Ear and audiology: stapedial reflex decay: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Ear and audiology: stapedial reflex decay

Sample item

A 48-year-old man with unilateral sensorineural hearing loss and normal tympanometry shows a stapedial reflex that fades to half of its initial amplitude within 10 seconds of a sustained 500 Hz tone. What does reflex decay suggest, and what should follow?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Retrocochlear pathology, and an MRI of the internal acoustic meatus

Abnormal reflex decay means the stapedius cannot sustain contraction during continuous stimulation. It is a sign of neural fatigue in the auditory nerve, so it points to a retrocochlear lesion such as a vestibular schwannoma. Gadolinium MRI is then the confirmatory test.

Option by option

  • A. Otosclerosis, and stapedotomy

    Otosclerosis abolishes the reflex rather than causing decay in a normal-tympanometry sensorineural loss.

  • B. Cochlear hair cell loss, and simple observation

    Cochlear loss typically shows recruitment and preserved reflex sustaining, not decay.

  • C. Middle ear effusion, and grommet insertion

    Effusion gives a flat tympanogram and absent reflexes, not decay.

  • D. Retrocochlear pathology, and an MRI of the internal acoustic meatus (correct)

    Correct. Rapid decay indicates a retrocochlear lesion and needs imaging.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is D, Retrocochlear pathology, and an MRI of the internal acoustic meatus. Abnormal reflex decay means the stapedius cannot sustain contraction during continuous stimulation.

Why is "Otosclerosis, and stapedotomy" not the answer?

Otosclerosis abolishes the reflex rather than causing decay in a normal-tympanometry sensorineural loss.

Why is "Cochlear hair cell loss, and simple observation" not the answer?

Cochlear loss typically shows recruitment and preserved reflex sustaining, not decay.

Why is "Middle ear effusion, and grommet insertion" not the answer?

Effusion gives a flat tympanogram and absent reflexes, not decay.

What concept does this question test?

It tests Ear and audiology: stapedial reflex decay in ENT. It is a sign of neural fatigue in the auditory nerve, so it points to a retrocochlear lesion such as a vestibular schwannoma. Gadolinium MRI is then the confirmatory test.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Ear and audiology: stapedial reflex decay?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.