A child scores poorly on dichotic digit tests and speech-in-noise tests but has normal peripheral audiogram and normal TEOAE. The most likely diagnosis is:

• A Conductive hearing loss due to middle ear effusion
• B Non-organic hearing loss (functional)
• C Auditory neuropathy spectrum disorder
• D Auditory processing disorder (APD) ✓

Explanation

Auditory processing disorder (APD) is characterised by difficulty understanding speech in noise, dichotic listening tasks, and temporal processing despite normal peripheral hearing (normal pure tone audiogram, normal OAEs). Central auditory processing occurs beyond the cochlea; normal TEOAEs confirm intact outer hair cell function. Auditory neuropathy spectrum disorder shows normal OAEs but absent/abnormal ABR, and typically a retrocochlear audiometric pattern. Non-organic hearing loss is a deliberate exaggeration, not a processing deficit.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.