A 28-year-old claims progressive hearing loss after a head injury at work. Pure-tone average (500, 1000 and 2000 Hz) in the right ear is 55 dB HL, but the speech recognition threshold obtained is 15 dB HL. This 40 dB discrepancy most strongly suggests:

• A Cochlear sensorineural loss with recruitment
• B Non-organic (functional) hearing loss ✓
• C Retrocochlear lesion of the eighth nerve
• D Conductive loss from otosclerosis

Explanation

In genuine hearing loss of any type, the speech recognition threshold agrees with the pure-tone average within about 6 to 10 dB, because both depend on the same peripheral sensitivity. A gap far exceeding this range means the patient hears speech well but exaggerates pure-tone thresholds, the classic audiometric signature of non-organic hearing loss. Otosclerosis and cochlear losses preserve the PTA-SRT agreement, and a retrocochlear lesion lowers rather than improves speech thresholds.

Reference: Katz, Handbook of Clinical Audiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.