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. 3–25)

1. Why is knowledge of typical intra- and intersubject variability in clinical audiometric measures, including threshold measures and loudness judgments, over an extended time period of 1 year important information?

   • It instills clinician confidence in the stability of the patient's performance (relative to his or her previous performance as well as with respect to that of others on comparable audiometric tests) independent of changes due to age or pathology.

   • It allows the clinician to gauge changes in relevant audiometric outcome measures used in assessing the efficacy or effectiveness of an experimental therapeutic intervention against inherent variability expected in these measures over an extended time in a control group of normalhearing individuals.

   • It may encourage the patient to return for annual hearing tests.

   • It is essential for powering and estimating sample size in evidence-based audiological research using these measures to assess treatment validity and efficacy.

   • A, B, and D are correct.

2. Repeated measures of pure tone thresholds yield the lowest intrasubject variability when measured

   • over a prolonged period of days

   • in close succession within the same test session with the headphones removed between the repeated measurements

   • in close succession within the same test session without the headphones removed between the repeated measurements

   • just after the end of an upper respiratory condition

   • none of the above

3. Repeated measures of loudness discomfort levels typically yield

   • larger values for intersubject variability than for intrasubject variability

   • smaller values for intersubject variability than for intrasubject variability

   • larger within-subject variability than typical test–retest reliability

   • no differences between inter- and intrasubject variability

   • none of the above

4. In this study, changes in level required for a categorical loudness change across the continuum for the Contour Test of Loudness

   • were similar for warble tones and spondee speech stimuli

   • were greatest for categorical judgments for warble tones between the “very soft” and “soft” categories

   • were greatest for categorical judgments for warble tones between the “loud, but OK” and “uncomfortably loud” categories

   • were more uniform across categories for warble tones than for the spondee speech stimuli

   • none of the above

5. In this study, repeated measures of categorical judgments for warble tones

   • increased in level over time for all categories

   • increased in level over time for 500 Hz, but not for either 2,000 or 4,000 Hz

   • decreased in level over time more for 4,000 Hz than for either 500 or 2,000 Hz

   • were independent of frequency

   • none of the above

   Article Two (pp. 26–52)

6. As defined and measured in this study, how were absolute judgments of loudness similar, but different from relative judgments of loudness?

   • Absolute judgments were greater in level (decibels) than corresponding relative judgments measured within group.

   • Absolute judgments were slightly less in level (decibels) than corresponding relative judgments measured within group.

   • Relative loudness judgments were made in virtual isolation from other judgments, whereas absolute loudness judgments were made in the context of a continuum of categorical judgments.

   • Absolute loudness judgments were clinically synonymous with relative loudness judgments for “soft” and for “loud, but OK” sound levels measured within group.

   • Both B and D are correct.

7. In this study, there was no clinically significant effect on loudness judgments within session and within group for

   • task order

   • trial order

   • left ear

   • right ear

   • all of the above

8. “Comfortable” judgments of loudness

   • annot be estimated from the measured levels judged to be “soft” and “loud, but OK”

   • can be estimated from measured “soft” and “loud, but OK” judgments by bisecting the levels for the respective judgments

   • predicted from measured “soft” and “loud, but OK” judgments underestimated measured “comfortable” judgments by ~2 dB

   • predicted from measured “soft” and “loud, but OK” judgments overestimated measured “comfortable” judgments by ~2 dB

   • B and C

9. Why might prescriptive fitting protocols based on average loudness data for groups of listeners fail?

   • An individual listener's loudness judgments may not be typical of average group loudness judgments.

   • An individual listener's loudness judgments may underestimate average loudness judgments by 20 dB or more.

   • An individual listener's loudness judgments may overestimate average loudness judgments by 20 dB or more.

   • The hearing-impaired listener cannot reliably perform loudness judgments.

   • A, B, and C are correct.

10. Average loudness judgments measured monthly across six test sessions in this study

    • were unchanged between sessions 1 and 6

    • increased by ~2 to 3 dB between sessions 1 and 6

    • decreased by ~2 to 3 dB between sessions 1 and 6

    • are consistent with changes in loudness discomfort level judgments measured after chronic exposure to amplified sound from bilateral hearing aids

    • are inconsistent with changes in loudness discomfort level judgments measured after chronic exposure to amplified sound from bilateral hearing aids

    Article Three (pp. 53–70)

11. People who are sensitive to sound should wear hearing protection devices under which of the following circumstances?

    • Any time they will be around sounds that are uncomfortable for them, including soft sounds

    • All the time

    • To protect their hearing from noiseinduced hearing loss

    • Never

12. Activity avoidance due to sound tolerance problems were most frequently reported by respondents for which of the following activities?

    • Driving the car and going to concerts

    • Going to concerts and movies

    • Going to church and movies

    • Taking care of children and doing housework

13. Nearly all questionnaires that could be used to identify the impact of reduced sound tolerance on hearing aid use evaluate other hypersensitivities (e.g., light, touch)

    • True

    • False

14. People fitted with hearing aids who complain about the hearing aids being too loud when they are having dinner with their family, but not when they are in a restaurant, may be experiencing this type of reduced sound tolerance

    • Misophonia

    • Recruitment

    • Hyperacusis

    • None of the above

15. The majority of the respondents indicated that tinnitus was their primary problem

    • True

    • False

    Article Four (pp. 71–93)

16. Auditory brainstem and middle latency responses were recorded in this study

    • bilaterally

    • unilaterally

    • simultaneously

    • to click stimuli

    • B and C

17. Auditory brainstem responses were evaluated for

    • wave I, III, and V latency

    • wave V latency

    • wave V-V peak-to-peak amplitude

    • wave I and wave V amplitudes to click stimuli

    • B and C

18. Middle latency responses were evaluated for

    • wave Pa latency

    • wave Na-Pa amplitude

    • wave Na amplitude

    • wave Na latency

    • A and B

19. The auditory brainstem response (ABR) wave V latency values were

    • inconsistent with pretreatment predictions (i.e., shorter than normal latency values) only at 500 Hz

    • inconsistent with posttreatment predictions (i.e., similar to normal latency values) only at 2,000 Hz

    • consistent with all pretreatment predictions

    • consistent with all posttreatment predictions

    • inconsistent with pre- and posttreatment predictions at 500 and 2,000 Hz

20. The only ABR or middle latency response (MLR) measure consistent with both pre- and posttreatment study predictions for all cases was

    • ABR amplitude for wave V-V' at 2000 Hz

    • ABR amplitude for wave V-V' at 500 Hz

    • MLR latency for wave Pa at 2,000 Hz

    • MLR latency for wave Pa at 500 Hz

    • MLR amplitude for wave Na-Pa at 500 and 2,000 Hz

    Article Five (pp. 94–114)

21. When normal-hearing adults judge the loudness of brief tonal stimuli on a behavioral loudness scaling technique, such as the Contour Test of Loudness, their individual responses

    • are homogeneous and show little intersubject variability

    • vary considerably (30 to 40 dB) when judging the loudness of these stimuli within a specific loudness category

    • display greater variability for the lowest loudness categories, such as “very soft” and “soft,” and little or no variability for the higher loudness categories, such as “loud, but OK” and “uncomfortably loud”

    • display a systematic increase of 10 dB for each loudness category

    • clearly identify a consistent anchor level across subjects for their loudness judgment of a “very soft” tone burst signal

22. When the participants' behavioral loudness judgments of the brief tone burst signals increased from “comfortable, but slightly soft” to “loud, but OK” categories, the response measures of the auditory brainstem response (ABR) and middle latency response (MLR) showed which of the following patterns?

    • Both the response latencies for ABR wave V and MLR wave Pa and their corresponding response amplitudes decreased.

    • The response latencies for ABR wave V and MLR wave Pa increased and their corresponding response amplitudes decreased.

    • There was an inverse relation, such that the response latencies for ABR wave V and MLR wave Pa decreased and the response amplitudes for these two waves increased as the loudness category increased.

    • There was no significant change in either the ABR/MLR response latencies or response amplitudes as a function of loudness categories.

    • The response measures for the ABR changed significantly as a function of loudness category; however, there were no corresponding changes in the response measures of the MLR.

23. Which response measures of tone-evoked ABRs/MLRs are the most sensitive indicator of the listener's perception of loudness?

    • Response latencies

    • Response amplitudes

    • Overall morphology of the response

    • Response latencies and amplitudes

    • Replicability of the response

24. To date, the literature has suggested that which of the following objective auditory measure(s) might provide insight into the behavioral processing of loudness that occurs in the peripheral and central auditory nervous systems?

    • Click-evoked ABRs

    • Late evoked wave P1-N1-P2 complex, the auditory steady state response, and tone-evoked ABRs/MLRs

    • Acoustic reflexes

    • Otoacoustic emissions

    • Real ear measurements

25. What clinical populations might benefit from having an objective audiologic tool to assess the growth of loudness to assist in prescriptive protocols for fitting nonlinear hearing aids?

    • Young children with a sensorineural hearing loss

    • Cognitively challenged adults with a sensorineural hearing loss

    • Individuals with reduced sound tolerance issues

    • Elderly individuals with a sensorineural hearing loss

    • All of the above

    Article Six (pp. 115–129)

26. Positive treatment outcome for hearing impaired persons with auditory reduced dynamic range includes

    • improvements in loudness discomfort levels

    • a comfortable transition into appropriate amplification

    • reduced complaints of discomfort to sound

    • all of the above

27. Sound therapy for auditory dynamic range expansion is best delivered by

    • a sound generator used in one ear set at soft level

    • sound generators used in both ears set at soft levels

    • sound machine or radio played all night

    • sound generators in both ears used with increased volume weekly

28. Reduced sound tolerance is

    • always accompanied by tinnitus

    • only seen in persons with bilateral hearing loss

    • a predictor of future changes in hearing sensitivity

    • controlled by the cortical and subcortical areas of the brain

29. Treatment of reduced sound tolerance should include

    • use of earplugs or earmuffs whenever a person is worried about the sounds in the environment

    • counseling, which includes correct use of sound therapy and appropriate use of noise protection

    • avoidance of social activities while under treatment

    • immediate use of hearing aids for predetermined periods of time daily

30. The counseling implemented in this study

    • was adapted from counseling used in Tinnitus Retraining Therapy

    • sets the stage for demystifying the subject's problem and neutralizing the negative emotional associations

    • is effective alone in decreasing auditory gain

    • both A and B

    Article Eight (pp. 130–150)

31. Low-level broadband sound therapy for dynamic range expansion was shown in this study to be most effective when offered with

    • a hearing aid

    • specialized structured counseling

    • placebo sound generators

    • no counseling

    • subthreshold noise

32. The sound therapy intervention is shown to be efficacious for hearing-impaired persons with

    • loudness adaptation

    • profound hearing loss

    • conductive hearing loss

    • hyperacusis

    • loudness recruitment

33. The sound therapy intervention described in this study is based on the idea that the therapeutic noise

    • increases the gain of an underlying central auditory neuronal process

    • reduces the gain of this process

    • has no effect on the gain setting of this process

    • operates by adaptive plasticity

    • B and D

34. After successfully completing the sound therapy intervention to expand the auditory dynamic range, aided listeners

    • were able to tolerate sound at higher levels

    • were unable to listen to sound at levels greater than at pretreatment

    • achieved improved word recognition scores (if not limited by ceiling performance)

    • demonstrated no aided benefit

    • reported reduced aided satisfaction

35. Hearing aid use subsequent to successful intervention to expand the auditory dynamic range was shown in this report to differ among participants. For some, amplification

    • sustained the intervention effects in full

    • fully eliminated the intervention effects

    • partially sustained the intervention effects

    • enhanced the intervention

    • A and C