A 68-year-old patient presents with gradual bilateral high-frequency sensorineural hearing loss, and their speech reception threshold matches their pure-tone average. What is the most likely etiology?

• A. Presbycusis
• B. Otosclerosis
• C. Ménière's disease
• D. Acoustic neuroma

Answer: (A)

Age-related cochlear degeneration leads to a gradual, bilateral, high-frequency sensorineural loss. When the speech reception threshold aligns with the pure-tone average, it indicates the primary issue is reduced audibility from cochlear damage rather than a processing problem or a middle/retrocochlear disorder. This pattern fits presbycusis, which involves hair cell loss, strial atrophy, or auditory nerve changes within the cochlea and tends to present symmetrically in older adults.

In contrast, otosclerosis would cause a conductive loss (not the SNHL pattern described), Ménière’s disease involves fluctuating SNHL with vertigo and episodic symptoms, and an acoustic neuroma typically shows unilateral SNHL with disproportionately reduced word recognition.