Based on audiometric pattern showing unilateral left-ear loss with poor word recognition and SRT discrepancy, the site of lesion is most likely retrocochlear in origin.

Based on audiometric pattern showing unilateral left-ear loss with poor word recognition and SRT discrepancy, the site of lesion is most likely retrocochlear in origin.

• A. Ménière's disease
• B. Retrocochlear in origin
• C. Cochlear hydrops
• D. Chronic ear infections

Answer: (B)

The key idea is that when a person has a unilateral hearing loss with word recognition that’s disproportionately poor compared with the pure-tone thresholds, plus a mismatch between speech reception measures, the problem is likely neural rather than cochlear. This pattern points to retrocochlear involvement—away from the cochlea itself and toward the auditory nerve or brainstem pathways on the affected side. Why this fits: the auditory nerve and central pathways are more critical for recognizing speech than for merely detecting tones. In retrocochlear lesions, listeners can have a measurable hearing loss, but their ability to understand speech—especially monosyllabic words—drops more steeply than the audiogram would predict. The SRT (the softest level at which speech is heard) may not align with the word-recognition performance, producing a discrepancy that signals neural impairment beyond the cochlea. The unilateral left-sided pattern further supports a lesion on the left retrocochlear pathway. Why other options don’t fit as well: Ménière’s disease and cochlear hydrops involve cochlear pathology with fluctuating hearing loss and vertigo/tinnitus patterns rather than a clear, disproportionate decline in word recognition relative to thresholds. Chronic ear infections cause conductive loss, which mainly reduces audibility through the middle ear and typically does not produce the targeted, disproportionate word-recognition deficit seen with retrocochlear involvement. In short, the combination of a unilateral loss with disproportionately poor speech recognition and SRT discrepancy is a hallmark of a retrocochlear lesion on the affected side.

The key idea is that when a person has a unilateral hearing loss with word recognition that’s disproportionately poor compared with the pure-tone thresholds, plus a mismatch between speech reception measures, the problem is likely neural rather than cochlear. This pattern points to retrocochlear involvement—away from the cochlea itself and toward the auditory nerve or brainstem pathways on the affected side.

Why this fits: the auditory nerve and central pathways are more critical for recognizing speech than for merely detecting tones. In retrocochlear lesions, listeners can have a measurable hearing loss, but their ability to understand speech—especially monosyllabic words—drops more steeply than the audiogram would predict. The SRT (the softest level at which speech is heard) may not align with the word-recognition performance, producing a discrepancy that signals neural impairment beyond the cochlea. The unilateral left-sided pattern further supports a lesion on the left retrocochlear pathway.

Why other options don’t fit as well: Ménière’s disease and cochlear hydrops involve cochlear pathology with fluctuating hearing loss and vertigo/tinnitus patterns rather than a clear, disproportionate decline in word recognition relative to thresholds. Chronic ear infections cause conductive loss, which mainly reduces audibility through the middle ear and typically does not produce the targeted, disproportionate word-recognition deficit seen with retrocochlear involvement.

In short, the combination of a unilateral loss with disproportionately poor speech recognition and SRT discrepancy is a hallmark of a retrocochlear lesion on the affected side.