Hearing Impairment: The Daily PANCE Blueprint
A 78-year-old female reports difficulty hearing conversations. It has gotten gradually worse. Physical examination of the ear is normal. On tuning fork testing, the Weber test lateralizes to the right ear, and the Rinne test shows air conduction greater than bone conduction bilaterally. Which of the following is the most likely diagnosis?
A. Conductive hearing loss due to bilateral cerumen impaction
B. Otosclerosis with mixed hearing loss
C. Noise-induced conductive hearing loss
D. Age-related sensorineural hearing loss
E. None of the above
Answer and topic summary
The answer is D. Age-related sensorineural hearing loss
Hearing loss is a common problem (over 30 million U.S. adults), especially in older adults (70s and 80s). It can be classified into 3 types: sensorineural (involving the inner ear, cochlea, or auditory nerve), conductive, and mixed. The Weber and Rinne tests can help distinguish conductive from sensorineural hearing loss. The most common cause of hearing loss in elderly patients is age-related sensorineural (presbycusis). Presbycusis represents sensorineural hearing loss due to cochlear or auditory nerve degeneration. It is typically bilateral and symmetric, with loss of high-frequency hearing first. The Rinne test (air > bone) and Weber test (no clear lateralization OR lateralization to the better-hearing ear) are consistent with sensorineural loss.
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