Self-Assessment Questions

This section provides a review. Mark each statement on the Answer Sheet according to the factual materials contained in this issue and the opinions of the authors.

Article One (pp. 1–8)

1. The N1 response is fully mature by the age of

   • 8 weeks

   • 18 weeks

   • 8 months

   • 8 years

   • 18 years

2. The main generators of the cortical auditory evoked potential (CAEP) are anatomically in Heschl's gyrus, which is in the

   • temporal lobe

   • parietal lobe

   • occipital lobe

   • frontal lobe

   • cerebellum

3. The spectral peak of the near-threshold CAEP is in the range

   • 0.2 to 0.5 Hz

   • 2 to 5 Hz

   • 20 to 50 Hz

   • 200 to 500 Hz

   • 2 to 5 kHz

4. The CAEP threshold could be defined by any of the following but is defined in this article as

   • the lowest level at which a response is present

   • midway between the lowest level at which a response is present and the highest level at which a response is absent

   • the lowest level at which a response is present, with a response absent at a level of 10 dB or less below this level

   • the level corresponding to the zero response amplitude, extrapolated from the amplitude input–output function

   • the lowest level at which a response is present with a response amplitude of less than 5 μV

5. There is an average difference between the CAEP threshold and the “true” behavioral threshold, sometimes known as the bias. In adults and using tone burst stimuli, this is typically

   • <5 dB

   • 5 to 10 dB

   • 10 to 15 dB

   • 15 to 20 dB

   • >20 dB

   Article Two (pp. 9–24)

6. When presenting stimuli at conversational levels (i.e., between 55- and 75-dB sound pressure level [SPL]) in the free field, the following conclusion is reached in this study. Hearing aid gain significantly affects CAEP amplitudes

   • in normal hearers and hearingimpaired users

   • in normal hearers but not in hearingimpaired users

   • not in normal hearers but only in hearing-impaired users

   • not in normal hearers nor hearingimpaired users

   • none of the above; this does not depend on hearing loss at all

7. For which one of the following applications can CAEPs not be used?

   • Hearing threshold estimation in adults

   • Evaluating the effects of plasticity in the brainstem

   • Evaluation of temporal processing

   • Evaluating the effects of aging in the auditory cortex

   • Evaluating the effects of changes in frequency or intensity of the stimulus

8. The observed differences in CAEP amplitude growth between normal-hearing and hearing-impaired groups in this study can be explained by

   • different cortical processing mechanisms in normal-hearing versus hearing-impaired groups

   • changing audibility of the stimulus

   • the hearing aid noise always being audible to one of the two groups

   • A and B

   • B and C

9. When stimulus audibility is close to threshold, increasing the hearing aid gain will have which of the following effects on CAEP amplitudes in hearing-impaired wearers?

   • CAEP amplitude will decrease.

   • CAEP amplitude will increase.

   • CAEP amplitude will stay the same.

   • This cannot be predicted. It depends on the relative size of the CAEP.

   • This cannot be predicted. It depends on the stimulus signal-to-noise ratio.

10. This study advocates that

    • CAEPs cannot be used for clinical hearing aid gain evaluation

    • CAEPs can be used for hearing aid gain evaluation

    • more research is still needed on the effect of other hearing aid parameters on CAEPs, but this does not prevent CAEP use in the clinic already

    • A and C

    • B and C

    Article Three (pp. 25–35)

11. CAEPs can be evoked by

    • clicks

    • tone bursts

    • vowels

    • consonants

    • all of the above

12. CAEPs can be detected in

    • infants and children with normal hearing

    • infants and children with sensorineural hearing loss

    • infants and children with conductive hearing loss

    • infants and children with hearing loss in aided conditions

    • all of the above

13. Which of the following questions has not been addressed in previous studies that related CAEPs to the effect of nonlinear frequency compression (NLFC) on children with hearing loss?

    • Do CAEPs predict changes in functional performance of children?

    • Do CAEPs relate to changes in audibility of speech sounds due to NLFC activation?

    • Does NLFC increase audibility of /t/and /s/?

    • A and B

    • A, B, and C

14. Which of the following statements is true in regards to the findings described in this research?

    • NLFC increased average sensation levels of speech stimuli.

    • CAEPs were detected more often when NLFC was activated than when it was deactivated.

    • CAEPs for /g/ are likely to be present when CAEPs for /t/ are present.

    • CAEPs for /t/ are likely to be present when CAEPs for /s/ are present.

    • All of the above are true.

15. Which of the following statements apply to a clinical protocol on using CAEPs for hearing aid validation described in this article?

    • Ensure that hearing aids have been verified to match prescriptive targets.

    • Commence assessments of CAEPs with /s/ as stimulus.

    • Complement objective testing with behavioral evaluation.

    • All of the above should be done.

    Article Four (pp. 36–52)

16. According to the Australian Hearing protocol, which of the following clients have priority for CAEP testing?

    • Children with unilateral hearing loss

    • Children with auditory neuropathy spectrum disorder

    • Children who can provide reliable behavioural results

    • A and B

    • B and C

17. According to the Australian Hearing protocol, when CAEPs are detected for a specific speech sound at 75-dB SPL but not at 65-dB SPL and residual electroencephalogram noise levels are acceptable, which of the following statements is true?

    • No change of the estimated audiogram is warranted.

    • The audiogram is reestimated at the corresponding frequency range by 5 dB.

    • The audiogram is reestimated at the corresponding frequency range by 10 dB.

    • The audiogram is reestimated at the corresponding frequency range by 15 dB.

    • The client is reassessed with the CAEP test on the same day.

18. According to the Australian Hearing protocol, which of the following is a valid reason for not conducting a CAEP test?

    • The child has a severe hearing loss.

    • The child has having otitis media.

    • The child is awake and alert.

    • The child is younger than 6 months of age.

    • The child is not being able to perform behavioural testing.

19. In which cases is CAEP testing not clinically possible or useful?

    • The child had a noisy electroencephalogram.

    • The child was uncooperative.

    • The child had a severe case of auditory neuropathy spectrum disorder.

    • None of the above is true.

    • All of the above are true.

20. Apart from providing additional objective information when behavioural information is not available, CAEP testing potentially can be used

    • to evaluate hearing aid fittings

    • to evaluate unaided ability in auditory neuropathy spectrum disorder cases

    • to provide additional objective information when deciding for cochlear implant (CI) candidacy

    • for parent counseling

    • all of the above

    Article Five (pp. 53–61)

21. Why is it not possible to use auditory brainstem response (ABR) testing to derive an estimated audiogram for infants with auditory neuropathy spectrum disorder (ANSD)?

    • There is insufficient evidence regarding the use of ABR testing for behavioral threshold estimation in infants with ANSD.

    • The absence of a clearly defined ABR wave V means thresholds cannot be determined.

    • The presence of otoacoustic emissions makes the estimated audiogram derived from ABR results unreliable in infants with ANSD.

    • A and C are true.

    • None of the above is true.

22. Which of the following can make ANSD a particularly challenging condition to manage audiologically?

    • Possible deterioration of auditory performance with amplification

    • Fluctuating auditory thresholds over time

    • Disproportional speech discrimination ability relative to the degree of hearing loss

    • None of the above

    • All of the above

23. Which of the following has been reported in previous studies regarding CAEPs?

    • The presence of a CAEP response indicated that the stimulus is at comfortable level to the listeners.

    • The absence of a CAEP response did not necessarily mean that the listener is unable to hear the sound.

    • CAEP detection rates were the same for all stimulus types.

    • The detection rate for N1 of the CAEP is the same as the detection rate for P1.

    • All of above are true.

24. Which of the statements about CAEPs is false?

    • An increase in stimulus sensation level has been shown to increase the detection rate of CAEPs in infants with normal hearing and sensory/neural hearing loss (SNHL).

    • CAEPs require lower temporal precision to be recorded compared with an ABR.

    • If a CAEP response is absent, it means the infant is unable to hear the sound.

    • Clinicians need to be cautious in how they interpret the CAEP results.

    • None of the above is true.

25. Which of the following conclusion is reached in the present study?

    • CAEP detection rates differ between infants with SNHL and ANSD.

    • There was no difference in the detection rates between infants with SNHL and ANSD.

    • Increases in stimulus audibility did not result in an increase in CAEP detection rate in infants with ANSD.

    • Amplification may result in a deterioration of performance in some infants with ANSD.

    • Speech perception ability differs between infants with SNHL and ANSD.

    Article Six (pp. 62–73)

26. According to Blamey et al, what factor is most associated with better speech perception outcomes in younger adult CI users?

    • Duration of profound deafness

    • Duration of implant experience

    • Severity of deafness preimplantation

    • Type of implant

    • Speech perception scores preimplantation

27. Researchers have explored the relationship between speech perception scores and evoked potentials in groups of cochlear implant users and found that speech scores are correlated with

    • latencies and amplitudes of a range of auditory evoked potentials

    • middle latency response (MLR) amplitudes

    • P3 latencies

    • N1 latency and amplitude

    • P2 amplitude

28. Cortical auditory evoked potentials change after implantation. Which of the following statements is correct?

    • N1 changes more quickly than P2.

    • P2 changes more quickly than N1.

    • Neither N1 nor P2 is sensitive to auditory plasticity in cochlear implant users.

    • Differences across studies may reflect differences across participants and stimulus paradigms, but in general both N1 and P2 show shorter latencies and larger amplitudes after cochlear implantation.

    • Differences across studies may reflect differences across participants and stimulus paradigms, but in general both N1 and P2 show longer latencies and smaller amplitudes after cochlear implantation.

29. MLRs have been used to investigate neuroplasticity after cochlear implantation. Which of the following statements is correct?

    • It is not possible to record MLRs in people with cochlear implants due to electrical artefacts.

    • The MLR changes parallel with changes seen in N1 and P2 cortical responses.

    • MLR is the evoked potential that is most sensitive to changes in the central auditory system after implantation.

    • MLRs show less reliable change after implantation than obligatory cortical responses (N1, P2) in adult implant recipients.

    • None of the statements above is correct.

30. Which statements accurately describe the association between mismatch negativity (MMN) and cochlear implant outcomes?

    • MMN detectability and latencies are correlated with speech perception in implant users.

    • MMN is not always present in adult implant users.

    • MMN responses correlate with a range of auditory perceptual skills.

    • Although on average MMN improves over time after implantation, results are variable and hence large sample sizes may be needed to show statistically significant improvements with greater implant experience.

    • All of the above are true.

    Article Seven (pp. 74–84)

31. When tracking the development of the central auditory nervous system using the CAEP, which of the following latency changes have been documented over time?

    • Reduction in P1 latency only

    • Increase in N1 latency only

    • Decrease in P2 latency only

    • Reduction of P1 and N1 latencies only

    • Reduction of P1, N1, and P2 latencies

32. When tracking the development of the central auditory nervous system using the CAEP, which of the following amplitude changes have been documented over time?

    • P1 amplitude reduction only

    • N1 amplitude reduction only

    • N1 amplitude increase

    • P2 amplitude decrease

    • Reduction of all component amplitudes

33. Behaviours often associated with auditory processing disorder (APD) include

    • difficulty hearing speech in noise

    • difficulty following instructions

    • literacy development difficulties

    • attention difficulties

    • all of the above

34. This study finds that children diagnosed with APD demonstrate

    • absent CAEPs

    • larger amplitude CAEPs compared with peers in all waves

    • smaller amplitude and increased latency in the earlier CAEP waves compared with peers

    • no significant difference in CAEPs compared with peers

    • smaller amplitude CAEPs compared with peers in later waves

35. This study compares the CAEPs in children diagnosed with APD to peers, and the findings suggest that

    • there are no cortical differences between the two groups

    • children with APD have a neuropathology present

    • children with APD have a neurodevelopmental delay

    • CAEPs are able to predict a child's cognitive ability

    • CAEPs provide a diagnostic tool for APD

    Article Eight (pp. 84–98)

36. An Australian study by Dowell et al reviewing the performance of adult CI users on speech perception found that

    • the median scores were 68% when listening to single words in quiet

    • the standard deviation was 68% when listening to speech in quiet

    • the median score was 86% when listening to words in quiet

    • the mean scores were 86% when listening to words in quiet

    • the median scores were 68% when listening to sentences in quiet

37. Surveys from a number of countries have shown that

    • hearing device uptake by people with hearing loss is greater than 40%

    • hearing devices are enthusiastically sought after by people with hearing loss

    • hearing devices once bought are worn by all with no exception

    • hearing devices are more often not sought or bought and even if accessed, are only used by up to 40% or not used at all

    • hearing devices are more often not sought or bought but once accessed, are used by all

38. Auditory training (AT) is recognized as an important aspect for management for people with hearing loss. Which of the following is true?

    • AT always should use speech stimuli such as sentences, words, or syllables.

    • It is well established that AT should be for at least 6 weeks.

    • The intensity of AT for adequate training is well accepted.

    • The outcomes of all the AT studies cited show optimal results.

    • There are only 13 studies cited in the 2013 review that included a wide variety of training materials, and duration and intensity of training with very mixed results.

39. Speech perception in experienced CI users is linked to a number of auditory processing abilities. Which of the following is true?

    • Spectral ripple noise discrimination is the only factor necessary for speech perception.

    • Iterated ripple noise is created by adding a delay to white noise and repeating the process a number of times and is a measure of spectro-temporal processing.

    • Frequency discrimination, temporal modulated discrimination, and iterated ripple noise do not correlate significantly with speech perception.

    • Gap detection is a temporal resolution task that is not linked to speech perception.

    • Temporal modulation transfer function task measures spectral resolution of modulations in the envelope of white noise.

40. Cortical auditory evoked potentials

    • are elicited only when short (up to 30 ms) speech stimuli are used

    • are never used to evaluate auditory plasticity

    • correlate with speech perception in experienced CI users

    • need multichannel recordings that require 32 electrode placements or more

    • in quiet and in noise elicit exactly the same responses, with the same latency and amplitude