A 45-year-old woman with a 10-year history of atticoantral CSOM presents with progressive hearing loss. Pure-tone audiometry shows a 55 dB air-bone gap with preserved bone thresholds at 4000 Hz. The Carhart notch typically seen in otosclerosis is absent. The hearing loss pattern in this patient is best described as:

• A Conductive hearing loss due to ossicular chain disruption ✓
• B Mixed hearing loss with a low-frequency bias
• C Sensorineural hearing loss due to cochlear erosion
• D Central hearing loss due to retrocochlear involvement

Explanation

The large air-bone gap with preserved bone thresholds indicates a conductive hearing loss pattern, which is characteristic of chronic otitis media with ossicular erosion or disruption. The Carhart notch is specific to otosclerosis, not CSOM. Preserved bone thresholds rule out sensorineural loss. The hallmark of long-standing atticoantral disease is progressive conductive hearing loss from ossicular destruction, most commonly the incus long process.

Reference: Cummings Otolaryngology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.