A 12-year-old boy has not heard well in his right ear since he had mumps 2 months ago. Both tympanic membranes are normal. With a 512 Hz fork, Rinne test is negative on the right and positive on the left, and Weber test is lateralised to the left. What do these findings indicate?

Severe sensorineural loss in the right ear

Conductive hearing loss in the left ear

Conductive hearing loss in the right ear

Sensorineural hearing loss in the left ear

A 31-year-old man with bilateral conductive hearing loss and normal tympanic membranes is suspected to have otosclerosis. The ENT resident places a vibrating tuning fork on the mastoid while raising and lowering the air pressure in the ear canal with a Siegle speculum. What does this test assess?

Mobility of the stapes footplate

Function of the Eustachian tube

Integrity of the cochlear nerve

A 25-year-old man was slapped hard on the left ear in a fight four weeks ago. He has had poor hearing in that ear since. The tympanic membrane is intact. Audiometry shows a 55 dB conductive loss on the left, and tympanometry shows a normal peak pressure with an abnormally high peak. What is the most likely cause?

Disruption of the incudostapedial joint

Fixation of the stapes footplate

A 3-year-old girl born with small, malformed pinnae on both sides has no visible ear canals. She is not yet speaking in sentences. BERA shows a 60 dB conductive loss in both ears with normal bone conduction thresholds, and CT shows bony atresia of both canals with normal inner ears. What is the best way to give her hearing now?

Bone-conduction hearing aid on a softband

Wait for canal surgery at 10 years

Behind-the-ear air-conduction aids

Hearing loss, tuning fork tests and audiometry

28 NEET-PG practice questions on Hearing loss, tuning fork tests and audiometry, part of ENT. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 12-year-old boy has not heard well in his right ear since he had mumps 2 months ago. Both tympanic membranes are normal. With a 512 Hz fork, Rinne test is negative on the right and positive on the left, and Weber test is lateralised to the left. What do these findings indicate?
1. AConductive hearing loss in the left ear
2. BConductive hearing loss in the right ear
3. CSevere sensorineural loss in the right ear
4. DSensorineural hearing loss in the left ear
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Answer: C · Severe sensorineural loss in the right ear
Mumps is a common cause of sudden, one-sided, profound sensorineural hearing loss in children. Weber goes to the better cochlea in sensorineural loss, which here is the left. The negative right Rinne is a false negative: bone-conducted sound from the mastoid crosses the skull and is heard by the good left ear, while air conduction is not heard on the dead right side. Masking the left ear with a Barany noise box during the test, followed by pure tone audiometry, reveals the true picture.
- A: Left conductive loss would make the left Rinne negative.
- B: Right conductive loss would send Weber to the right, not the left.
- D: Left sensorineural loss would lateralise Weber to the right.
Question 2 · Medium
A 21-year-old college student wakes with dull hearing and ringing in both ears after spending five hours close to the speakers at a wedding DJ party. Audiometry the next day shows a bilateral sensorineural dip at 4 kHz. Two days later the hearing and tinnitus have recovered completely. What does this episode represent?
1. APermanent threshold shift
2. BAcoustic trauma with rupture
3. CSudden idiopathic hearing loss
4. DTemporary threshold shift
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Answer: D · Temporary threshold shift
Short exposure to loud noise causes a temporary threshold shift: hair cells are fatigued and recover within hours to days. Repeated exposures without enough recovery lead to a permanent threshold shift from hair cell loss, again starting around 4 kHz. Recovery here confirms the temporary nature, but it is a warning. He should be counselled to limit exposure and use ear protection near loudspeakers.
- A: A permanent shift does not recover after two days.
- B: Blast or impulse trauma can rupture the drum or cochlear membranes; this exposure did neither.
- C: Sudden idiopathic loss is usually one-sided and not linked to noise.
Question 3 · Easy
A 31-year-old man with bilateral conductive hearing loss and normal tympanic membranes is suspected to have otosclerosis. The ENT resident places a vibrating tuning fork on the mastoid while raising and lowering the air pressure in the ear canal with a Siegle speculum. What does this test assess?
1. AMobility of the round window
2. BFunction of the Eustachian tube
3. CMobility of the stapes footplate
4. DIntegrity of the cochlear nerve
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Answer: C · Mobility of the stapes footplate
This is the Gelle test. Raising the canal pressure pushes the ossicular chain inwards and normally reduces the loudness of the bone-conducted sound, because the stapes is pressed into the oval window; the test is then positive. When the stapes is fixed, as in otosclerosis, the pressure change makes no difference and the test is negative. It is a simple bedside clue to stapes fixation before audiometry and tympanometry.
- A: The Gelle test examines stapes fixation at the oval window, not the round window.
- B: Eustachian tube function is tested by Valsalva, Politzer or tympanometry, not by Gelle.
- D: The cochlear nerve is assessed by BERA and speech audiometry, not by canal pressure.
Question 4 · Medium
A 25-year-old man was slapped hard on the left ear in a fight four weeks ago. He has had poor hearing in that ear since. The tympanic membrane is intact. Audiometry shows a 55 dB conductive loss on the left, and tympanometry shows a normal peak pressure with an abnormally high peak. What is the most likely cause?
1. ADisruption of the incudostapedial joint
2. BBlood in the middle ear cavity
3. CFracture involving the cochlea
4. DFixation of the stapes footplate
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Answer: A · Disruption of the incudostapedial joint
A conductive loss of about 50-60 dB behind an intact drum with a very compliant (type Ad) tympanogram means the ossicular chain is broken, most often at the incudostapedial joint, the weakest link. The drum, no longer loaded by the chain, moves excessively. The loss is large because the drum now pushes on nothing that reaches the oval window. Treatment is exploratory tympanotomy with ossiculoplasty, or a hearing aid.
- B: Haemotympanum gives a flat (type B) tympanogram and usually resolves in weeks.
- C: A cochlear fracture causes sensorineural, not conductive, loss.
- D: Stapes fixation stiffens the system and gives a low (type As) peak.
Question 5 · Medium
A 3-year-old girl born with small, malformed pinnae on both sides has no visible ear canals. She is not yet speaking in sentences. BERA shows a 60 dB conductive loss in both ears with normal bone conduction thresholds, and CT shows bony atresia of both canals with normal inner ears. What is the best way to give her hearing now?
1. ABilateral cochlear implants
2. BWait for canal surgery at 10 years
3. CBehind-the-ear air-conduction aids
4. DBone-conduction hearing aid on a softband
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Answer: D · Bone-conduction hearing aid on a softband
Bilateral congenital aural atresia gives a maximal conductive loss with healthy cochleae. Air-conduction aids cannot be fitted because there is no canal, so sound is delivered through the skull by a bone-conduction aid, worn on a softband in young children and later as an implanted bone-anchored device. Early amplification matters because the first years are the critical period for speech and language. Reconstructive surgery of the canal or pinna is considered later, if at all.
- A: Cochlear implants are for severe sensorineural loss; her cochleae are normal.
- B: Waiting years without amplification harms speech and language development.
- C: An air-conduction aid needs an ear canal to deliver sound.
Question 6 · Medium
A 50-year-old man has had slowly worsening hearing in his left ear for two years, with tinnitus and mild unsteadiness. Pure-tone audiometry shows a moderate left sensorineural loss, but his speech discrimination score in that ear is only 30%. The acoustic reflex decays rapidly on the left. What is the investigation of choice?
1. ACaloric testing with ice water
2. BHigh-resolution CT temporal bone
3. CMRI with gadolinium contrast
4. DElectrocochleography
Answer and explanation in LearnFree account
Question 7 · Easy
A house surgeon in the ENT OPD is about to do Rinne and Weber tests on a man with unilateral deafness. Which tuning fork is preferred for these tests?
1. A256 Hz
2. B512 Hz
3. C2048 Hz
4. D128 Hz
Answer and explanation in LearnFree account
Question 8 · Medium
A 35-year-old bank clerk has had a blocked, dull right ear for a week after trying to clean it with a cotton bud. Otoscopy shows hard wax filling the right canal; the left ear is normal. Consider these expected tuning fork findings: 1. Rinne test is negative on the right. 2. Weber test lateralises to the right. 3. The absolute bone conduction test is the same as the examiner's. 4. Schwabach test is prolonged on the right. Which findings are expected?
1. A1 and 2 only
2. B2, 3 and 4 only
3. C1, 2, 3 and 4
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 9 · Hard
A 32-year-old woman with bilateral otosclerosis has an air-bone gap on audiometry, and her bone conduction curve shows a dip at 2 kHz in both ears. The ENT resident lists four statements about this dip: 1. It is greatest at about 2 kHz in the bone conduction curve. 2. It reflects permanent damage to the cochlear hair cells. 3. It usually disappears after a successful stapedotomy. 4. It is seen only in the air conduction curve. Which statements are correct?
1. A1, 2 and 3 only
2. B1, 3 and 4 only
3. C1 and 3 only
4. D2 and 4 only
Answer and explanation in LearnFree account
Question 10 · Medium
A 10-year-old girl has had bilateral sensorineural hearing loss since early childhood and now has a diffuse goitre. Her thyroid function is normal. A perchlorate discharge test is positive, and CT shows enlarged vestibular aqueducts. What is the most likely diagnosis?
1. AUsher syndrome
2. BAlport syndrome
3. CWaardenburg syndrome
4. DPendred syndrome
Answer and explanation in LearnFree account
Question 11 · Medium
A 2-year-old boy has bilateral profound sensorineural hearing loss confirmed by BERA at 6 months. He has used well-fitted bilateral hearing aids with auditory training for over six months but shows no speech development. MRI shows normal cochleae and cochlear nerves. His parents ask what can be done. What is the most appropriate option?
1. ABilateral cochlear implantation
2. BSign language with no device
3. CMore powerful hearing aids only
4. DBone-anchored hearing aid
Answer and explanation in LearnFree account
Question 12 · Hard
A 36-year-old factory worker files a compensation claim for total deafness in his right ear after a machine burst beside him. Hearing in the left ear is normal. During testing his answers are inconsistent. Two tuning forks of the same frequency are held beside the ears, the one near the 'deaf' ear being louder, and he says he hears nothing at all. Which test is this?
1. AStenger test
2. BBing test
3. CSchwabach test
4. DGelle test
Answer and explanation in LearnFree account
Question 13 · Hard
A 33-year-old man has a conductive hearing loss in his left ear. Rinne tests on that ear are done with three forks: with 256 Hz bone conduction is louder, with 512 Hz bone conduction is louder, and with 1024 Hz air conduction is louder. What air-bone gap does this pattern indicate?
1. AAbout 15-30 dB
2. BAbout 45-60 dB
3. CLess than 15 dB
4. DAbout 30-45 dB
Answer and explanation in LearnFree account
Question 14 · Medium
A 45-year-old man with fluctuating hearing loss in his right ear complains that loud sounds, such as a pressure cooker whistle, become painfully loud in that ear, although soft sounds are hard to hear. Which test result would best localise the lesion to the cochlea?
1. ARapid tone decay over one minute
2. BNormal speech discrimination score
3. CRecruitment present on loudness balance
4. DPositive Rinne with negative Weber
Answer and explanation in LearnFree account
Question 15 · Medium
Audiometry is done for 120 workers in a stone-crushing unit near Jaipur during an occupational health survey. The medical officer prepares a talk on noise-induced hearing loss with four statements: 1. It is usually bilateral and roughly symmetrical. 2. It is sensorineural, from damage to the outer hair cells. 3. It keeps worsening for years after noise exposure stops. 4. Hearing protectors such as earmuffs reduce the risk. Which statements are correct?
1. A1 and 2 only
2. B2, 3 and 4 only
3. C1, 2, 3 and 4
4. D1, 2 and 4 only
Answer and explanation in LearnFree account
Question 16 · Medium
A 42-year-old woman wakes up with sudden deafness and a blocked feeling in her right ear. There is no vertigo or ear pain, and the drum is normal. Weber lateralises to the left, Rinne is positive on both sides, and audiometry the same day shows a 60 dB sensorineural loss in the right ear. What is the next best step?
1. AInsert a ventilation tube in the drum
2. BStart high-dose oral corticosteroids
3. CWatch and repeat audiometry in 4 weeks
4. DGive oral antibiotics and decongestants
Answer and explanation in LearnFree account
Question 17 · Easy
A 29-year-old schoolteacher from Thrissur has slowly progressive hearing loss in both ears for three years, which became worse during her recent pregnancy. Both eardrums look normal. She says she follows her husband's conversation better on a noisy bus than at home. What is this phenomenon called?
1. ARecruitment
2. BDiplacusis
3. CParacusis Willisii
4. DAutophony
Answer and explanation in LearnFree account
Question 18 · Medium
A 5-year-old boy in Kanpur is brought because his teacher says he does not respond in class. He had several colds this winter. Both drums look dull and retracted, with a few air bubbles behind them. Pure-tone audiometry shows a 25-30 dB conductive loss in both ears. What will tympanometry most likely show?
1. AVery tall peak at normal pressure (type Ad)
2. BFlat curve with no peak (type B)
3. CPeak at negative pressure (type C)
4. DShallow peak at normal pressure (type As)
Answer and explanation in LearnFree account
Question 19 · Medium
A 34-year-old woman with bilateral progressive conductive deafness is found at exploratory tympanotomy to have a fixed stapes footplate due to otosclerosis. At which site does this disease most commonly begin?
1. ARound window niche
2. BFissula ante fenestram
3. CHead of the malleus
4. DLong process of the incus
Answer and explanation in LearnFree account
Question 20 · Easy
A healthy term baby born by normal delivery at a district hospital is due to go home on day 2. The paediatrician wants to screen her hearing before discharge. Which test is used for this first screen?
1. AImpedance audiometry
2. BBehavioural observation audiometry
3. CPure tone audiometry
4. DOtoacoustic emissions
Answer and explanation in LearnFree account
Question 21 · Easy
A 72-year-old retired clerk from Pune is brought by his daughter because he 'hears but does not understand', especially in family gatherings. Both drums are normal. Audiometry shows a bilateral, symmetrical sensorineural loss that slopes down steadily towards the high frequencies, with no notch. What is the most likely diagnosis?
1. APresbycusis
2. BMeniere disease
3. CNoise-induced hearing loss
4. DOtosclerosis
Answer and explanation in LearnFree account
Question 22 · Easy
A 40-year-old man is treated in a medical ward with IV amikacin for three weeks for a multidrug-resistant Klebsiella infection. He now has bilateral tinnitus. At which frequencies will audiometry most likely show the loss first?
1. AAll frequencies equally, from the nerve
2. BMid frequencies, from the middle turn
3. CLow frequencies, from the cochlear apex
4. DHigh frequencies, from the basal turn
Answer and explanation in LearnFree account
Question 23 · Hard
A newborn was in the NICU for 10 days with severe hyperbilirubinaemia needing exchange transfusion. At 3 months, otoacoustic emissions are present in both ears, but automated ABR shows absent or grossly abnormal waveforms on both sides. The cochlear microphonic is present. What is the most likely diagnosis?
1. ABilateral otitis media with effusion
2. BAuditory neuropathy spectrum disorder
3. CNormal hearing with a technical error
4. DOuter hair cell loss in both cochleae
Answer and explanation in LearnFree account
Question 24 · Medium
A 30-year-old woman has bilateral progressive hearing loss for two years. The drums are normal and mobile on pneumatic otoscopy. Pure-tone audiometry shows a 35 dB air-bone gap in both ears. Tympanometry shows a normal peak pressure with a peak of reduced height, and the acoustic reflexes are absent in both ears. What is the most likely diagnosis?
1. AEustachian tube obstruction
2. BOssicular discontinuity
3. COtosclerosis
4. DOtitis media with effusion
Answer and explanation in LearnFree account
Question 25 · Hard
A 41-year-old man has bilateral otosclerosis confirmed on audiometry and tympanometry. The air-bone gap is 40 dB in the right ear and 25 dB in the left, and bone conduction is normal on both sides. He wants surgery and asks which ear will be operated on first. What is the best answer?
1. AThe left ear, which hears better
2. BBoth ears in the same sitting
3. CEither ear, as results are alike
4. DThe right ear, which hears less
Answer and explanation in LearnFree account

3 more Hearing loss, tuning fork tests and audiometry questions

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Hearing loss, tuning fork tests and audiometry

A 12-year-old boy has not heard well in his right ear since he had mumps 2 months ago. Both tympanic membranes are normal. With a 512 Hz fork, Rinne test is negative on the right and positive on the left, and Weber test is lateralised to the left. What do these findings indicate?

A 31-year-old man with bilateral conductive hearing loss and normal tympanic membranes is suspected to have otosclerosis. The ENT resident places a vibrating tuning fork on the mastoid while raising and lowering the air pressure in the ear canal with a Siegle speculum. What does this test assess?

A house surgeon in the ENT OPD is about to do Rinne and Weber tests on a man with unilateral deafness. Which tuning fork is preferred for these tests?

A 10-year-old girl has had bilateral sensorineural hearing loss since early childhood and now has a diffuse goitre. Her thyroid function is normal. A perchlorate discharge test is positive, and CT shows enlarged vestibular aqueducts. What is the most likely diagnosis?

A 33-year-old man has a conductive hearing loss in his left ear. Rinne tests on that ear are done with three forks: with 256 Hz bone conduction is louder, with 512 Hz bone conduction is louder, and with 1024 Hz air conduction is louder. What air-bone gap does this pattern indicate?

A 45-year-old man with fluctuating hearing loss in his right ear complains that loud sounds, such as a pressure cooker whistle, become painfully loud in that ear, although soft sounds are hard to hear. Which test result would best localise the lesion to the cochlea?

A 29-year-old schoolteacher from Thrissur has slowly progressive hearing loss in both ears for three years, which became worse during her recent pregnancy. Both eardrums look normal. She says she follows her husband's conversation better on a noisy bus than at home. What is this phenomenon called?

A 34-year-old woman with bilateral progressive conductive deafness is found at exploratory tympanotomy to have a fixed stapes footplate due to otosclerosis. At which site does this disease most commonly begin?

A healthy term baby born by normal delivery at a district hospital is due to go home on day 2. The paediatrician wants to screen her hearing before discharge. Which test is used for this first screen?

A 40-year-old man is treated in a medical ward with IV amikacin for three weeks for a multidrug-resistant Klebsiella infection. He now has bilateral tinnitus. At which frequencies will audiometry most likely show the loss first?

A 41-year-old man has bilateral otosclerosis confirmed on audiometry and tympanometry. The air-bone gap is 40 dB in the right ear and 25 dB in the left, and bone conduction is normal on both sides. He wants surgery and asks which ear will be operated on first. What is the best answer?