Audiometry

Audiometry

Q. 1 Over the past 10 years, a 50-year-old male has had progressive difficulty hearing, particularly on the left side. Audiometry testing reveals that he has a bone conduction type of deafness. Which of the following conditions is he most likely to have?
 A Otosclerosis
 B Cholesteatoma
 C Schwannoma
 D Otitis media
Q. 1 Over the past 10 years, a 50-year-old male has had progressive difficulty hearing, particularly on the left side. Audiometry testing reveals that he has a bone conduction type of deafness. Which of the following conditions is he most likely to have?
 A Otosclerosis
 B Cholesteatoma
 C Schwannoma
 D Otitis media
Ans. A

Explanation:

Otosclerosis can be familial, particularly  when it  is severe. It results  from fibrous ankylosis followed by bony overgrowth of the little ossicles of the middle car. A schwannoma typically  involves  the  eighth cranial nerve and results in  a  nerve  conduction form  of  deafness. Schwannomas are usually unilateral. although familial neurofibromatosis could result in the appearance of multiple schwannomas. A cholesteatoma is typically a unilateral process that complicates  chronic  otitis  media  in  a  child  or young adult otitis media by itself is usually self- limited and uncommon in an adult Chondrosarcomas may involve the skull in older adults but are rare and are solitary bulky masses in the region of the jaw.


Q. 2

A young man presents with an accident leading to loss of hearing in the right ear. On otoscopic examination, the tympanic membrane was intact. Pure tone audiometry shows an Air – Bone gap of 55 dB in the right ear with normal cochlear reserve. Which of the following will be the likely tympanometry finding?

 A

As type tympanogram

 B

Ad type tympanogram

 C

B type tympanogram

 D

C type tympanogram

Q. 2

A young man presents with an accident leading to loss of hearing in the right ear. On otoscopic examination, the tympanic membrane was intact. Pure tone audiometry shows an Air – Bone gap of 55 dB in the right ear with normal cochlear reserve. Which of the following will be the likely tympanometry finding?

 A

As type tympanogram

 B

Ad type tympanogram

 C

B type tympanogram

 D

C type tympanogram

Ans. B

Explanation:

The threshold of bone conduction is a measure of cochlear function in pure tone audiometry.

The difference in the thresholds of air and bone conduction (A-B) is a measure of the degree of conductive deafness.

Here this patient is having a normal cochlear function.

So A-B gap of 55 dB will be because of defect in air conduction.

Otoscopic examination showed an intact tympanic membrane means the ossicular discontinuity will be the reason for the hearing loss.

Therefore the tympanometry finding in this patient will be Ad type tympanogram.
 

Q. 3

Which of the following is a subjective test in the assessment of hearing?

 A

BERA

 B

Impedence audiometry

 C

Pure tone audiometry

 D

Oto acoustic emission

Q. 3

Which of the following is a subjective test in the assessment of hearing?

 A

BERA

 B

Impedence audiometry

 C

Pure tone audiometry

 D

Oto acoustic emission

Ans. C

Explanation:

Pure tone audiometry is a subjective test used in the assessment of hearing in a patient presenting with impairment in hearing. 

Pure tone audiometry:
  • It is a subjective, behavioural measurement of hearing threshold enabling determination of degree, type, and configuration of any hearing loss.
  • The test can provide both bone and air conduction threshold.
  • The frequency range tested includes 250Hz to 8kHz.
  • The threshold of lower limit of normal is considered to be 20dB.
  • 30dB equates to the threshold of a whispered voice at 2 feet from the ear, 60dB a conversational voice, and 100dB a pneumatic drill in the street.

Q. 4

In which of the following condition continuous tracing above pulsed tracing is used in Bekesy audiometry?

 A

Otosclerosis

 B

Ototoxicity

 C

Non-organic hearing loss

 D

Meniere’s disease

Q. 4

In which of the following condition continuous tracing above pulsed tracing is used in Bekesy audiometry?

 A

Otosclerosis

 B

Ototoxicity

 C

Non-organic hearing loss

 D

Meniere’s disease

Ans. C

Explanation:

Bekesy audiometry:

It is a self-recording audiometry where various pure tone frequencies automatically move from low to high while the patient controls the intensity. Two tracings, one with continuous and and the other with pulsed tone are obtained.
 
Types of tracings obtained from Bekesy audiometry:
 
  • Type I: Continuous and pulsed tracings overlap. Seen in normal hearing or conductive hearing loss.
  • Type II: Continuous and pulsed tracings overlap up to 1000 Hz and then continuous tracing falls. Seen in cochlear loss.
  • Type III: Continuous tracing falls below pulsed tracing at 100 to 500 Hz even up to 40-50 dB. Seen in retrocochlear/neural lesion.
  • Type IV: Continuous tracing falls below pulsed lesion at frequencies up to 1000 Hz by more than 25 dB. Seen in retrocochlear/neural lesion.
  • Type V: Continuous tracing is above pulsed one. Seen in non-organic hearing loss.
 

Q. 5

High frequency audiometry uses frequency higher than the frequency region required to understand speech. It is used to monitor which of the following?

 A

Otosclerosis

 B

Ototoxicity

 C

Otospongiosis

 D

Meniere’s disease

Q. 5

High frequency audiometry uses frequency higher than the frequency region required to understand speech. It is used to monitor which of the following?

 A

Otosclerosis

 B

Ototoxicity

 C

Otospongiosis

 D

Meniere’s disease

Ans. B

Explanation:

High-frequency audiometry is specifically for ototoxicity monitoring, comprises air conduction thresholds from 10,000 to 20,000 Hz.

 Most ototoxic hearing losses will first occur in that frequency region, which is higher than the speech range. 


Q. 6

A 30-year old woman with family history of hearing loss from her mother’s side developed hearing problem during pregnancy. Hearing loss is bilateral, slowly progressive, with bilateral tinnitus that bothers her at night. Pure tone audiometry shows conductive hearing loss with an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Q. 6

A 30-year old woman with family history of hearing loss from her mother’s side developed hearing problem during pregnancy. Hearing loss is bilateral, slowly progressive, with bilateral tinnitus that bothers her at night. Pure tone audiometry shows conductive hearing loss with an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Ans. A

Explanation:

Otosclerosis is characterized by abnormal removal of mature dense otic capsule bone by osteoclasts, and replacement with the woven bone of greater thickness, cellularity, and vascularity.

When disease involves the annular ligament of the oval window and stapes footplate, a conductive hearing loss (CHL) occurs which is slowly progressive, usually bilateral and asymmetric. 

The hallmark of bone conduction thresholds in otosclerosis is the Carhart notch which is as a result from the disruption of normal ossicular resonance, approximately at 2000 Hz. One of the earliest signs of otosclerosis is an abnormal acoustic reflex.
 
Hormonal influences during pregnancy might cause a more rapid progression in women, bringing them to clinical attention.
 

Q. 7

Pure-tone audiometry of a 30 year old field worker shows Carhart’s notch. He has the following condition:

 A

Otospongiosis

 B

CSOM

 C

Meniere’s disease

 D

Acoustic neuroma

Q. 7

Pure-tone audiometry of a 30 year old field worker shows Carhart’s notch. He has the following condition:

 A

Otospongiosis

 B

CSOM

 C

Meniere’s disease

 D

Acoustic neuroma

Ans. A

Explanation:

The hallmark of bone conduction thresholds in otosclerosis/otospongiosis is the Carhart notch.

This is characterized by the elevation of bone conduction thresholds of approximately 5, 10, and 15 dB at 500, 1000, and 2000 Hz, respectively.

The Carhart notch is thought to result from the disruption of normal ossicular resonance, which is approximately 2000 Hz.

It is therefore a mechanical phenomenon and not a true reflection of cochlear reserve since it reverses after successful surgery.

Q. 8

Secretory otitis media is diagnosed by:

 A

Impedance audiometry

 B

Pure tone audiometry

 C

X-ray

 D

a and c

Q. 8

Secretory otitis media is diagnosed by:

 A

Impedance audiometry

 B

Pure tone audiometry

 C

X-ray

 D

a and c

Ans. A

Explanation:

 

Pure tone audiometry gives information about the quantity and quality of hearing loss.

In secretory otitis media: conductive deafness of 20-40 dB is seen (which is not a specific finding as conductive deafness can be seen in many other conditions). Therefore, pure tone audiometry is not diagnostic of serous otitis media but provides an assessment of the hearing loss and is therefore important in monitoring the progress of the condition and provides information useful for management decisions

On otoscopy: Tympanic membrane appears dull, opaque with loss of light reflex

X-ray mastoid: Shows clouding of air cells. (not diagnostic)

Impedance audiometry is an accurate way of diagnosing serous otitis media. It shows type B tympanogram which is diagnostic of fluid in ear.


Q. 9

A 30- year old woman with family history of hearing loss from her mother’s side developed hearing problem dur­ing pregnancy. Hearing loss is bilateral, slowly progres­sive, Pure tone audiometry bone conduction hearing loss with an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Q. 9

A 30- year old woman with family history of hearing loss from her mother’s side developed hearing problem dur­ing pregnancy. Hearing loss is bilateral, slowly progres­sive, Pure tone audiometry bone conduction hearing loss with an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Ans. A

Explanation:

Q. 10

A pure tone audiogram with a dip at 2000 Hz is char­acteristic of:

 A

Presbyacusis

 B

Ototoxicity

 C

Otosclerosis

 D

Nose induced hearing loss

Q. 10

A pure tone audiogram with a dip at 2000 Hz is char­acteristic of:

 A

Presbyacusis

 B

Ototoxicity

 C

Otosclerosis

 D

Nose induced hearing loss

Ans. C

Explanation:


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