A 40-year-old claims severe bilateral hearing loss for medicolegal reasons. Pure-tone audiometry shows thresholds around 75 dB across frequencies, but the speech recognition threshold measures only 35 dB. This discrepancy of more than 10 dB between SRT and pure-tone average suggests:

• A Bilateral Meniere disease
• B Non-organic (functional) hearing loss ✓
• C Advanced presbycusis with phonemic regression
• D Bilateral otosclerosis

Explanation

In genuine hearing loss the speech recognition threshold agrees with the pure-tone average of 500, 1000 and 2000 Hz within about 6 to 10 dB, because both depend on the same peripheral sensitivity. When SRT is far better than the pure-tone average, the patient is responding inconsistently, which points strongly to non-organic hearing loss. Phonemic regression gives poor word scores but does not produce this threshold mismatch.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.