Pure-tone audiometry of a 30-year-old shows an average air-conduction threshold of 55 dB HL across speech frequencies. Her speech recognition threshold measures 15 dB HL. What does this discrepancy most strongly suggest?
- A Bilateral otosclerosis
- B Non-organic (functional) hearing loss ✓
- C Ménière disease
- D Auditory neuropathy spectrum disorder
Correct answer: B. Non-organic (functional) hearing loss
Explanation
The speech recognition threshold should agree with the pure-tone average of 500, 1000 and 2000 Hz within about 6 to 10 dB in genuine hearing loss. A gap far greater than this, as here (40 dB), is a classic indicator of non-organic hearing loss and should prompt tests such as the Stenger or tone-in-noise testing. Otosclerosis and Ménière disease produce concordant PTA and SRT values, which eliminates those distractors.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.