Snapshot A 30-year-old man presents with constant right ear pain and hearing loss for the last 3 months. He also states that at times he experiences ringing of the right ear. He was previously diagnosed with an ear infection that was treated with antibiotics. On physical examination, there is amorphous and white debris in the right middle ear. A tuning fork was placed on the mastoid process and sequently by the external auditory canal. Bone conduction was louder than air conduction on the right ear. When the tuning fork is placed in the middle of the patient's ear, the tone was louder in the right ear. It is explained to the patient that a non-contrast computer tomography (CT) scan of the temporal bone will be scheduled. (Conductive hearing loss secondary to a cholesteatoma) Introduction Hearing loss basic principles unilateral hearing loss can result from lesions affecting the login to view 5 more bullets bilateral hearing loss suggests login to view 2 more bullets hearing loss is generally divided into conductive hearing loss login to view 3 more bullets sensorineural hearing loss login to view 3 more bullets Conductive hearing loss etiologies include otitis externa squamous cell carcinoma osteoma cerumen otitis media cholesteatomoa otosclerosis tympanic membrane perforation Sensorineural hearing loss etiologies include hereditary hearing loss presbycusis ototoxic drugs Meniere disease barotrauma acoustic neuroma multiple sclerosis Physical exam maneuver whispered voice test the examiner stands behind the patient at arm's length and one of the patient's ears are occluded login to view 1 more bullet normal findings login to view 1 more bullet pathology login to view 1 more bullet Rinne test compares air conduction to bone conduction login to view 4 more bullets normal findings login to view 1 more bullet Weber test the vibrating tuning fork is placed in the middle of the patient's forehead login to view 1 more bullet normal findings login to view 1 more bullet pathology login to view 5 more bullets Diagnostic studies audiogram useful confirmatory diagnostic study in patients with hearing impairment that cannot be explained by obvious causes (e.g., cerumen imapaction) pathology In conductive hearing loss bone conduction is greater than air conduction this is because bone conduction bypasses issues involving the external and middle ear In sensorineural hearing loss air conduction is greater than bone conduction bilaterally (just like in normal conditions) there is decreased hearing in the affected ear