An elderly patient with lifelong untreated otosclerosis now has profound deafness with a non-measurable air-bone gap, intact tympanic membrane, absent stapedial reflex, and bone conduction thresholds beyond the audiometer limits. This condition is termed:

• A Malignant otosclerosis
• B Otospongiosis
• C Cochlear otosclerosis
• D Far advanced otosclerosis ✓

Explanation

Far advanced otosclerosis describes the end stage where the stapes is completely fixed and buried and cochlear involvement destroys bone conduction, so no air-bone gap can be measured even though the middle ear pathology persists. These patients were traditionally considered unsuitable for stapedectomy. Malignant otosclerosis refers to rapidly progressive disease rather than this end stage, making option A the tempting distractor.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.