Clinical Audiogram of The Week - Vol3,No4

This case was presented in the recent (vol3No4) edition of otorhinolaryngology news: An 46-year old male presented with difficulty in hearing conversation speech of 12 years duration. He often resorted to carrying out 'Toynbee's maneuvre" - swallow against pinched nose, closed mouth in order to be able to hear in the right ear. He gave a history of unsuccessful ossiculoplasty both ears ten years previously. Examination revealed bilaterally normal EACs and Tympanic membranes. Tuning fork assessment revealed bilateral conductive hearing loss. Pure tone audiometry revealed the audiogram displayed here. You may click on the audiogram to view a larger picture of the audiogram.
Diagnosis: Bilateral Conductive Hearing Loss with wide air-bone gap. Otosclerosis was the initial diagnosis, but exploratory tympanotomy revealed loose PORP in the right middle ear. The patient demonstrated significant amplification gains and is doing well on binaural ITC Hearing aids.