A 36-year-old woman has progressive bilateral sensorineural hearing loss over six years. Her mother underwent stapedectomy for otosclerosis. Otoscopy shows a faint flamingo-pink tint over the promontory. Tympanometry is normal and there is no air-bone gap. The most likely diagnosis is:

• A Autoimmune inner ear disease
• B Cochlear otosclerosis ✓
• C Otosyphilis
• D Meniere's disease

Explanation

When the otosclerotic focus extends into the cochlear endosteum it damages the organ of Corti and produces sensorineural loss without any stapes fixation, hence a normal tympanogram and no air-bone gap. The pink promontory blush reflects the same active hypervascular focus seen in fenestral disease, and the strong family history supports otosclerosis. Autoimmune inner ear disease progresses far more rapidly over weeks to months, and Meniere's disease adds episodic vertigo with fluctuating low-frequency loss.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.