An otologically normal 13-year-old with PTA 50 dB, SRT 20 dB, and WRS 100% at 50 dB; which step is most appropriate next?

An otologically normal 13-year-old with PTA 50 dB, SRT 20 dB, and WRS 100% at 50 dB; which step is most appropriate next?

• A. Administer central-auditory-processing test battery
• B. Obtain reflex thresholds
• C. Reinstruct the boy and use an ascending-threshold measurement technique
• D. Administer pure-tone Stenger tests

Answer: (C)

Reliability of behavioral thresholds in children depends on clear instructions and how the threshold search is conducted. When pure-tone thresholds don’t line up with other measures (SRT and WRS), the first step is to verify the child understands the task and is responding reliably. Here, the pure-tone average around 50 dB with a much better SRT (20 dB) and perfect WRS at 50 dB is a red flag for potential unreliable responses. Reinstating instructions and using an ascending-threshold search minimizes response bias and guessing, helping you obtain thresholds that better reflect true sensitivity and align with the functional measures. Putting in reflex thresholds or Stenger testing isn’t the immediate need here. Reflex thresholds don’t resolve the reliability question, and Stenger testing targets nonorganic or exaggerated unilateral loss, which isn’t indicated by this pattern of results. Central-auditory-processing tests aren’t the next step when the issue appears to be task reliability in basic audiometry.

Reliability of behavioral thresholds in children depends on clear instructions and how the threshold search is conducted. When pure-tone thresholds don’t line up with other measures (SRT and WRS), the first step is to verify the child understands the task and is responding reliably. Here, the pure-tone average around 50 dB with a much better SRT (20 dB) and perfect WRS at 50 dB is a red flag for potential unreliable responses. Reinstating instructions and using an ascending-threshold search minimizes response bias and guessing, helping you obtain thresholds that better reflect true sensitivity and align with the functional measures.

Putting in reflex thresholds or Stenger testing isn’t the immediate need here. Reflex thresholds don’t resolve the reliability question, and Stenger testing targets nonorganic or exaggerated unilateral loss, which isn’t indicated by this pattern of results. Central-auditory-processing tests aren’t the next step when the issue appears to be task reliability in basic audiometry.