Which finding most strongly suggests nonorganic hearing loss when there is a discrepancy between behavioral and test results?

Which finding most strongly suggests nonorganic hearing loss when there is a discrepancy between behavioral and test results?

• A. PTA equals SRT
• B. Discrepancy between PTA and SRT
• C. Normal word recognition scores
• D. Normal tympanometry

Answer: (B)

Discrepancy between pure-tone thresholds and the speech-reception threshold is the strongest clue for nonorganic hearing loss when behavioral results don’t align. Pure-tone thresholds show what a person can detect, while the SRT reflects how well they understand speech at conversational levels. In genuine, organic hearing loss these two measures tend to track each other closely, usually within about 10–15 dB. A large gap between PTA and SRT suggests the patient is not responding to hearing stimuli in a way that matches their true auditory ability, pointing toward nonorganic (functional) loss. The other findings don’t inherently indicate nonorganic behavior: PTA equaling SRT fits a real level of loss; normal word recognition doesn’t address the mismatch between detection and understanding; and normal tympanometry shows middle-ear status but doesn’t explain a discrepancy between tone thresholds and speech tests.

Discrepancy between pure-tone thresholds and the speech-reception threshold is the strongest clue for nonorganic hearing loss when behavioral results don’t align. Pure-tone thresholds show what a person can detect, while the SRT reflects how well they understand speech at conversational levels. In genuine, organic hearing loss these two measures tend to track each other closely, usually within about 10–15 dB. A large gap between PTA and SRT suggests the patient is not responding to hearing stimuli in a way that matches their true auditory ability, pointing toward nonorganic (functional) loss. The other findings don’t inherently indicate nonorganic behavior: PTA equaling SRT fits a real level of loss; normal word recognition doesn’t address the mismatch between detection and understanding; and normal tympanometry shows middle-ear status but doesn’t explain a discrepancy between tone thresholds and speech tests.