JAAA CEU Program

Questions refer to Billings et al, “A Large-Scale Examination of Veterans with Normal Pure-Tone Hearing Thresholds within the Department of Veterans Affairs,” 928–935.

Learner Outcomes:

Readers of this article should be able to:

• Identify the prevalence of Veterans with normal pure-tone thresholds seen within the VA system.

• Describe the prevalence of abnormal clinical test results among these Veterans with normal pure-tone thresholds.

CEU Questions:

1. Which of the following is true regarding best practice guidelines for treatment of patients with hearing difficulties that have normal pure-tone hearing thresholds?

   • guidelines have been published

   • all audiologists agree on what treatment(s) should be recommended for those with normal hearing reporting hearing difficulties

   • guidelines have not been published and many audiologists are unsure how to treat this population.

2. Patients with normal hearing thresholds who report hearing difficulty have been linked to following conditions:

   • selective dysacusis, auditory processing disorder

   • addiction disorders, obscure auditory dysfunction

   • auditory inferiority complex, obesity

3. Veteran’s with normal hearing pure-tone thresholds are unique in that they often have

   • an affinity for singing

   • difficulties expressing their desires in the clinic

   • comorbidities related to military service

4. Why can't conclusions about age and hearing loss be drawn from the results?

   • thresholds were limited to 25 dB HL

   • patients over 90 were aggregated into a single category because of HIPAA regulations

   • standard error for populations older than 60 were too large

5. In this study, what percentage of veterans were determined to have normal hearing with pure-tone thresholds ≤ 25 dB HL at all octave frequencies?

   • 5%

   • 10%

   • 3%

6. In Veterans with normal hearing pure-tone thresholds, what is the prevalence of having an abnormality on at least one additional test in either ear?

   • 23%

   • 30%

   • 41%

7. Which of the following is true regarding notches in this population of Veterans?

   • left ear notches were more prevalent and deeper

   • right ear notches were more prevalent and deeper

   • no differences were seen in the prevalence or depth of notches between the right and left ear

8. Compared to civilian populations, this study found the prevalence of Veterans with normal hearing to be:

   • twice as high

   • the same

   • lower

9. Which of the following is a reason that the prevalence number from this article may underestimate the number of Veterans with normal thresholds?

   • interoctave frequencies were not considered in the analysis

   • test results were not consistently entered into the repository when hearing aids were not ordered

   • the majority of patients presented with subjective complaints of hearing loss

10. What evidence from this article supports testing -inter-octave frequencies in Veterans?

    • abnormal word recognition in about 5% of normal-hearing Veterans

    • audiometric notches are present only at 3k and 6k Hz in about 5% of normal-hearing Veterans

    • abnormal acoustic reflex testing results in 30% of normal-hearing Veterans