100+ Free ABOHNS Neurotology Practice Questions

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A 55-year-old man presents with unilateral progressive left-sided sensorineural hearing loss, tinnitus, and mild imbalance over 2 years. Audiogram shows asymmetric SNHL with poor word recognition (45%) in the left ear. MRI with gadolinium shows a 1.8 cm intracanalicular and cisternal enhancing mass at the left cerebellopontine angle. Which tumor is most likely?

Vestibular schwannoma (acoustic neuroma)

Meningioma

Epidermoid cyst

Glomus jugulare

to track

2026 Statistics

Key Facts: ABOHNS Neurotology Exam

Written

New Format (from oral)

ABOHNS announced Nov 2025, effective Fall 2028

Fall 2028

Next Administration

First written format neurotology exam

ACGME

Fellowship Required

2-year neurotology fellowship

2026

Eligibility Update

Passing Written Exam now qualifies for subspecialty exam

≥9 months

Pediatric CI Age

FDA expanded pediatric CI candidacy

7 years

Eligibility Window

From ACGME fellowship completion

The ABOHNS Neurotology Subspecialty Exam is the subcertification exam for neurotology fellowship graduates. ABOHNS announced in November 2025 a format change from oral to written (multiple-choice) — the next exam is anticipated Fall 2028. Candidates must complete an ACGME-accredited 2-year neurotology fellowship. Starting in 2026, candidates may take the subspecialty exam after passing the ABOHNS Written Exam (primary certification still required for full subcertification). Core content covers CPA tumors, cochlear implantation (expanded candidacy including ≥9 months pediatric and CMS AzBio ≤60% adult criteria), vestibular disorders, and facial nerve pathology.

Sample ABOHNS Neurotology Practice Questions

Try these sample questions to test your ABOHNS Neurotology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 55-year-old man presents with unilateral progressive left-sided sensorineural hearing loss, tinnitus, and mild imbalance over 2 years. Audiogram shows asymmetric SNHL with poor word recognition (45%) in the left ear. MRI with gadolinium shows a 1.8 cm intracanalicular and cisternal enhancing mass at the left cerebellopontine angle. Which tumor is most likely?

A.Vestibular schwannoma (acoustic neuroma)

B.Meningioma

C.Epidermoid cyst

D.Glomus jugulare

Explanation: Vestibular schwannomas are the most common CPA tumor (80-90%), arising most often from the inferior vestibular nerve (not cochlear). Classic presentation: asymmetric SNHL, tinnitus, and imbalance. MRI shows enhancing lesion centered in the internal auditory canal with 'ice cream cone' CPA extension. Meningiomas are dural-based with broader tumor-dural interface; epidermoid cysts are hyperintense on DWI (restricted diffusion); glomus jugulare originates in the jugular foramen.

2A 58-year-old woman is newly diagnosed with a 1.2 cm intracanalicular vestibular schwannoma on surveillance MRI. She has 78% word recognition and Class A hearing (AAO-HNS). What are the three main management options?

A.Observation with serial MRI; stereotactic radiosurgery (SRS); microsurgical resection

B.Chemotherapy alone

C.Immediate radical temporal bone resection

D.Hearing aid fitting only

Explanation: Management of vestibular schwannoma: (1) observation with serial MRI (initially every 6 months, then annually) — especially for small tumors with stable hearing; (2) stereotactic radiosurgery (Gamma Knife or LINAC) for tumors <3 cm with good local control and modest hearing preservation rates; (3) microsurgical resection (translabyrinthine, retrosigmoid, or middle fossa approach) for hearing preservation attempts, larger tumors, or younger patients. Approach choice depends on tumor size, hearing status, and surgeon experience.

3A 40-year-old woman has a 2.5 cm right vestibular schwannoma with serviceable hearing (Class A, 85% WR). Microsurgical resection via which approach offers the best chance of hearing preservation for medium-sized intracanalicular/CPA tumors?

A.Middle cranial fossa approach (for intracanalicular/laterally-placed small tumors) or retrosigmoid approach (for larger CPA tumors)

B.Translabyrinthine approach (sacrifices hearing)

C.Transcochlear approach (sacrifices hearing and is used for far-lateral tumors)

D.Orbitozygomatic approach

Explanation: Hearing-preservation approaches to vestibular schwannoma: (1) Middle cranial fossa (MCF) — best for small intracanalicular tumors with lateral IAC extension; (2) Retrosigmoid (suboccipital) — workhorse for larger CPA tumors, requires drilling posterior IAC. Translabyrinthine approach sacrifices hearing (the semicircular canals are removed) and is used when hearing is not serviceable or when translabyrinthine exposure is needed for large tumors. Outcomes depend on tumor size, preoperative hearing, and surgeon experience.

4A 42-year-old man with bilateral vestibular schwannomas (one 1.5 cm with serviceable hearing, one 2.5 cm with poor hearing), a posterior subcapsular cataract, and meningiomas in the brain. Which diagnosis is most consistent?

A.Neurofibromatosis type 2 (NF2)

B.Neurofibromatosis type 1 (NF1)

C.Von Hippel-Lindau

D.Tuberous sclerosis

Explanation: Bilateral vestibular schwannomas are pathognomonic for NF2 (autosomal dominant, chromosome 22q12.2, NF2 gene encoding merlin). Additional features: meningiomas, ependymomas, peripheral schwannomas, juvenile posterior subcapsular lenticular opacity. Hearing preservation strategies include bevacizumab (anti-VEGF) for tumor control and hearing stability, stereotactic radiosurgery, and hearing rehabilitation with cochlear implant or auditory brainstem implant (ABI) if cochlear nerve not preserved.

5A 50-year-old woman has a 1.8 cm petroclival meningioma with hearing loss. MRI characteristics include a dural tail and broad-based tumor attached to the dura. Compared to vestibular schwannoma, which feature most suggests meningioma?

A.Broad dural base with dural tail sign and hyperostosis of adjacent bone on CT

B.Small intracanalicular component only

C.High DWI signal intensity (restricted diffusion)

D.T1 hyperintense signal

Explanation: Meningiomas are extra-axial dural-based tumors. Imaging features that distinguish from vestibular schwannomas: broad dural base, dural tail sign (contrast-enhancing dural thickening adjacent to tumor), often hyperostosis of adjacent bone on CT, and homogeneous enhancement. Vestibular schwannomas are centered on the IAC with 'ice cream cone' appearance. Epidermoid cysts have characteristic restricted diffusion on DWI. Management of CPA meningioma: observation for small/stable, surgical resection (retrosigmoid), or SRS.

6A 48-year-old presents with a CPA lesion that is hyperintense on DWI (restricted diffusion) and isointense on T1 and hyperintense on T2, without significant contrast enhancement. What is the most likely diagnosis?

A.Epidermoid cyst

B.Vestibular schwannoma

C.Arachnoid cyst

D.Glioma

Explanation: Epidermoid cysts (congenital inclusions of ectoderm) have a 'pearl-like' appearance at surgery and are characterized by restricted diffusion on DWI due to their pasty keratinaceous contents — a key differentiating feature from arachnoid cysts (CSF signal, no restriction) and other CPA lesions. They encase neurovascular structures and require careful surgical removal with accepted small residual to avoid injury to cranial nerves. Chemical meningitis from capsule rupture is a known complication.

7A 7-year-old with bilateral congenital severe-to-profound SNHL has been wearing hearing aids with limited benefit. Speech perception in the best aided condition is 30%. What age threshold and criteria qualify this child for cochlear implantation per current FDA and AAO-HNS practice?

A.Children as young as 9 months of age with bilateral severe-to-profound SNHL and limited benefit from appropriately fit hearing aids

B.Only children ≥12 years of age

C.Only children with normal CT temporal bone anatomy

D.Only unilateral profound SNHL

Explanation: FDA approved Cochlear Nucleus for children as young as 9 months (2020) and MED-EL for children ≥9 months (2023). AAO-HNS/ACIA pediatric candidacy guidelines support bilateral severe-to-profound SNHL (≥70-80 dB average) with limited auditory benefit from well-fitted hearing aids (typically <30-40% speech perception in best aided condition). Earlier implantation (ideally before 12-18 months) is associated with superior spoken-language outcomes. Cochlear nerve aplasia is a contraindication — consider auditory brainstem implant.

8A 62-year-old man with progressive bilateral SNHL over 10 years has pure tone average of 75 dB bilaterally and best-aided speech perception (AzBio sentences in quiet) of 35% in the poorer ear. His contralateral ear scores 60%. Which criterion makes him a candidate for cochlear implantation per expanded adult criteria?

A.Bilateral moderate-to-profound SNHL with AzBio sentence score ≤60% in the ear to be implanted in best-aided conditions (per expanded Medicare criteria, 2022)

B.Only profound bilateral hearing loss (>90 dB)

C.Only sudden hearing loss

D.Only unilateral total hearing loss

Explanation: CMS expanded cochlear implant candidacy in 2022 to include AzBio sentence score ≤60% in the ear to be implanted under best-aided conditions, broadening eligibility for adults with moderate-to-severe SNHL who struggle with speech understanding despite hearing aids. Current FDA and MED-EL criteria also support lower thresholds than historical 'severe-to-profound' requirements. Assessment includes audiometry, speech perception in quiet and noise, imaging (CT or MRI), and medical clearance.

9A 68-year-old man with residual low-frequency hearing (PTA 500-1000 Hz ~35 dB) and profound high-frequency loss (>90 dB at 2-8 kHz) is being considered for cochlear implantation. Which strategy is designed to preserve residual low-frequency acoustic hearing?

A.Electroacoustic stimulation (EAS) / hybrid cochlear implant with soft-surgery atraumatic electrode insertion through the round window

B.Traditional cochleostomy with full-length electrode insertion regardless of residual hearing

C.Stapedectomy with piston prosthesis

D.Bone-anchored hearing aid only

Explanation: Electroacoustic stimulation (EAS, hybrid CI) combines a shorter/softer electrode with hearing preservation surgery — round window approach, slow insertion, intraoperative steroids (systemic or topical), atraumatic technique — to preserve residual low-frequency acoustic hearing, which is then amplified by an integrated hearing aid while the implant electrically stimulates high-frequency regions. Indications: low-frequency PTA ≤60 dB with poor high-frequency hearing. Hearing preservation rates are 50-80% with soft surgery.

10A 4-year-old congenitally deaf child is being evaluated for cochlear implantation. CT temporal bone shows cochlear nerve aplasia (absent cochlear nerve on oblique sagittal MRI through the IAC). What is the recommended auditory rehabilitation?

A.Auditory brainstem implant (ABI) — stimulates the cochlear nucleus at the brainstem

B.Standard cochlear implant (contraindicated)

C.Bone-anchored hearing aid

D.No auditory rehabilitation possible

Explanation: Cochlear nerve aplasia/hypoplasia is a contraindication to conventional cochlear implantation because the electrical signal requires the cochlear nerve to transmit to the brain. Auditory brainstem implant (ABI) bypasses the cochlear nerve by stimulating the cochlear nucleus on the brainstem directly. Originally developed for NF2 patients after vestibular schwannoma resection, ABI candidacy has expanded to children with cochlear nerve aplasia/deficiency. Auditory outcomes with ABI in pediatric non-NF2 patients are more variable than CI but provide sound awareness and limited speech perception.

About the ABOHNS Neurotology Exam

The ABOHNS Neurotology Subspecialty Certification Examination validates expertise in diseases of the lateral skull base and neurotology — including vestibular schwannoma and other CPA tumors, cochlear implantation and hearing rehabilitation, vestibular disorders (Meniere disease, BPPV, vestibular migraine, SCDS, bilateral vestibular hypofunction), facial nerve disorders (Bell palsy, Ramsay Hunt, hemifacial spasm, facial reanimation), genetic and autoimmune hearing loss, temporal bone fractures, and skull base pathology (paragangliomas, dAVF, IIH with spontaneous CSF leaks). In November 2025, ABOHNS announced the transition from an oral to written multiple-choice format, with the first written exam anticipated in Fall 2028.

Questions

100 scored questions

Time Limit

Computer-based written exam (duration TBD for 2028 inaugural written administration)

Passing Score

Criterion-referenced scaled passing standard set by ABOHNS

Exam Fee

Set by ABOHNS (contact for current fee) (American Board of Otolaryngology-Head and Neck Surgery (ABOHNS))

ABOHNS Neurotology Exam Content Outline

~25%

Lateral Skull Base / CPA Tumors

Vestibular schwannoma management (observation with serial MRI, SRS with ~12-13 Gy marginal dose, microsurgery via middle fossa/retrosigmoid/translabyrinthine), CPA meningioma (dural tail), epidermoid cyst (restricted diffusion on DWI), glomus jugulare, facial nerve schwannoma, NF2 (merlin, bilateral VS), bevacizumab in NF2, auditory brainstem implant (ABI) for NF2 and cochlear nerve aplasia.

~20%

Cochlear Implantation

Pediatric CI candidacy (≥9 months, bilateral severe-to-profound SNHL with limited HA benefit), adult candidacy (CMS 2022 expanded AzBio ≤60% best-aided), EAS/hybrid CI with hearing-preservation soft surgery (round window, atraumatic insertion), ABI for cochlear nerve aplasia, Mondini/inner ear malformations with CSF gusher risk, single-sided deafness CI (FDA 2019), bilateral CI, meningitis risk with pneumococcal vaccination, MRI compatibility, T/C mapping, ECAP.

~18%

Vestibular Disorders

Meniere disease 2015 AAO-HNS/Bárány criteria (≥2 episodes of 20 min-12 h vertigo + audiometric SNHL + fluctuating aural symptoms), stepwise management to intratympanic gentamicin, BPPV (Dix-Hallpike + Epley), vestibular neuritis with HINTS, vestibular migraine (Bárány criteria), superior canal dehiscence (Tullio, Hennebert, reduced VEMP thresholds, CT Pöschl/Stenvers), bilateral vestibular hypofunction, PPPD, vestibular rehabilitation, vestibular implant (investigational).

~15%

Otology / Hearing Loss

Sudden SNHL (AAO-HNSF 2019 CPG corticosteroids within 2 weeks, oral or intratympanic), otosclerosis (stapedectomy with only-hearing-ear contraindication), AIED/Cogan syndrome (high-dose steroids), genetic SNHL (GJB2 most common AR, SLC26A4/Pendred with EVA, MT-RNR1 aminoglycoside sensitivity, Usher, Alport), noise-induced HL (4 kHz notch, OSHA conservation), cisplatin ototoxicity (UHF audiometry monitoring).

~10%

Facial Nerve Disorders

Bell palsy (AAO-HNSF 2013 CPG — oral corticosteroids within 72 hours), Ramsay Hunt (antiviral + steroid combination within 72 hours), progressive palsy suggesting facial schwannoma, hemifacial spasm (MVD Jannetta), temporal bone fracture with facial palsy (transverse > longitudinal), ENoG >90% degeneration threshold, facial reanimation (hypoglossal-facial transfer <18-24 months, masseter-facial, cross-face, gracilis free flap), eye protection (gold weight, tarsorrhaphy), Möbius syndrome.

~7%

Skull Base Pathology

Paragangliomas (glomus jugulare/tympanicum/carotid body, SDH mutations in familial disease, Shamblin classification, preoperative embolization), dural arteriovenous fistula (endovascular treatment), IIH/pseudotumor cerebri with spontaneous CSF leaks (acetazolamide, venous stenting, VP shunt), sigmoid sinus dehiscence, petrous apicitis (Gradenigo: CN V + VI + otitis), EAC temporal bone SCC (Pittsburgh staging), cranial nerves IX-XII at jugular foramen.

~5%

Trauma and Infection

Temporal bone fractures (longitudinal ~80%, transverse ~20%), traumatic perilymphatic fistula with pneumolabyrinth, necrotizing (malignant) otitis externa (Pseudomonas, diabetics, gallium-67), cholesteatoma complications (labyrinthine fistula of LSC), pneumococcal meningitis risk in CI, tympanic membrane perforations (70-90% heal spontaneously), tegmen dehiscence with encephalocele.

How to Pass the ABOHNS Neurotology Exam

What You Need to Know

Passing score: Criterion-referenced scaled passing standard set by ABOHNS
Exam length: 100 questions
Time limit: Computer-based written exam (duration TBD for 2028 inaugural written administration)
Exam fee: Set by ABOHNS (contact for current fee)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABOHNS Neurotology Study Tips from Top Performers

1Master vestibular schwannoma management — (1) observation for small stable tumors; (2) stereotactic radiosurgery (Gamma Knife ~12-13 Gy marginal dose) for tumors <3 cm; (3) microsurgery — middle fossa (intracanalicular), retrosigmoid (CPA with hearing preservation), translabyrinthine (non-serviceable hearing, large tumors) — and know NF2 features (bilateral VS, merlin, bevacizumab for hearing stabilization)

2Know the 2015 AAO-HNS/Bárány criteria for definite Meniere disease: ≥2 spontaneous vertigo episodes of 20 minutes to 12 hours, audiometrically documented low-to-medium-frequency SNHL in the affected ear on at least one occasion, and fluctuating aural symptoms (tinnitus, fullness, hearing); stepwise management to intratympanic gentamicin (vestibulotoxic, preserves hearing better than systemic)

3Recognize superior canal dehiscence syndrome (SCDS) by the triad of sound-induced vertigo (Tullio), pressure-induced vertigo (Hennebert), and autophony; audiometry shows apparent conductive loss with SUPRANORMAL bone conduction thresholds and reduced cVEMP thresholds; diagnose with high-resolution CT Pöschl (parallel to superior canal) and Stenvers reformats

4Cochlear implant candidacy has expanded significantly — pediatric ≥9 months (FDA approvals 2020 Cochlear, 2023 MED-EL), adult CMS expanded 2022 to AzBio sentence score ≤60% in the ear to be implanted under best-aided conditions, single-sided deafness CI FDA-approved 2019, EAS/hybrid CI for low-frequency residual hearing with soft surgery

5Apply HINTS bedside exam for acute vestibular syndrome — central findings (Head Impulse normal, direction-changing Nystagmus, Test of Skew positive) have higher sensitivity than early MRI DWI for posterior circulation stroke in first 24-48 hours (Kattah et al.)

Frequently Asked Questions

What is the ABOHNS Neurotology Subspecialty Certification Exam?

The ABOHNS Neurotology Subspecialty Exam is a subcertification exam administered by the American Board of Otolaryngology-Head and Neck Surgery for physicians who have completed an ACGME-accredited 2-year neurotology fellowship. Neurotology focuses on diseases of the lateral skull base — the interface of dura, inner ear, facial nerve, and neighboring cranial nerves — including vestibular schwannoma, hearing rehabilitation, vestibular disorders, and skull base surgery.

What is the new format and date for the ABOHNS Neurotology Exam?

In November 2025, ABOHNS announced the transition of the Neurotology Certifying Exam from an oral to a written multiple-choice format. The next Neurotology exam is anticipated in Fall 2028 with the new written format. The change aligns the Neurotology exam with other ABOHNS subcertifications and with other ABMS Member Board subcertification exams.

What are the 2026 eligibility updates for the Neurotology subspecialty exam?

Starting in 2026, ABOHNS will no longer require candidates for subcertification to wait until achieving primary board certification before applying for and taking the Neurotology subspecialty exam. After completing an ACGME-accredited neurotology fellowship and passing the ABOHNS Written Exam, candidates are eligible to apply for the subspecialty exam. However, full subcertification still requires ABOHNS primary certification, passing the subspecialty exam, and additional subspecialty requirements.

What is the content of the ABOHNS Neurotology Exam?

Content covers lateral skull base and neurotology: vestibular schwannoma and CPA tumors (observation, SRS, microsurgical approaches), cochlear implantation (pediatric ≥9 months, adult CMS expanded AzBio ≤60% criteria, EAS/hybrid, ABI, SSD), vestibular disorders (Meniere, BPPV, vestibular migraine, SCDS, vestibular neuritis, PPPD), facial nerve disorders (Bell palsy, Ramsay Hunt, hemifacial spasm MVD, facial reanimation), skull base pathology (paragangliomas, CSF leaks, IIH, temporal bone fractures, necrotizing otitis externa).

What are the eligibility requirements for the ABOHNS Neurotology Exam?

Candidates must (1) complete an ACGME-accredited Neurotology fellowship program (2 years after otolaryngology residency); (2) starting 2026, pass the ABOHNS Written Exam (primary certification previously required in full); (3) maintain an active unrestricted medical license. Full subcertification requires ABOHNS primary certification. The eligibility window is 7 years from fellowship completion.

How should I study for the ABOHNS Neurotology Exam?

Use a 6-12 month structured plan during or after neurotology fellowship. Focus on: vestibular schwannoma management (observation criteria, SRS dose ~12-13 Gy, microsurgical approach selection by tumor size and hearing); cochlear implantation criteria (pediatric ≥9 months, adult CMS AzBio, EAS/hybrid, ABI, SSD with FDA 2019 approval); Meniere disease (2015 AAO-HNS/Bárány criteria, stepwise management); HINTS exam for acute vestibular syndrome; Bell palsy (AAO-HNSF 2013 CPG) and Ramsay Hunt treatment; facial reanimation options by time window; SCDS with CT Pöschl/Stenvers views and VEMP.

What are the highest-yield topics on the ABOHNS Neurotology Exam?

Highest-yield topics: vestibular schwannoma (80-90% of CPA tumors), NF2 (bilateral VS, bevacizumab), cochlear implant candidacy (FDA ≥9 months pediatric, CMS expanded AzBio ≤60%), hearing preservation approaches (MCF for intracanalicular, retrosigmoid for CPA, vs translabyrinthine which sacrifices hearing), Meniere disease 2015 criteria and intratympanic gentamicin, BPPV with Epley, superior canal dehiscence syndrome (Tullio, Hennebert, cVEMP, Pöschl views), facial nerve disorders (Bell palsy 72-hour steroid window, Ramsay Hunt combination therapy), temporal bone fractures (transverse vs longitudinal), necrotizing otitis externa (Pseudomonas in diabetics).

What is the pass rate for the ABOHNS Neurotology Exam?

Historical pass rates for the oral format have been high (>90% typically). Specific pass rates for the new written format starting Fall 2028 are not yet available. ABOHNS uses criterion-referenced scaled passing standards (modified Angoff) for subspecialty exams.