Unilateral left-ear hearing loss with a significant discrepancy between speech reception threshold and word recognition scores suggests what?

• A. Ménière's disease
• B. Retrocochlear pathology
• C. Cochlear hydrops
• D. Chronic otitis media

Answer: (B)

A large gap between how softly speech can be heard and how well words are recognized at a comfortable loudness points to a problem beyond the cochlea—in the neural pathways of hearing. This pattern, where SRT (speech reception threshold) is better than WRS (word recognition scores) at the same loudness, suggests retrocochlear pathology, such as a lesion on the auditory nerve or along the brainstem pathways. The issue is not just the ear’s sensitivity, but how the auditory system encodes and codes complex speech signals.

In cochlear hydrops or Ménière’s disease, the problem lies in the inner ear itself, and while speech perception can be affected, the discrepancy between SRT and WRS isn’t as characteristic. Chronic otitis media is a middle-ear (conductive) problem; it changes air-conduction thresholds and can show an air-bone gap, not the specific neural-discrimination pattern described. So the presence of unilateral hearing loss with a significant SRT–WRS discrepancy most strongly points to retrocochlear pathology.