A 45-year-old man has bilateral 'profound' hearing loss with air conduction thresholds beyond audiometric limits and apparently dead ears on testing. He has a strong family history of surgically confirmed otosclerosis. Exploration of the middle ear shows a fixed stapes. What best explains this picture?
- A Far-advanced otosclerosis, where bone conduction loss is exaggerated by the mechanical artefact and stapes surgery can restore usable hearing ✓
- B True cochlear aplasia with no residual function
- C Bilateral vestibular schwannomas compressing the cochlear nerves
- D Congenital fixation of the malleus head
Correct answer: A. Far-advanced otosclerosis, where bone conduction loss is exaggerated by the mechanical artefact and stapes surgery can restore usable hearing
Explanation
In far-advanced otosclerosis the patient appears to have a dead ear, but much of the apparent sensorineural loss is the Carhart artefact from stapes fixation. When any recordable bone conduction exists, stapedectomy can produce dramatic improvement, sometimes restoring hearing to socially useful levels. This distinguishes it from true profound cochlear loss, where surgery offers nothing.
Reference: Glasscock-Shambaugh Surgery of the Ear, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.