Which combination of audiometric results in an adolescent would suggest nonorganic hearing loss?

• A. PTA 50 dB, SRT 20 dB, WRS 100% at 50 dB
• B. PTA 10 dB, SRT 10 dB, WRS 100% at 20 dB
• C. PTA 60 dB, SRT 50 dB, WRS 0% at 60 dB
• D. PTA 30 dB, SRT 30 dB, WRS 100% at 30 dB

Answer: (A)

Nonorganic hearing loss is suspected when there is a large gap between pure-tone thresholds and how the person actually hears and understands speech. In organic loss, the speech threshold (SRT) and the pure-tone threshold (PTA) line up closely, and word recognition (WRS) follows expected patterns. But in nonorganic cases, the person may show much poorer PTA than their real ability to hear speech would suggest, while SRT and WRS indicate much better hearing.

Here, the pure-tone average around 50 dB would imply a moderate hearing loss, yet the speech-reception threshold is only 20 dB and word recognition is perfect at 50 dB. This means the adolescent can understand speech at a level far better than the PTA would predict and can recognize words with full accuracy at the level used for testing, which is inconsistent with the measured tonal loss. That mismatch—poor PTA with excellent speech understanding—fits nonorganic hearing loss.

The other patterns either show close alignment between PTA and SRT (and typically consistent WRS), or present results that don’t reflect the same kind of suspicious discrepancy, so they don’t point to nonorganic loss in the same way.