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IHS ILE International Licensing Exam (Hearing Instrument Specialist)

Practice Questions126 questions Study Guide

Exam Review

Key Facts: BC-HIS Exam

100

NCE Questions

100 scored items

105 min

Time Limit

NBC-HIS

~80%

Pass Rate

NBC-HIS 2022

25%

Top Three Domains

Each of Domains 1-3

$225

Exam Fee (US)

NBC-HIS 2026

3 years

Certification Cycle

24 CE credits required

The BC-HIS NCE contains 100 scored questions in 105 minutes across 5 competency domains. Assessment, Hearing Analysis, and Instrument Prescription are weighted equally at 25% each and together account for 75% of scored items. Pass rate is approximately 80%. Eligibility requires a current state dispensing license plus 2 years of experience. The $225 exam fee is one of the lowest among allied health certifications. Recertification requires 24 CE credits every 3 years.

Sample BC-HIS Practice Questions

Try these sample questions to review concepts for the BC-HIS exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 113+ question experience with AI tutoring.

1A patient reports difficulty hearing in noisy restaurants but hears well in quiet environments. Which audiometric finding is most consistent with this complaint?

A.Conductive hearing loss with air-bone gap >20 dB

B.Sensorineural hearing loss with poor speech-in-noise performance

C.Normal pure-tone audiogram with intact word recognition

D.Flat conductive loss across all frequencies

Explanation: Sensorineural hearing loss — particularly high-frequency SNHL — degrades temporal fine structure processing and frequency selectivity, causing disproportionate difficulty in noise. A conductive loss typically affects all environments relatively equally; pure-tone thresholds may be normal but SNR performance can still be impaired in SNHL.

2On a pure-tone audiogram, the symbol 'O' (open circle) conventionally represents:

A.Left ear air conduction

B.Right ear air conduction

C.Right ear bone conduction

D.Left ear bone conduction

Explanation: By ASHA audiogram convention, 'O' (open circle) = right ear air conduction, 'X' = left ear air conduction, '<' or '[' = right ear bone conduction, and '>' or ']' = left ear bone conduction. Red is used for the right ear and blue for the left.

3An air-bone gap greater than 10 dB at the same frequency indicates:

A.Sensorineural hearing loss

B.Mixed hearing loss only

C.A conductive component to the hearing loss

D.Normal middle ear function

Explanation: An air-bone gap (AC threshold worse than BC threshold by >10 dB) indicates a conductive component — the inner ear is functioning better than the outer/middle ear is transmitting sound. If both AC and BC are elevated with no significant gap, the loss is purely sensorineural.

4The Speech Reception Threshold (SRT) is defined as the lowest hearing level at which a patient can correctly repeat spondee words:

A.100% of the time

B.75% of the time

C.50% of the time

D.25% of the time

Explanation: The SRT is the lowest dB HL at which spondee words (two-syllable, equal-stress words like 'baseball' or 'hotdog') are correctly repeated 50% of the time. It should agree within ±6–10 dB of the pure-tone average (PTA) for the three-frequency average (500, 1000, 2000 Hz).

5Word Recognition Score (WRS) is measured using phonetically balanced (PB) word lists presented at:

A.The patient's SRT level

B.A suprathreshold level, typically 30–40 dB above SRT

C.0 dB HL

D.The patient's most comfortable loudness level only

Explanation: WRS is typically tested at 30–40 dB above the SRT (suprathreshold) to ensure audibility is not limiting performance. Results are reported as a percentage correct. Poor WRS (<80%) despite adequate audibility suggests retrocochlear pathology or poor cochlear reserve.

6Tympanometry measures:

A.Cochlear hair cell function via otoacoustic emissions

B.Middle ear pressure and tympanic membrane mobility

C.Neural synchrony of the auditory brainstem

D.Loudness growth and dynamic range

Explanation: Tympanometry (acoustic immittance testing) measures the compliance/mobility of the tympanic membrane and middle ear system as ear canal pressure is varied. A Type A tympanogram is normal; Type B (flat) suggests fluid or perforation; Type C indicates negative middle ear pressure (Eustachian tube dysfunction).

7A Type B tympanogram with a large ear canal volume (>2.0 cm³) most likely indicates:

A.Otitis media with effusion

B.Tympanic membrane perforation or patent pressure equalization tube

C.Negative middle ear pressure

D.Normal middle ear function

Explanation: A flat (Type B) tympanogram with a large equivalent ear canal volume (ECV) suggests a tympanic membrane perforation or open PE tube — probe tone energy is dissipating into the middle ear space rather than being reflected back. Fluid (Type B with normal ECV) typically shows low compliance with normal ECV.

8During a case history, a patient mentions taking loop diuretics (furosemide) for heart failure. The hearing instrument specialist should be aware that this drug class is associated with:

A.Conductive hearing loss from ear canal swelling

B.Ototoxicity causing sensorineural hearing loss

C.Tinnitus relief

D.Improved word recognition scores

Explanation: Loop diuretics (furosemide, ethacrynic acid) are well-documented ototoxic agents that can cause temporary or permanent sensorineural hearing loss by affecting the stria vascularis of the cochlea. This information is critical during patient intake to distinguish medication-related loss from other etiologies.

9Which condition requires medical referral BEFORE fitting a hearing instrument, according to FDA guidelines?

A.Bilateral symmetric high-frequency SNHL in a 70-year-old

B.Unilateral hearing loss of recent or sudden onset

C.Mild flat sensorineural hearing loss bilaterally

D.Aided speech recognition improvement expected >20%

Explanation: FDA regulations (21 CFR 801.421) require medical evaluation within 6 months before hearing aid fitting, with specific 'red flag' conditions mandating physician referral prior to dispensing. Sudden or recent-onset unilateral hearing loss is a red flag requiring ENT evaluation to rule out acoustic neuroma or other retrocochlear pathology.

10The pure-tone average (PTA) used for hearing aid candidacy is most commonly calculated from thresholds at:

A.250, 500, and 1000 Hz

B.500, 1000, and 2000 Hz

C.1000, 2000, and 4000 Hz

D.2000, 4000, and 8000 Hz

Explanation: The three-frequency PTA at 500, 1000, and 2000 Hz is the most common clinical average, representing the critical speech frequency range. It should agree within ±6–10 dB of the SRT. Some clinicians also use a four-frequency average including 3000 Hz for comprehensive assessment.

About the BC-HIS Exam

The BC-HIS (Board Certified in Hearing Instrument Sciences) credential is awarded by the National Board for Certification in Hearing Instrument Sciences (NBC-HIS) upon passing the National Competency Exam (NCE). The exam contains 100 scored multiple-choice items administered in 105 minutes and covers five domains: Assess Patient Presenting Problem and Needs (25%), Test and Analyze Patient Hearing (25%), Prescribe and Analyze Hearing Instruments (25%), Fit/Adjust/Program/Service Hearing Instruments (15%), and Counseling and Rehabilitation (10%). Hearing aid dispensing is licensed in all 50 U.S. states; BC-HIS is the voluntary national board certification that demonstrates excellence above licensure.

Exam sponsor: NBC-HIS (National Board for Certification in Hearing Instrument Sciences) / Kryterion. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

100 questions

Time Limit

105 minutes (100-item form); 120 minutes (115-item form)

Passing Score

Criterion-referenced (modified Angoff methodology); pass/fail only

Exam / Certification Fees

$225–250

Exam sponsor website

Reported exam pass rate: ~80%. Based on 2022 NBC-HIS administration data This describes exam candidates, not OpenExamPrep users or results from using our resources. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25%

Assess patient presenting problem and needs

Medical and audiological history, ototoxic medication review, hearing loss impact on daily activities, family hearing history, prior amplification experience, assessment for medical referral, and evaluation of patient/family expectations

25%

Test and analyze patient hearing

Pure-tone air and bone conduction audiometry, Hughson-Westlake procedure, masking, speech reception threshold (SRT), word recognition scores (WRS), tympanometry (Types A/B/C/As/Ad), acoustic reflexes, sound-field testing, OAEs, and loudness measures (UCL/LDL)

25%

Prescribe and analyze hearing instruments

Style, configuration, matrix and rechargeable vs. battery selection, telephone use options, assistive listening devices, IIC contraindications, ear impression procedure/material modifications, tube/dome/earmold/receiver selection for OTE, RIC and BTE, custom vs. non-custom trade-offs, and CROS/BiCROS for asymmetry and single-sided deafness

15%

Fit, adjust, program, and service hearing instruments and equipment

Sound-field aided/unaided verification with warble tones and narrow-band noise, real-ear measurement and speech mapping (REUR, REUG, REAR, REIG, RESR), physical-fit modification of earmolds, custom shells, OTE/BTE/RIC, adjustment from subjective validation, programming troubleshooting, obstruction/moisture/battery faults, and wireless pairing

10%

Counseling and rehabilitation

Patient explanation of otoscopic and audiometric findings, limitations and benefits of amplification, counseling from subjective validation (COSI, IOI-HA, APHAB), communication strategies by environment, and manual adjustments for patients, family members, and caregivers

Preparing for the BC-HIS Exam

What You Need to Know

Passing score: Criterion-referenced (modified Angoff methodology); pass/fail only
Exam length: 100 questions
Time limit: 105 minutes (100-item form); 120 minutes (115-item form)
Exam / certification fees: $225–250 Official sources

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BC-HIS: Suggested Study Strategy

1Focus heavily on audiogram interpretation: practice classifying loss type (conductive, SNHL, mixed), degree, and configuration from sample audiograms

2Memorize tympanogram types (A, As, Ad, B, C) and their clinical correlates — expect multiple questions on immittance testing

3Master the five competency domains and their weightings to allocate study time proportionally

4Understand OSPL90 and why it must be set below the patient's LDL — this is a patient safety concept tested repeatedly

5Know the difference between NAL-NL2 and DSL v5: who each is for, what each optimizes, and when to use each

6Study the FDA red flag conditions (21 CFR 801.421) — all 8 conditions requiring medical referral before dispensing

7Review the 2022 FDA OTC Hearing Aid Rule: who it applies to, what it allows, and what it does NOT change for licensed dispensers

8Practice real-ear measurement calculations: REIG = REAR − REUR; know what RESR measures and why it matters

9Learn ANSI S3.22 electroacoustic terms: OSPL90, full-on gain, HFA gain, reference test gain, THD, and EIN

10Review NBC-HIS Code of Ethics scenarios — expect questions on conflicts of interest, patient rights, and referral obligations

Frequently Asked Questions

What is the BC-HIS certification?

The BC-HIS (Board Certified in Hearing Instrument Sciences) is the national voluntary certification for hearing instrument specialists, awarded by the National Board for Certification in Hearing Instrument Sciences (NBC-HIS). It is earned by passing the National Competency Exam (NCE) and demonstrates advanced competency above the state licensure minimum. Hearing aid dispensing is licensed in all 50 U.S. states; BC-HIS is a mark of excellence within the profession.

What are the eligibility requirements for the BC-HIS exam?

To sit for the NCE, candidates must have: (1) a current state/provincial hearing instrument dispensing license or registration, AND (2) a minimum of 2 years of full-time dispensing experience within the last 5 years — OR a diploma from an NBC-HIS approved hearing instrument sciences program. Application requires a copy of the license and a notarized self-attestation form.

How many questions are on the BC-HIS exam and how long is it?

The NCE contains 100 scored multiple-choice items. NBC-HIS allows 105 minutes for the 100-item form and 120 minutes for a 115-item form that adds 15 unscored beta items; NBC-HIS states forms sometimes include as many as 30 non-scored beta items, and your exam length and allotted time are posted when you register. Only the 100 scored items determine the pass/fail result. The exam is administered at pre-approved Kryterion computer-lab testing centers in the U.S., Canada, and select international locations.

What is the passing score for the BC-HIS exam?

NBC-HIS uses a modified Angoff criterion-referenced methodology to set the passing standard. The actual passing score may vary between test forms based on item difficulty. Candidates receive a pass/fail result immediately after the exam. Failing candidates receive percentage breakdowns by competency area to guide remediation; passing candidates do not receive a numerical score.

What content areas does the BC-HIS exam cover?

The NCE covers five competency domains: Assess Patient Presenting Problem and Needs (25%), Test and Analyze Patient Hearing (25%), Prescribe and Analyze Hearing Instruments (25%), Fit, Adjust, Program, and Service Hearing Instruments and Equipment (15%), and Counseling and Rehabilitation (10%). The first three domains are weighted equally and together account for 75% of the 100 scored items.

How much does the BC-HIS exam cost?

The NBC-HIS NCE exam fee is $225 for candidates in the United States or Canada, and $250 for international candidates, and it must be paid each time you schedule, including retakes. Rescheduling within 72 hours of the appointment incurs a $95 fee. Annual fees after certification are $299 (US), $215 USD (Canada), and $299 USD (international). Bulk exam voucher discounts are available: 10% for 5-9 vouchers and 20% for 10 or more.

How do I maintain my BC-HIS certification?

BC-HIS certification must be renewed every 3 years. Recertification requires 24 continuing education credits earned within the 36-month period through approved in-person or online programs; there is no limit on online CEs and excess credits do not carry over to the next cycle. Recertification also confirms the certificant holds a state or provincial license where applicable. Annual fees ($299 US, $215 USD Canada, $299 USD international) are billed in May and due by June 30.