A 28-year-old woman referred from a medico-legal board has pure tone audiometry showing a flat sensorineural loss averaging 60 dB HL in the right ear. Her speech recognition threshold measures 15 dB HL in the same ear, and she responds inconsistently to repeat pure tone testing. What is the most likely diagnosis?
- A Early Meniere disease
- B Otosclerosis
- C Non-organic (functional) hearing loss ✓
- D Auditory neuropathy spectrum disorder
Correct answer: C. Non-organic (functional) hearing loss
Explanation
In genuine sensorineural loss the speech recognition threshold should agree with the pure tone average within about 6 to 10 dB because both measure sensitivity in the speech frequencies. A threshold far better than the PTA, together with inconsistent responses, is the classic audiometric fingerprint of non-organic hearing loss. Otosclerosis produces a conductive pattern with an air-bone gap, and ANSD shows absent acoustic reflexes and abnormal ABR rather than this discrepancy.
Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.