A 40-year-old woman presents with unilateral right-sided sensorineural hearing loss and tinnitus. On audiometric reflex decay testing, the acoustic stapedial reflex is present at normal sensation levels (within 10 seconds) for a 1000 Hz tone presented to the right ear for the full 10 seconds. What does this finding suggest?

• A Conductive hearing loss
• B Retrocochlear (vestibular schwannoma) hearing loss
• C Cochlear (sensory) hearing loss ✓
• D Functional hearing loss

Explanation

Reflex decay (adaptation) is the weakening of the stapedial reflex amplitude during a sustained tone. Absence of reflex decay (reflex persists for 10 seconds) is characteristic of cochlear (outer hair cell) pathology. Significant reflex decay (reflex disappears within 10 seconds at a sensation level 75 dB or less) is a hallmark of retrocochlear pathology such as vestibular schwannoma. C maintained reflex for the full duration argues against retrocochlear involvement.

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

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Written and medically reviewed by the StethoPrep medical team.