A 70-year-old presents with symmetric high-frequency sensorineural hearing loss affecting frequencies above 2000 Hz, with poor word recognition. Histopathologically, this corresponds to loss of which cochlear structure?
- A Outer hair cells at the basal turn of the cochlea (sensory presbycusis) ✓
- B Stria vascularis (metabolic/flat audiogram pattern)
- C Spiral ganglion neurons (neural presbycusis)
- D Inner hair cells at the apex of the cochlea
Correct answer: A. Outer hair cells at the basal turn of the cochlea (sensory presbycusis)
Explanation
Sensory presbycusis (the commonest subtype) results from progressive loss of outer hair cells at the basal turn of the cochlea (which encodes high-frequency sounds). This produces a sharply sloping, high-frequency SNHL — the typical audiometric pattern of age-related hearing loss. Stria vascularis atrophy causes 'metabolic' presbycusis with a flat audiogram. Spiral ganglion loss causes 'neural' presbycusis with disproportionately poor word recognition.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.