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. 65–73)

1. Which of the following best approximates prevalence of tinnitus in the general population?

   • 15%

   • 30%

   • 40%

   • 0.5%

   • 10 to 17 million in the United States

2. Which of the following is not a common comorbid condition in tinnitus?

   • Insomnia

   • Anxiety

   • Depression

   • Attention deficit hyperactivity disorder

   • Cognitive dysfunction

3. Which of the following is not likely involved in the pathophysiology of tinnitus?

   • Decreased inhibition along the auditory pathway

   • Increased spontaneous activity along the auditory pathway

   • Enhanced lateral inhibition (correct answer)

   • Neuroplasticity

   • Enhanced rhythmic activity

4. All of the following are legitimate means that may be used in tinnitus management except

   • masking

   • tinnitus retraining therapy

   • cognitive behavioral therapy

   • anxiolytics

   • labyrinthectomy

5. Which of the following is likely not among areas of current tinnitus research?

   • Improving tinnitus evaluation tools

   • Identifying medications effective in treating tinnitus

   • Developing electromagnetic stimulation protocols for tinnitus treatment

   • Cochlear transplant for tinnitus (correct answer)

   • Increasing knowledge on brain activities correlated to tinnitus

   Article Two (pp. 74–83)

6. Hyperacusis refers to

   • extraordinarily good hearing like Superman

   • reduced tolerance to environmental sound

   • a cochlear hearing loss

   • recruitment

   • hearing your own voice too loudly

7. The prevalence of hyperacusis in adults is

   • 90%

   • 70%

   • 50%

   • 30%

   • less than 10%

8. In a patient with hyperacusis, loudness tolerance testing is indicated

   • never

   • always

   • only in children

   • in some patients, but caution is advised

   • in patients with acoustic shock

9. The physiological mechanism suspected as underpinning hyperacusis is

   • increased central auditory gain

   • cochlear dead regions

   • ossicular chain abnormalities

   • vestibular dysfunction

   • auditory neuropathy

10. The first mention of hyperacusis in the clinical literature was in

    • 1971

    • 1881

    • 2002

    • 1906

    • 1984

    Article Three (pp. 84–91)

11. Which of the following is/are questionnaire(s) available to use with misophonia patients?

    • Misophonia and Tinnitus Assessment (MTA)

    • Amsterdam Misophonia Scale (A-MISO-S)

    • Misophonia Reaction Questionnaire (MRQ)

    • Sound Sensitivity Index (SSI)

    • All of the above

12. Which of the following trigger sounds listed in this article are associated with misophonia?

    • The dog's nails on the floor

    • Other's chewing

    • Other's lip smacking

    • Other's yawning

    • All of the above

13. Based on this article, which of the following describes misophonia?

    • An abnormally strong reaction to certain sounds

    • Hearing one's own voice louder than normal

    • Sensitivity to loud sounds associated with hearing loss

    • A hatred of musical sounds

    • None of the above

14. According to Schröder, the misophonia trigger sounds are primarily auditory and then may be associated with which other sensory modality(ies)?

    • Visual

    • Tactile

    • Olfactory

    • Tactile and visual

    • None of the above

15. Based on this article, misophonia research has concluded

    • that imaging studies suggest the auditory cortex is responsible for the initiation of the misophonia trigger sounds

    • that misophonia is associated with tinnitus and hearing loss as reported by subjective questionnaires

    • that misophonia initiates with the patients noting bothersome reactions from their own voice and progresses to include reactions to family members' vocal sounds, as reported by subjective questionnaires and history forms

    • that misophonia has been associated with bipolar disorder

    • none of the above

    Article Four (pp. 92–104)

16. The tinnitus intervention with the strongest evidence base for clinical use employs

    • repetitive transcranial magnetic stimulation

    • cognitive-behavioral therapy

    • tinnitus retraining therapy

    • ginkgo biloba

    • zinc

17. For a patient who is not a cochlear implant candidate, surgery for subjective tinnitus is indicated in a few specific situations, and should be used primarily to

    • improve hearing

    • insert an electrode into the brainstem

    • section the VIIIth nerve

    • both A and C

    • both B and C

18. Which of the following should be considered a tinnitus treatment?

    • Hearing aids

    • Cognitive-behavioral therapy

    • Intradural electrode implant

    • Tinnitus retraining therapy

    • Mindfulness meditation

19. Which strategy was used by Norena and Eggermont when they demonstrated cortical reorganization may be minimized following damaging exposures to noise employed?

    • Neuromodulation

    • Repetitive transcranial magnetic stimulation

    • Enriched acoustic environment

    • Deep-brain implant

    • Cochlear implant

20. Searchfield described hearing aid programming that improved outcomes among patients with tinnitus; which of the following characteristics should not be included in a “tinnitus setting”?

    • Omnidirectional microphone

    • High outputs to facilitate masking

    • Open fit whenever possible

    • Noise suppression disengaged

    • High compression ratios for inputs above 60-dB SPL

    Article Five (pp. 105–120)

21. In cases of hyperacusis,

    • sensitivity to sound is determined by the physical characteristics of sound

    • patients always have normal hearing

    • patients should protect their ears with both earplugs and earmuffs

    • patients are very afraid of sounds

    • patients are typically oversensitive to specific sounds only

22. Loudness discomfort levels in tinnitus retraining therapy

    • should not be measured in patients with decreased sound tolerance

    • generally exceed 120-dB hearing level

    • are a direct measure of loudness recruitment

    • should be measured only in patients reporting hyperacusis

    • none of the above

23. Hyperacusis is

    • only present when a person is exposed to very loud sounds

    • an abnormal emotional reaction to sound, typically involving fear

    • closely associated with recruitment

    • a condition that occurs only in patients with normal hearing

    • none of the above

24. Treatment for misophonia

    • always involves the use of ear-level instruments

    • should be performed by the use of sound only

    • can be effectively treated by counseling and specific protocols of sound usage

    • requires the use of pink noise

    • cannot be performed for patients who also have hyperacusis

25. Misophonia is

    • a psychiatric problem and as such should be treated exclusively by psychiatrists

    • a condition that always creates a strong uncontrollable reaction in patients

    • a condition that occurs only to soft sounds

    • a condition that occurs only to patterns of sound that are specific for a given patient

    • observed when physical features of sound determine the reactions to a sound

    Article six (pp. 121–130)

26. Misophonia is

    • a reaction to specific sounds

    • usually visual response

    • a reaction to the loudness of the sound

    • sensitivity to the sounds of ambulances, blenders, and so on

    • responsive to aversive techniques in therapy

27. The severity of tinnitus is related to

    • the loudness of tinnitus

    • the duration tinnitus has been present

    • the frequency of the tinnitus

    • level of disturbance of the tinnitus

    • A and C only

28. Hyperacusis is best treated with

    • suitable noise-reducing earplugs

    • reimaging, reimagining, refocusing

    • ear-level sound generators

    • isolation from competitive sounds

    • A and B

29. Hyperacusis, misophonia, and tinnitus are all caused by

    • damage to the cochlea

    • heightened reaction of the limbic system

    • reduced reaction of the autonomic nervous system

    • all of the above

    • none of the above

30. Tinnitus retraining therapy incorporates

    • collaborative counseling

    • directive counseling

    • patient centered counseling

    • mindfulness-based counseling

    • cognitive behavioral therapy

    Article Seven (pp. 131–144)

31. Which of the following affirmations is correct?

    • Electroencephalography and magnetoencephalography provide high temporal resolution.

    • Functional magnetic resonance imaging and positron emission tomography provide high temporal resolution.

    • Electroencephalography and magnetoencephalography provide poor spatial resolution.

    • Functional magnetic resonance imaging provides poor spatial resolution.

    • Both A and C are true.

32. Regarding the brain resting-state activity, which of the following statements is true?

    • The resting state is the least metabolically demanding component of neural activity.

    • Resting-state studies focused on the observation of modification of brain activity in response to a task or stimuli.

    • Resting-state brain networks look like networks activated during tasks.

    • Resting-state paradigms are difficult to apply in clinical setting.

    • Resting-state paradigms have never been applied to the study of tinnitus.

33. According to neuroimaging findings, which of the following statements is true?

    • Changes of brain activity in auditory cortices accompany tinnitus.

    • Tinnitus is associated to modification of brain activity in nonauditory brain areas.

    • Alteration of functional interactions between key neural circuits of the brain seems to be crucial for the emergence of tinnitus.

    • None of the above is true.

    • All of the above are true.

34. When doing tinnitus studies, one has to carefully control for

    • hearing loss

    • hyperacusis

    • age

    • anxiety/depression

    • all of the above

35. Which of the following affirmations is correct?

    • Tinnitus affects brain activity only in auditory regions.

    • Tinnitus is easily treated.

    • Tinnitus characteristics cannot be correlated to the activity of particular brain regions.

    • Tinnitus neuroimaging findings have helped to design tinnitus theoretical models.

    • Tinnitus studies have always had proper control groups as well as good control of confounding factors.

    Article Eight (pp. 145–156)

36. The air—bone gap in patients with superior semicircular canal dehiscence is due to

    • improved bone-conduction transmission

    • dissipation of air-conducted sound through the dehiscence

    • fixation of the ossicular chain

    • a hole in the tympanic membrane

    • A and B

37. The audiometric configuration in superior semicircular canal dehiscence is most similar to test results found in patients with

    • otosclerosis

    • Meniere disease

    • ototoxicity

    • presbycusis

    • cholesteatoma

38. Vestibular evoked myogenic potential responses in patients with superior semicircular canal dehiscence are typically

    • absent

    • prolonged

    • difficult to interpret due to excessive noise

    • present with reduced thresholds

    • present with elevated thresholds

39. A positive malleolus sign means

    • a tuning fork placed on the forehead localized to the dehiscent ear

    • the patient was able to hear a 128-or 256-Hz tuning fork placed on his or her ankle

    • the patient became symptomatic when exposed to high-intensity sound

    • the patient became symptomatic when pressure was presented in the external auditory canal

    • C and D

40. Diagnosis of superior semicircular canal dehiscence is based on

    • computed tomography findings

    • vestibular evoked myogenic potential thresholds

    • audiometric findings

    • case history

    • all of the above