On pure tone audiometry, a patient shows normal air conduction thresholds but elevated bone conduction thresholds with absent acoustic reflexes bilaterally. The most likely diagnosis is:

• A Conductive hearing loss with middle ear effusion
• B Auditory neuropathy spectrum disorder (ANSD)
• C Sensorineural hearing loss with poor word recognition
• D Cochlear (sensory) hearing loss ✓

Explanation

The pattern described — normal air conduction but elevated bone conduction with absent acoustic reflexes — is inconsistent because the statement implies bone conduction is worse than air conduction without the usual air-bone gap. A more likely interpretation is that the acoustic reflex may be absent due to a cochlear pathology with recruitment, but this combination is atypical. If air conduction is normal and bone conduction is also normal but acoustic reflexes are absent, consider auditory neuropathy spectrum disorder (ANSD), where OAEs are present but ABR is absent/abnormal. The question as framed best fits cochlear hearing loss with recruitment-mediated reflex abnormalities. In clinical ANSD: OAEs present, ABR absent, acoustic reflexes absent.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.