Speech audiometry in a 52-year-old man with asymmetric sensorineural hearing loss shows a word recognition score of 84% at 30 dB SL, which falls to 56% when intensity is increased to 60 dB SL. This pattern is most suggestive of:
- A Cochlear hearing loss from Meniere disease
- B Retrocochlear lesion such as vestibular schwannoma ✓
- C Conductive hearing loss from otosclerosis
- D Normal adaptation of the auditory system
Correct answer: B. Retrocochlear lesion such as vestibular schwannoma
Explanation
Rollover describes a fall in word recognition score as presentation intensity rises beyond the level yielding the maximum score, quantified by a roll over ratio of 0.25 or greater. It occurs because neural synchrony degrades at high stimulus rates in retrocochlear lesions such as vestibular schwannoma. Cochlear lesions typically plateau or slightly improve with intensity, conductive losses shift curves without abnormal shape, and true physiological adaptation does not reduce scores by nearly 30 percentage points.
Reference: Katz's Handbook of Clinical Audiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.