A 25-year-old with normal hearing threshold on pure-tone audiometry cannot follow speech in background noise and performs poorly on dichotic digit testing. ABR is normal. The most likely diagnosis is:

• A Central auditory processing disorder (CAPD) ✓
• B Malingering (functional hearing loss)
• C Auditory neuropathy spectrum disorder (ANSD)
• D Meniere's disease

Explanation

Central auditory processing disorder (CAPD) presents with normal peripheral hearing thresholds but difficulty understanding speech in noise, following rapid speech, binaural integration deficits (dichotic tests), and poor auditory memory. Peripheral audiometry including OAE and ABR are typically normal, confirming that the deficit lies at the level of the central auditory pathways (cortex/brainstem) rather than the cochlea or nerve. Management includes auditory training, preferential seating, and FM systems.

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.