A 52-year-old man with unilateral sensorineural hearing loss undergoes speech audiometry. The word recognition score is 84% at 30 dB SL, 80% at 50 dB SL, and 52% at 70 dB SL. What does this pattern indicate?
- A Retrocochlear lesion such as vestibular schwannoma ✓
- B Cochlear hearing loss with loudness recruitment
- C Conductive hearing loss with normal cochlear reserve
- D Functional (non-organic) hearing loss
Correct answer: A. Retrocochlear lesion such as vestibular schwannoma
Explanation
B progressive fall in word recognition score as intensity increases beyond the maximum is the roll-over phenomenon, quantified by a roll-over ratio greater than 0.45. It occurs because increasing loudness further degrades temporal coding in a retrocochlear lesion, classically vestibular schwannoma. In cochlear loss the score plateaus or improves slightly with more intensity due to recruitment, so option B is killed by the falling rather than rising score.
Reference: Dhingra Diseases of Ear, Nose and Throat, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.