Absent OAEs Confirming SNHL

A 5-year-old boy is referred for audiological evaluation after his kindergarten teacher noted he frequently asks for repetition and struggles with phonics. He had passed newborn OAE screening but experienced recurrent otitis media in early childhood. Examination reveals normal external ears, patent canals, and clear tympanic membranes. Tympanometry shows Type A curves bilaterally. Pure-tone audiometry demonstrates air conduction thresholds of 35–55 dB HL across frequencies with bone conduction thresholds overlying air conduction thresholds bilaterally, confirming no air-bone gap. The pattern shown in the diagram at **C** — ABSENT BILATERAL DPOAEs combined with ELEVATED PURE-TONE THRESHOLDS and NO AIR-BONE GAP — is consistent with which underlying pathophysiology?