Behavioral psychoacoustics tests detect retrocochlear pathology poorly but rule out healthy ears well

Evidence

Before physiological tests and the MRI were developed, audiologists conducted behavioral assessments of retrocochlear auditory disorders, or disorders in the auditory system at a level above the cochlea. In many cases, a retrocochlear disorder is caused by a tumor on the auditory nerve or in the brainstem. With the advent of physiological tests such as otoacoustic emissions (a test of cochlear function), immitance testing (a test of middle ear and brainstem function), and auditory brainstem response (ABR; a brainstem evoked potential), behavioral assessment is no longer routinely conducted to determine whether a sensorineural hearing loss is retrocochlear. Importantly, these psychoacoustics tests collectively have reasonably good specificity (ability to identify the healthy ears), but fairly poor sensitivity (ability to accurately identity the presence of a retrocochlear pathology; Turner, Shepard, & Frazer; 1984). Today, an MRI is considered the gold standard of retrocochlear assessment. However, there are patients for whom an MRI is contraindicated, and there are some cases where retrocochlear assessment using behavioral techniques may still be needed. — Jennifer Lentz, Psychoacoustics- Perception of Normal…, 1747

Categorization

• XREF: Connects to earlier chapters’ discussion of loudness recruitment, otoacoustic emissions, and ABR as physiological correlates of cochlear vs neural sites; also links to general screening-test logic where specificity and sensitivity trade off.