Audiology Praxis Examination:
Practice Questions with
Answers & Rationales
Domain I: Assessment (50 Questions)
1. A patient presents with a sudden unilateral sensorineural hearing loss.
Which of the following is the most critical initial step in management?
A. Immediate high-dose oral corticosteroids
B. MRI with gadolinium to rule out acoustic neuroma
C. Antibiotic therapy for suspected labyrinthitis
D. Referral for a hearing aid evaluation
Answer: A
, Rationale: Sudden Sensorineural Hearing Loss (SSNHL) is an
otologic emergency. The standard of care is a prompt course of high-dose oral corticosteroids
(prednisone) to reduce cochlear inflammation, ideally initiated within 72 hours of onset. An MRI
is important for ruling out retrocochlear pathology but is typically ordered concurrently or after
initiating steroids, not as the primary first step. Antibiotics are for bacterial causes (rare).
Hearing aids are for long-term management, not acute treatment.
2. Which of the following acoustic reflex findings is MOST consistent with a
diagnosis of cochlear hearing loss?
A. Ipsilateral reflexes absent, contralateral reflexes present
B. Ipsilateral reflexes present at normal levels, contralateral reflexes absent
C. Reflexes present at lower than normal sensation levels (e.g., 60 dB SL)
D. Reflexes absent at all frequencies
Answer: C
Rationale: In cochlear hearing loss, the acoustic reflex
threshold is often present at lower than normal sensation levels (e.g., at 40-60 dB above the
hearing threshold instead of the normal 70-100 dB). This is due to recruitment (abnormal
loudness growth). Ipsilateral and contralateral reflexes are typically present unless the hearing
loss is profound. Absence of reflexes or specific absent patterns is more indicative of conductive
or retrocochlear pathology.
3. When performing a pure-tone audiogram, which bone conduction masking
dilemma is characterized by the inability to obtain a reliable bone conduction threshold in the
test ear because the masking noise in the non-test ear crosses the skull and elevates the
threshold?
,A. Overmasking
B. Undermasking
C. The Plateau Method
D. Maximum Masking Dilemma
Answer: D
Rationale: The maximum masking dilemma occurs when the
maximum effective masking level in the non-test ear is not sufficient to mask it, but a further
increase in masking would cause the masking noise to cross over to the test ear via interaural
attenuation (usually around 0 dB for bone conduction) and elevate its threshold. This makes it
impossible to get a true bone conduction threshold.
4. A patient has a type As tympanogram. This is most consistent with:
A. Otosclerosis
B. Ossicular discontinuity
C. Patulous eustachian tube
D. Middle ear effusion
Answer: A
Rationale: A type As tympanogram is characterized by normal
middle ear pressure (0 daPa) but abnormally low compliance (peak < 0.3 mL). This is classically
associated with otosclerosis or other conditions that stiffen the ossicular chain, such as
tympanosclerosis. Ossicular discontinuity typically shows a type Ad (high compliance). Patulous
ET shows a type AD or shallow tracing with breathing artifact. Middle ear effusion shows a type
B (flat).
, 5. Which of the following is NOT a standard component of the Immittance
Battery?
A. Tympanometry
B. Acoustic Reflex Thresholds
C. Acoustic Reflex Decay
D. Eustachian Tube Function (ETF) Testing
Answer: D
Rationale: While Eustachian tube function testing can be
performed with immittance equipment, it is not considered a standard component of the
routine clinical immittance battery. The standard battery consists of tympanometry, acoustic
reflex thresholds (ipsilateral and contralateral), and acoustic reflex decay testing.
6. The primary purpose of performing speech testing in quiet and in noise is
to:
A. Confirm the pure-tone audiogram results
B. Determine the need for a hearing aid
C. Assess the functional impact of hearing loss on communication
D. Differentiate between conductive and sensorineural loss
Answer: C
Rationale: The primary purpose of speech testing, especially
in noise, is to assess the patient's functional ability to understand speech in realistic listening
environments. It provides valuable information about the impact of the hearing loss on daily
communication, which is crucial for counseling and rehabilitation planning.
Practice Questions with
Answers & Rationales
Domain I: Assessment (50 Questions)
1. A patient presents with a sudden unilateral sensorineural hearing loss.
Which of the following is the most critical initial step in management?
A. Immediate high-dose oral corticosteroids
B. MRI with gadolinium to rule out acoustic neuroma
C. Antibiotic therapy for suspected labyrinthitis
D. Referral for a hearing aid evaluation
Answer: A
, Rationale: Sudden Sensorineural Hearing Loss (SSNHL) is an
otologic emergency. The standard of care is a prompt course of high-dose oral corticosteroids
(prednisone) to reduce cochlear inflammation, ideally initiated within 72 hours of onset. An MRI
is important for ruling out retrocochlear pathology but is typically ordered concurrently or after
initiating steroids, not as the primary first step. Antibiotics are for bacterial causes (rare).
Hearing aids are for long-term management, not acute treatment.
2. Which of the following acoustic reflex findings is MOST consistent with a
diagnosis of cochlear hearing loss?
A. Ipsilateral reflexes absent, contralateral reflexes present
B. Ipsilateral reflexes present at normal levels, contralateral reflexes absent
C. Reflexes present at lower than normal sensation levels (e.g., 60 dB SL)
D. Reflexes absent at all frequencies
Answer: C
Rationale: In cochlear hearing loss, the acoustic reflex
threshold is often present at lower than normal sensation levels (e.g., at 40-60 dB above the
hearing threshold instead of the normal 70-100 dB). This is due to recruitment (abnormal
loudness growth). Ipsilateral and contralateral reflexes are typically present unless the hearing
loss is profound. Absence of reflexes or specific absent patterns is more indicative of conductive
or retrocochlear pathology.
3. When performing a pure-tone audiogram, which bone conduction masking
dilemma is characterized by the inability to obtain a reliable bone conduction threshold in the
test ear because the masking noise in the non-test ear crosses the skull and elevates the
threshold?
,A. Overmasking
B. Undermasking
C. The Plateau Method
D. Maximum Masking Dilemma
Answer: D
Rationale: The maximum masking dilemma occurs when the
maximum effective masking level in the non-test ear is not sufficient to mask it, but a further
increase in masking would cause the masking noise to cross over to the test ear via interaural
attenuation (usually around 0 dB for bone conduction) and elevate its threshold. This makes it
impossible to get a true bone conduction threshold.
4. A patient has a type As tympanogram. This is most consistent with:
A. Otosclerosis
B. Ossicular discontinuity
C. Patulous eustachian tube
D. Middle ear effusion
Answer: A
Rationale: A type As tympanogram is characterized by normal
middle ear pressure (0 daPa) but abnormally low compliance (peak < 0.3 mL). This is classically
associated with otosclerosis or other conditions that stiffen the ossicular chain, such as
tympanosclerosis. Ossicular discontinuity typically shows a type Ad (high compliance). Patulous
ET shows a type AD or shallow tracing with breathing artifact. Middle ear effusion shows a type
B (flat).
, 5. Which of the following is NOT a standard component of the Immittance
Battery?
A. Tympanometry
B. Acoustic Reflex Thresholds
C. Acoustic Reflex Decay
D. Eustachian Tube Function (ETF) Testing
Answer: D
Rationale: While Eustachian tube function testing can be
performed with immittance equipment, it is not considered a standard component of the
routine clinical immittance battery. The standard battery consists of tympanometry, acoustic
reflex thresholds (ipsilateral and contralateral), and acoustic reflex decay testing.
6. The primary purpose of performing speech testing in quiet and in noise is
to:
A. Confirm the pure-tone audiogram results
B. Determine the need for a hearing aid
C. Assess the functional impact of hearing loss on communication
D. Differentiate between conductive and sensorineural loss
Answer: C
Rationale: The primary purpose of speech testing, especially
in noise, is to assess the patient's functional ability to understand speech in realistic listening
environments. It provides valuable information about the impact of the hearing loss on daily
communication, which is crucial for counseling and rehabilitation planning.
