CLINICAL CASE 1 OF 8

An inconsistent audiogram in a compensation claim

Vignette

A 48-year-old claims a severe bilateral hearing loss following occupational noise exposure and is pursuing compensation. Behavioural thresholds are around 60–70 dB HL, but they fluctuate between sessions and the speech reception threshold is much better than the pure-tone average would predict. Tympanometry and OAEs are normal. You proceed to cortical electric response audiometry.

Findings

0204060801002505001k2k4k8kFrequency (Hz)
○ Right — PTA 68 dB (Moderately severe)✕ Left — PTA 67 dB (Moderately severe)
Pure-tone audiogram companion. dB HL increases downward, following clinical convention. Illustrative thresholds — not recorded patient data.
0100200300400latency (ms)Stimulus at 35 dB HL
A clear, repeatable cortical response is recorded at 35 dB HL — a level well below the claimed 60–70 dB thresholds.

Diagnostic question

A robust cortical response is present at 35 dB HL across the speech frequencies. What is the correct interpretation?

References