<prompt> Loudness recruitment phenomenon is associated withRetrocochlear deafnessConductive deafnessSensorineural deafnessCochlear deafness  <response>: Ans. d Cochlear deafness Ref. Dhingra 3rd ed., 4, 49; 29, 148The rapid growth of loudness in ears with sensorineural hearing loss is known as loudness recruitment. Its presence helps signify that the hearing loss is caused by pathology within the cochlea. Recruitment is a symptom of cochlear pathology associated with hair cell damage, particularly to outer hair cells.ASSESSMENT OF HEARING LOSS1. Clinical testsa. Finger friction testb. Watch testc. Speech testd. Tuning fork tests2. Audiometric testsa. Pure tone audiometry measures threshold of hearing by air and bone conduction and thus the degree and type of hearing lossb. Speech audiometry measures ability of patient to hear and understand speechc. Bekesy audiometry differentiates cochlear from retrocochlear and organic from functional hearing lossd. Impedance audiometry, i.e., tympanometry and acoustic reflex measurements particularly useful in children.3. Special testsa. Recruitment seen typically in lesions of cochlea, e.g., Menieres disease, presbycusisb. Short increment sensitivity index SISI testc. Threshold tone decay Carharts test a decay more than 25dB is diagnostic of a retrocochlear lesiond. Evoked response audiometry e.g., BERAe. Otoacoustic emissionsf. Central auditory testsAcoustic Reflex Loud sound 70 dB; causes bilateral contraction of stapedial muscles which can be detected by tympanometry. Reflex mediated by VII and VIII nerves. It is protective reflex against loud sound. Normally, stapedial reflex is elicited at 70-100 dB SL. If patient claims total deafness but the reflex can be elicited, it indicates NOHL non-organic hearing loss. Hyperacusis in Bells palsy is due to the paralysis of the stapedius muscle. Uses:1. Objective method to detect hearing in infants and children.2. To find malingering3. To detect cochlear pathology. Presence of Stapedial reflex at lower frequencies, instead of 70 dB indicates Recruitment and cochlear pathology.4. To detect VIII and VII nerve lesions. 