A 55-year-old factory worker with 25 years of occupational noise exposure presents with bilateral progressive hearing loss. Pure tone audiometry shows a bilateral notch centered at 4000 Hz with recovery at 8000 Hz. The most characteristic audiometric pattern is:

• A Flat sensorineural hearing loss
• B Low-frequency ascending sensorineural hearing loss
• C High-frequency gently sloping sensorineural hearing loss
• D Notch at 4000 Hz with recovery at higher frequencies ✓

Explanation

Noise-induced hearing loss characteristically produces a bilateral notch centered at 4000 Hz with recovery at 8000 Hz. The 4000 Hz region of the cochlea is most vulnerable to noise damage due to its resonance properties and the mechanical vulnerability of the basal turn. This pattern distinguishes it from presbycusis, which shows a progressive high-frequency slope without a discrete notch, and from flat losses seen in conductive pathology.

Reference: Ballenger's Otorhinolaryngology: Head and Neck Surgery, 18th ed.

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Written and medically reviewed by the StethoPrep medical team.