Inform the patient that her hearing aids were improperly fit and recommend finding a new audiologist

Answer 13

Fit and program demo hearing aids to match her current hearing thresholds and real ear targets, then perform the Cl evaluation

Question 14

Which of the following is not a Cl candidacy criterion for SSD?
Limited benefit from unilateral amplification
Aided speech perception score of 5% or less on monosyllabic CNC words in quiet, tested in the ear to be implanted alone
Aided speech perception score of 5% or less on monosyllabic CNC words in quiet when tested binaurally
Normal hearing in the contralateral ear

Answer 14

Aided speech perception score of 5% or less on monosyllabic CNC words in quiet when tested binaurally

Question 15

An electroacoustic stimulation (EAS) implant system is an appropriate solution for patients with _________ hearing loss.
Low frequency
Cookie-bite
Mixed
High frequency

Answer 15

HF

Question 16

What is the primary benefit of bone conduction implants for individuals with SSD?
Reduction of the head shadow effect
Improved sound localization
Improved speech understanding in noise
Enhanced binaural summation

Answer 16

Reduction of the head shadow effect

Question 17

Which of the following is not included in the candidacy criteria for a middle ear implant?
Age 18 or older
Moderate to moderately severe hearing loss
Open-set word recognition scores above 60%
Severe to profound hearing loss

Answer 17

Severe to profound hearing loss

Question 18

The natural properties of piezoelectric materials make them attractive for use in implantable hearing devices. Which of the following statements about piezoelectric transducers is incorrect?
They do not require an external power source to convert mechanical vibrations into electrical signals
When deformed, piezoelectric materials generate an electrical voltage
When a voltage is applied, piezoelectric materials oscillate and produce mechanical movement
They provide high output levels, making them ideal for patients with severe hearing loss

Answer 18

They provide high output levels, making them ideal for patients with severe hearing loss

Question 19

Which of the following is an advantage of middle ear implants compared to traditional hearing aids?
They provide greater benefit for individuals with severe to profound hearing loss
They provide superior speech recognition and aided thresholds compared to air conduction hearing aids
They eliminate issues related to ear canal occlusion and acoustic feedback
They are generally more affordable than cochlear implants

Answer 19

They eliminate issues related to ear canal occlusion and acoustic feedback

Question 20

Which of the following Baha systems does not provide 1-to-1 compensation for each decibel of sound lost due to skin attenuation in its gain prescription?
BAHA Attract
BAHA connect
BAHA Softband
BAHA start

Answer 20

connect

Question 21

A 3-year-old child is referred for Cl candidacy evaluation. The child cannot complete open-set speech test. What is the most appropriate next step?
Attempt the CNC word test with parental support
Administer a closed-set speech perception measure such as the ESP or NU-CHIPS
Base candidacy solely on electrophysiologic test results
Reschedule testing in 6 months when the child is older

Answer 21

Administer a closed-set speech perception measure such as the ESP or NU-CHIPS

Question 22

An adult Cl patient returns for a follow-up visit six months post implantation. He uses a Cl in the right ear and a hearing aid (HA) in the left ear.
CNC monosyllabic word testing with the Cl-alone (contralateral ear masked) shows good performance. You now wish to evaluate the potential bimodal benefits. Which of the following test conditions is most appropriate?
AzBio sentences in noise at 0 SNR; comparing Cl-alone vs. Cl+ HA conditions
AzBio sentences in noise at +10 SNR, using Cl + HA condition only
AzBio sentences in noise at +10 SNR, comparing Cl-alone vs. CI+HA conditions
AzBio sentences in noise at +10 dB SNR, with the Cl turned off and the HA worn in the opposite ear

Answer 22

AzBio sentences in noise at +10 SNR, comparing Cl-alone vs. CI+HA conditions

Question 23

Which type of transducer used in middle ear implants is most likely to be affected by head and jaw movements?
Electromagnetic
Piezoelectric
Electromechanical
Cochlear

Answer 23

Electromagnetic

Question 24

The Envoy Esteem system contains all of the following components except:
Sensor
External microphone processor
Sound processor
Driver

Answer 24

External microphone processor

Question 25

A 4-year-old child presents with unilateral aural atresia and conductive hearing loss. Which bone conduction device would be the most appropriate option? Osia Baha Attract BoneBridge AdHear

Answer 25

AdHear

Question 26

An audiologist is conducting speech-in-noise testing with a bone conduction device on a patient with SSD. To accurately assess device benefit under real-world listening conditions, how should the speech and noise be presented? Both speech and noise presented from the better-hearing side Speech presented from the front (0° azimuth), noise presented form the better ear side Speech presented from the poorer-hearing side, noise presented from the better-hearing side Both speech and noise presented from the front (0° azimuth)

Answer 26

Speech presented from the poorer-hearing side, noise presented from the better-hearing side

Question 27

In the U.S., who defines the candidacy criteria listed in the physician's package insert for Cl devices? Food and Drug Administration (FDA) Centers for Medicare and Medicaid Services (CMS) Device manufacturers Centers for Disease Control and Prevention (CDC)

Answer 27

Device manufacturers

Question 28

Which of the following is considered a true contraindication for cochlear implantation? Prelingual deafness Aplasia Mild cognitive impairment Previous history of meningitis

Answer 28

aplasia

Question 29

For pediatric Cl patients, which factor is most strongly associated with better outcomes? Use of sign language only Age at hearing loss onset Earlier age at implantation Longer use of hearing aids prior to implantation

Answer 29

Earlier age at implantation

Question 30

Under Centers for Medicare & Medicaid Services (CMS) guidelines, what is the maximum allowable score on open-set sentence recognition in the best-aided condition for a candidate to qualify for Cl? 40% 50% 60% 70%

Answer 30

60

Question 31

What is the rational for transitioning from AzBio sentence test to CNC test as the clinical basis for determining Cl candidacy in the current MSTB-3 protocol? CNC test is more likely to result in ceiling effects post-implant compared to AzBio sentence test Recent FDA-approved indications for Hybrid, EAS, AHL, and SSD are based on CNC word scores CNC word scores are more susceptible to top-down cognitive factors, making them ideal for assessing real-world speech understanding CNC test provides a more accurate measure of peripheral hearing by minimizing contextual cues

Answer 31

Recent FDA-approved indications for Hybrid, EAS, AHL, and SSD are based on CNC word scores CNC test provides a more accurate measure of peripheral hearing by minimizing contextual cues

Question 32

When administering the CNC word test to assess cochlear implant candidacy in traditional adult candidates, which of the following procedures best reflects current best practice? Present recorded speech materials at 0° azimuth, with a presentation level of 60 BA, and masking applied to the contralateral ear Present recorded speech materials at 0° azimuth, with a presentation level of 60 dBA, and the contralateral ear plugged and muffed Present recorded speech materials at 0° azimuth, with a presentation level of 65 dBA, without masking the contralateral ear Present recorded speech materials at 90° azimuth to the poorer ear, with a presentation level of 60 dBA, and masking applied to the contralateral ear

Answer 32

Present recorded speech materials at 0° azimuth, with a presentation level of 60 BA, and masking applied to the contralateral ear

Question 33

Sends power and digital information via RF to the internal receiver/stimulator

Answer 33

Cl external coil

Question 34

Applies biphasic electrical stimulation to auditory nerve fibers at discrete intracochlear sites

Answer 34

CI electrode array

Question 35

Magnet and coil housed together; eliminates proximity variability issues

Answer 35

Electromechanical transducer

Question 36

Attached to the incus and used to convert ossicular movement into electric signal via piezoelectric transduction.

Answer 36

Esteem Sensor

Question 37

Contains microphone, DSP, and transmits signal from within the ear canal.

Answer 37

MAXUM

Question 38

Changes in device design, labeling, or manufacturing often require submission of ______

Answer 38

PMA

Question 39

The use of a device outside its FDA-approved indications is referred to as _______ use.

Answer 39

off label

Question 40

CMS (Medicare) Cl coverage, sentence recognition must be _____% or lower in the best-aided condition

Answer 40

60

Question 41

Etiologies such as ______ disease are associated with poorer-than-average outcomes after cochlear implantation.

Answer 41

Temporal bone fracture Acoustic neuroma Auditory neuropathy spectrum disorder ANSD

Question 42

In a one-stage surgery, the implant and ________ are placed in a single operation.

Answer 42

abutment

Question 43

Candidates for CHL/MHL are typically eligible if their average BC threshold at 5, 1, 2, and 3 kHz is ≤ ______ dB HL

Answer 43

65

Question 44

The fixed part of the electromagnetic transducer is called the ______

Answer 44

yoke

Question 45

When evaluating Cl candidacy in a patient with AHL, full list of AzBio sentences should be administered at ________ dBA using _____ SNR. The sentences should be presented from the _______ speaker, with noise delivered from the speaker positioned near the patient’s ________

Answer 45

65 0 Front (or 0 degrees) Good ear (or better ear)

Question 46

Output calibration during aided speech testing in the soundfield is completed using ______ signal.

Answer 46

Speech noise Speech shaped noise SSN

Question 47

For Cl users, aided soundfield thresholds should ideally range from ______ to _____ dB HL across 250 to 6000 Hz using ________ stimuli

Answer 47

20 30 Warble (or warble pure tone)