On pure-tone audiometry, a patient has air-bone gap of 35 dB at all frequencies. Tympanometry shows a flat (Type B) tympanogram with normal ear canal volume. The most likely diagnosis is:

• A Otosclerosis
• B Ossicular chain disruption
• C Sensorineural hearing loss
• D Secretory otitis media (Glue ear) ✓

Explanation

A flat Type B tympanogram with normal ear canal volume (ruling out TM perforation) indicates fluid in the middle ear, i.e., secretory otitis media or glue ear. The conductive hearing loss (air-bone gap) results from damping of tympanic membrane movement by viscous mucoid fluid. This is most common in children, often associated with Eustachian tube dysfunction.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.