Speech audiometry shows 100% word recognition score (WRS) at 40 dB above speech reception threshold (SRT). A rollover phenomenon — declining WRS at higher intensities — is observed. This pattern is most suggestive of:
- A Cochlear sensorineural hearing loss
- B Conductive hearing loss
- C Retrocochlear pathology (e.g., acoustic neuroma) ✓
- D Functional (non-organic) hearing loss
Correct answer: C. Retrocochlear pathology (e.g., acoustic neuroma)
Explanation
Rollover is defined as a significant decrease (>20–25%) in WRS when test intensity is increased beyond the optimum level. This paradoxical decrease at higher intensities is a hallmark of retrocochlear lesions such as acoustic neuroma (vestibular schwannoma), where the VIII nerve cannot sustain high-rate neural firing. Cochlear losses do not show rollover; they plateau at maximum WRS.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.