Hard of hearing

Step 1: View clinicals

A 41-year-old woman presents with worsening left-sided hearing impairment for six months, along with a ringing noise in the same ear. There is no history of earache, fullness of the ear, otorrhea, or dizziness. She works as a history teacher in a local high school, and recounts experiencing sudden difficulty in hearing her students, who in turn noticed that she had started talking rather quietly. There is no history of trauma, her medical and surgical histories are unremarkable, and she is not on any medications. A careful family history reveals that her father experienced progressive hearing loss starting from a young age, although this was not investigated further.

Step 2: Order all relevant investigations

MRI Brain

You realize that MRI imaging of the brain is probably not indicated here.

HRCT Brain, Bone View

The HRCT scan shows a thickened stapes footplate and sclerotic lesions around the oval window.

Audiometric Evaluation

Pure-tone audiometry: low-frequency conductive hearing loss. Tympanometry: Type A tympanogram. Acoustic reflex testing: elevated reflex threshold.

Measurement of Workplace Noise

Occupational noise is within accepted standards

Step 3: Select appropriate management

Cochlear Implant Placement
Sodium fluoride

Score: ★★☆