Exam 1 Questions

Question 1

Which of the following about tinnitus is accurate
Tinnitus can be the first symptom of hearing loss
Tinnitus may occur with a rhythm that matches your heartbeat
Tinnitus can develop without any clear cause
All

Answer 1

all

Question 2

Your next PT for the afternoon is a 58 year old male who was referred to you with complaint of right constant acute tinnitus. Based on your tinnitus knowledge the time frame for acute tinnitus would mean the Apt Has been suffering for

Answer 2

6 months or less

Question 3

Which NT receptor is involved in protecting against noise induced excitotoxicity in the auditory nerve fibers

Answer 3

nmda

Question 4

According to Jasterboff neurophysiological model which system plays a secondary role to tinnitus

Answer 4

auditory system

Question 5

What is the primary difference between subjective and objective tinnitus

Answer 5

objective can be heard by others

Question 6

Primary function of the limbic system

Answer 6

Regulating emotions memory and behavior

Question 7

The tymp below indicates pulsatile tinnitus secondary to which conditions

Answer 7

glomus jugulare

Question 8

According to neurophysiological models what is considered a primary cause of how tinnitus is perceived

Answer 8

Increased spontaneous activity

Question 9

When identifying tinnitus ear and stimulus ear for psychoacoustic testing which ear should be used for stimulus in a patient with bilateral tinnitus

Answer 9

ear with the quietest tinnitus

Question 10

Which of the following is a primary goal of audiological assessment for PTs with bothersome tinnitus
Rule out or confirm any underlying disease or pathology
Define impact of tinnitus on quality of life
Diagnose tinnitus as primary disease
Quantify severity of PTs tinnitus

Answer 10

Rule out or confirm any underlying disease or pathology
Define impact of tinnitus on quality of life
Quantify severity of PTs tinnitus

Question 11

When performing pitch matching for a PT with hearing loss at what level should the stimulus be presented at

Answer 11

5-10 dB sl

Question 12

During loudness matching at what level should testing begin in relation to the PTs hearing threshold for matched frequency

Answer 12

5 dB below threshold

Question 13

What role does selective attention play in McKenna’s cognitive behavioral model
It can intensify tinnitus perception, often leading to exaggerated descriptions and heightened distress
It reduces tinnitus distress by focusing on positive thoughts
It increases habituation by decreasing awareness of tinnitus sounds
It helps filter out tinnitus sounds as irrelevant stimuli

Answer 13

It can intensify tinnitus perception, often leading to exaggerated descriptions and heightened distress

Question 14

According to the concept of safety seeking behaviors in McKena’s model, how might these behaviors impact tinnitus management
They reduce tinnitus intensity through avoidance and escape
They help decrease arousal by promoting distraction from tinnitus
They eliminate tinnitus perception by enhancing auditory focus
They reinforce negative beliefs about tinnitus and may delay habituation

Answer 14

They reinforce negative beliefs about tinnitus and may delay habituation

Question 15

A 45 yr old woman reports new onset unilateral tinnitus in her right ear accompanied by mild hearing loss and occasional dizziness, she has not experienced tinnitus before and is concerned about what this might mean. What is the best course of action

Answer 15

Refer for an ENT evaluation due to unilateral tinnitus and hearing loss

Question 16

Emma a 65 year old retiree has been diagnosed with Menieres disease. She experiences tinnitus, fluctuating hearing loss and vertigo. What type of tinnitus is commonly associated with Menieres

Answer 16

LF tinnitus

Question 17

What is the recommended method to determine if a PTs pulsatile tinnitus is related to the cardiac cycle

Answer 17

Have the PT count the # of pulses they hear while the examiner silently counts the PTs cardiac pulse then compare the two counts

Question 18

In cases where tinnitus can be modified by jaw clenching or head movements the phenomenon is referred to as

Answer 18

Somatic modulation

Question 19

Which of the following factors can impede the habituation process in tinnitus according to Hallam’s model
Low levels of arousal and consistent tinnitus sound
Low auditory input and reduced neural response gain
High levels of arousal, sudden onset, or emotionally significant tinnitus
Consistent exposure to environmental noise

Answer 19

High levels of arousal, sudden onset, or emotionally significant tinnitus

Question 20

Sara is a 45 yr old woman recently started experiencing a persistent ringing sound in her ears. She feels anxious about it worrying that it might signify a serious health issue and often finds herself focusing on the sound which makes it seem even louder. Her distress over the tinnitus is affecting her sleep, mood and daily activities. Her doctor explains two approaches to understanding and managing her tinnitus
Approach A: key to managing her tinnitus is to understand her cognitive and emotional reactions to the sound and work on changing her thoughts and beliefs about tinnitus
Approach B: suggests that over time her brain may naturally start ignoring the tinnitus sound treating it as a background noise that doesn’t require attention or emotional response
Based on the information provided which of the following statements best matches each approach to the respective model of tinnitus

Answer 20

Approach A aligns with McKenna’s Cognitive Behavioral Model, as it emphasizes addressing Sarah’s thoughts and reactions to tinnitus, while Approach B aligns with Hallam’s Habituation Model, which focuses on the brain’s natural tendency to tune out the tinnitus sound.

Question 21

Which of the following are characteristic features of somatic tinnitus? (Select all that apply)
It is perceived as a high-pitched, constant ringing.
It is associated with hearing loss and balance issues.
It is always perceived in the ear on the same side as the somatic event.
It is associated with abnormalities in neurological examinations.

Answer 21

It is perceived as a high-pitched, constant ringing.

It is always perceived in the ear on the same side as the somatic event.

Question 22

Tinnitus is always heard as a ringing sound.

Answer 22

falase

Question 23

The autonomic nervous system controls voluntary bodily functions.

Answer 23

false

Question 24

Imaging techniques can often identify the underlying cause of objective tinnitus.

Answer 24

true

Question 25

Tinnitus models offer explanations for various tinnitus-related phenomena by focusing exclusively on peripheral auditory system dysfunction and ignoring central auditory processes.

Answer 25

false

Question 26

Neurophysiological models propose that tinnitus results from the auditory system’s interpretation of external sounds as abnormal neural activity, though the precise physiological mechanism remains unclear.

Answer 26

false

Question 27

Dishabituation is defined as the re-emergence of tinnitus awareness due to stress or psychological change.

Answer 27

true

Question 28

Hallam’s model addresses the perception of tinnitus, aiming to reduce awareness of the sound, whereas McKenna’s model focuses on managing reactions to tinnitus through cognitive and emotional interventions.

Answer 28

true

Question 29

The autonomic nervous system controls voluntary bodily functions.

Answer 29

False
The ANS controls involuntary bodily functions.

Question 30

Somatic modulation refers to changes in tinnitus perception caused by physical movements, such as jaw clenching.

Answer 30

true

Question 31

Reduced cochlear input can lead to increased neural activity in higher auditory centers through homeostatic modulation.

Answer 31

true

Question 32

Imaging techniques can often identify the underlying cause of objective tinnitus.

Answer 32

true

Question 33

Tinnitus models offer explanations for various tinnitus-related phenomena by focusing exclusively on peripheral auditory system dysfunction and ignoring central auditory processes.

Answer 33

false

Question 34

Neurophysiological models propose that tinnitus results from the auditory system’s interpretation of external sounds as abnormal neural activity, though the precise physiological mechanism remains unclear.

Answer 34

false

Question 35

Dishabituation is defined as the re-emergence of tinnitus awareness due to stress or psychological change.

Answer 35

true

Question 36

Hallam’s model addresses the perception of tinnitus, aiming to reduce awareness of the sound whereas mckenna’s model focuses on managing reactions to tinnitus through cognitive and emotional interventions

Answer 36

true

Question 37

Discordant damage between inner and outer hair cells causes balanced neural activity in the auditory pathways, eliminating the perception of tinnitus.

Answer 37

false

Question 38

The goal of MML testing is to identify the tone frequency and intensity closest to the patient’s tinnitus sound.

Answer 38

false

Question 39

According to the neural crosstalk theory, tinnitus can result from artificial connections between auditory nerve fibers and nearby cranial nerves.

Answer 39

true

Question 40

Displacement of the tectorial membrane can lead to tinnitus by causing prolonged depolarization of inner hair cells in damaged cochlear regions.

Answer 40

true

Question 41

Both hyperactivity and hypersynchrony can contribute to tinnitus, but hyperactivity involves an increase in individual neuron activity, whereas hypersynchrony involves neurons firing in a coordinated manner.

Answer 41

true

Question 42

Contralateral OAE suppression is measured by presenting white noise to the same ear as the OAE measurement.

Answer 42

false

Question 43

The residual inhibition (RI) test is conducted by presenting white noise 10 dB below the Minimum Masking Level.

Answer 43

false

Question 44

This model suggests that high levels of stress or arousal make it harder to filter out tinnitus-related information.

Answer 44

habituation

Question 45

This model suggests that negative thoughts can trigger arousal and emotional distress.

Answer 45

cognitive

Question 46

Used in Jastreboff’s model to illustrate difficulty in ignoring tinnitus perception.

Answer 46

tiger analogy

Question 47

Mechanism in which the brain attempts to restore balance by increasing neural activity to compensate for reduced auditory input, potentially leading to spontaneous activity and tinnitus

Answer 47

central gain

Question 48

This model emphasizes that tinnitus distress stems primarily from the individual’s reactions and perceptions of tinnitus rather than the sound itself, often creating a cycle of distress.

Answer 48

McKena’s cognitive behavioral model

Question 49

A feedback loop where anxiety, stress, and insomnia increase tinnitus perception and distress

Answer 49

vicious cycle of tinnitus

Question 50

A system that blocks tinnitus signals from reaching the auditory cortex, preventing the perception of tinnitus.

Answer 50

Inhibitory gating mechanism

Question 51

A 45-year-old teacher presents with a clicking sound in the left ear that started around four months ago. He notices the clicking a few times daily, with each episode lasting from 15 to 30 minutes. The patient can briefly stop the sound by yawning or moving the jaw, though it often returns shortly afterward. There is no history of loud noise exposure, ear infections, or recent health issues, and the sound does not interfere with sleep or concentration. Previous tests showed normal hearing.
Based on the case history provided, classify the patient’s tinnitus in terms of its impact, duration, and temporal characteristics. Provide a rationale for each classification. (3 pts)
What is the likely type of tinnitus the patient is experiencing? (1 pt)
What assessment would you use to confirm the clicking tinnitus? Describe the procedure. (3 pts)

Answer 51

1. Temporal characteristics to classifying tinnitus relates to how often the patient experiences the tinnitus. In this patients case, I would classify this as acute because his tinnitus started less than 6 months ago. For temporal characteristics, I would classify this patient’s tinnitus as intermittent tinnitus because the patient experiences his tinnitus every day a few times a day that lasts longer than 5 minutes which is the criteria for it to be intermittent. In terms of impact, he has nonbothersome tinnitus and this is because his tinnitus doesn’t impact his daily life or health and he is able to continue on in his everyday life without any impact from nis tinnitus. For duration classification, it refers to how long they are experiencing the tinnitus. In this patient’s case, he is expereincing it often and the episodes are lasting between 15-30 minutes every day.
2. The tinnitus that the patient is experiencing is most likely clicking tinnitus or somatosensory tinnitus. It could be somatosensory because he is able to get the tinnitus to stop when he moves his jaw in some way and it provides tinnitus relief. It could be clicking because he is describing it as a clicking sound.
3. The best way to confirm if this tinnitus is of clicking nature is to perform a reflex decay test. During the test, have the patient tap their leg with their finger or tap their foot everytime they hear the clicking sound during the testing. When they tap, the audiologist can see if this corresponds to a spike that will be visualized on the reflex decay screen. Reflex decay testing puts a continuous loud sound into the patients ear over a period of time to see if the muscles in the middle ear can hold their contraction for the normal amount of time. This is done at 10dB above their contralateral acoustic reflex threshold. If the patient’s reflex threshold contralaterally is too high, then reflex decay will not be able to be performed. The best way to confirm then if it is not clicking tinnitus and may be somatosensory is to perform jaw manipulations during 10 second increments to see if the tinnitus is relieved in anyway. This can be done by having the patient protrude their lower jaw out and hold it for 10 seconds. Then ask if the patient noticed any difference to their tinnitus. Or they can clench their jaw for 10 seconds to see again if there is any change.

Question 52

A 38-year-old woman with a known diagnosis of otosclerosis presents with a gradual bilateral hearing loss and tinnitus, which became worse over the past year. She describes the tinnitus as resembling white noise, primarily noticeable in quiet settings. The hearing loss initially affected only her left ear but has recently progressed to her right ear as well. She is now seeking hearing aids to manage the bilateral hearing loss and improve her hearing in daily life.
Tinnitus is a common symptom in otosclerosis patients and sometimes it can appear as the first symptom, explain. (2 pts)
What is the common description of tinnitus reported by patients with otosclerosis? (2 pt)
Discuss three additional theories proposed to explain how otosclerosis can result in tinnitus? (3 pts)

Answer 52

If tinnitus is the initial symptom it means that the patient hasn’t yet experienced CHL so there is no auditory deprivation triggering the brain to compensate for the reduced auditory input. OTSC initially causes pulsatile tinnitus which results from the increased blood flow around the affected area or the newly formed bone

The common description of those with tinnitus with otosclerosis is that it is high-pitched or pulsatile in nature or it can even sound like white noise.
This can be due to the conductive hearing loss and deafferentation, the bony growth in the middle ear space resulting in hyperactivity heard by the brain due to decrease in input, or the increased blood flow to the area resulting in the tinnitus the patient experiences with otosclerosis.