A 38-year-old woman with unilateral Meniere disease complains that sounds in the affected ear suddenly become unbearably loud once they reach a certain intensity. Which test best documents this abnormal growth of loudness?
- A Alternate binaural loudness balance test ✓
- B Stenger test
- C Tone decay test
- D Acoustic reflex decay test
Correct answer: A. Alternate binaural loudness balance test
Explanation
Recruitment, the abnormally rapid growth of loudness, is a hallmark of cochlear (hair cell) disease. In the alternate binaural loudness balance test, tones of increasing intensity are alternated between the two ears, and recruitment is shown when the two ears perceive equal loudness at intensities well below those matching the threshold difference. Tone decay and reflex decay are retrocochlear signs, and the Stenger test detects feigned unilateral loss.
Reference: Dhingra, Diseases of Ear, Nose and Throat, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.