Ear and audiology: speech audiometry in retrocochlear lesion: 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: speech audiometry in retrocochlear lesion

Sample item

A patient with unilateral hearing loss has a speech discrimination score far lower than expected from the pure-tone loss, and it falls further when the presentation level is raised (rollover). Where is the lesion most likely?

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

The answer and the reasoning

A. Retrocochlear, such as the eighth nerve

Rollover, a paradoxical fall in speech discrimination at higher intensities, and speech scores disproportionately poor for the pure-tone loss, point to a retrocochlear lesion such as vestibular schwannoma. Cochlear lesions show recruitment with preserved discrimination in proportion to loss. Conductive lesions have normal discrimination at adequate loudness.

Option by option

  • A. Retrocochlear, such as the eighth nerve (correct)

    Correct. Rollover and disproportionate poor discrimination are signs of eighth nerve pathology.

  • B. Cochlear hair cells

    Cochlear disease typically shows recruitment and discrimination proportionate to loss.

  • C. Middle ear ossicles

    Ossicular disease causes a conductive loss, with good discrimination when the sound is loud enough.

  • D. External auditory canal

    Canal disease is a conductive problem and does not reduce discrimination.

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 A, Retrocochlear, such as the eighth nerve. Rollover, a paradoxical fall in speech discrimination at higher intensities, and speech scores disproportionately poor for the pure-tone loss, point to a retrocochlear lesion such as vestibular schwannoma.

Why is "Cochlear hair cells" not the answer?

Cochlear disease typically shows recruitment and discrimination proportionate to loss.

Why is "Middle ear ossicles" not the answer?

Ossicular disease causes a conductive loss, with good discrimination when the sound is loud enough.

Why is "External auditory canal" not the answer?

Canal disease is a conductive problem and does not reduce discrimination.

What concept does this question test?

It tests Ear and audiology: speech audiometry in retrocochlear lesion in ENT. Cochlear lesions show recruitment with preserved discrimination in proportion to loss. Conductive lesions have normal discrimination at adequate loudness.

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: speech audiometry in retrocochlear lesion?

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.