Speech audiometry in a 55-year-old with asymmetric sensorineural hearing loss shows a word recognition score of 88% at 30 dB SL, which FALLS to 52% when the intensity is raised to 60 dB SL. This finding is called roll-over and is most characteristic of:

• A Meniere disease
• B Otosclerosis
• C Noise-induced hearing loss
• D Vestibular schwannoma ✓

Explanation

Roll-over means the word recognition score declines as stimulus intensity increases above the optimal level. It reflects poor neural synchrony and distortion at higher input levels, classically seen in retrocochlear lesions such as acoustic neuroma. Cochlear losses may show mild roll-over, but a marked drop of this magnitude points to the eighth nerve. Otosclerosis shows excellent discrimination once audibility is restored.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.