Neural presbycusis: a diagnostic dilemma.

The combined term, sensorineural, is useful because clinical distinction between sensory and neural lesions is often difficult, and because sensory lesions may lead to secondary neural degeneration or, though rarely, a neural lesion may lead to secondary sensory degeneration. The threat of lawsuits for failure to identify treatable neurologic conditions has led to overuse of tests, while fiscal constraints exert pressure to limit expensive diagnostic testing. The purpose of this review of the relation between sensory and neural hearing loss is to provide a practical method to screen for neural lesions using pure-tone thresholds and a single speech discrimination score. The difference between the articulation index and the word recognition score of a patient provides a statistically reliable index of suspicion that may reduce the diagnostic dilemma of neural presbycusis.