Medicine>>>>>Geriatrics
Question 9#

A 78-year-old man complains of slowly progressive hearing loss. He finds it particularly difficult to hear his grandchildren and to appreciate conversation in a crowded restaurant. On examination, ear canal and tympanic membranes are normal. Audiology testing finds bilateral upper-frequency hearing loss with difficulty in speech discrimination.

Which of the following is the most likely diagnosis? 

A. Presbycusis
B. Cerumen impaction
C. Ménière disease
D. Chronic otitis media
E. Acoustic neuroma

Correct Answer is A

Comment:

Presbycusis is the most common cause of sensorineural hearing loss in the elderly. Probably the result of cochlear damage over time, it is characterized by bilateral high-frequency hearing loss above 2000 Hz. Diminished speech discrimination is more apparent compared to other causes of hearing loss. Both Ménière’s disease and chronic otitis media are causes of hearing loss in the elderly; they usually present as unilateral hearing loss. Acoustic neuroma is uncommon and also causes unilateral neurosensory hearing loss. Otoscopy should always be used to rule out hearing loss associated with cerumen impaction in the elderly patient.