A 55-year-old man presents with bilateral progressive hearing loss. Pure tone audiometry shows a 40 dB air-bone gap across all frequencies bilaterally. Speech discrimination is excellent. Tympanometry shows type As curves. Acoustic reflexes are absent. Which additional finding would most strongly support a diagnosis of otosclerosis over congenital stapes fixation?

• A Normal tympanic membrane on otoscopy
• B Bilateral involvement
• C Absent acoustic reflexes
• D Progressive worsening of hearing loss over 10 years ✓

Explanation

The key distinguishing feature is progression. Otosclerosis characteristically causes progressive hearing loss, often worsening with pregnancy or after viral illness (measles association). Congenital stapes fixation presents with non-conductive hearing loss that is stable from childhood. Both conditions can show bilateral involvement, absent reflexes, and normal tympanic membranes, so progression is the discriminating factor.

Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.