A 28-year-old woman with slowly progressive hearing loss tells her doctor that she hears dinner conversation surprisingly well at a crowded, noisy restaurant but struggles badly when talking in a quiet room. This paradoxical improvement in noisy surroundings is called:

• A Loudness recruitment, indicating a cochlear site of lesion
• B Hyperacusis, due to stapedius muscle paralysis
• C Tullio phenomenon, caused by sound-induced vestibular stimulation
• D Paracusis Willisii, because speakers raise their voice above the ambient noise ✓

Explanation

Paracusis Willisii is classical of otosclerotic conductive hearing loss. The patient already hears through a conductive barrier, so ambient noise adds little masking, while normal listeners instinctively raise their voice in a noisy room, allowing her to follow speech relatively well. Recruitment occurs in sensory (cochlear) loss, not conductive loss. Tullio phenomenon produces vertigo with sound, not better hearing, and hyperacusis means intolerance of sound.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.