Review Question - QID 109463

This patient's age and progressive bilateral sensorineural hearing loss is suggestive of presbycusis, which can result from degeneration of cochlear hair cells.

Hearing loss can be divided into conductive and sensorineural. Conductive hearing loss describes an impairment in transmitting sound from the external environment into the inner ear. Sensorineural hearing loss describes an impairment in transducing sound into neuronal signals. Therefore, conductive hearing loss results from pathology affecting the outer (e.g., trauma) and middle ear (e.g., cholesteatoma,) and sensorineural hearing results from pathology affecting the inner ear (e.g., presbycusis). Presbycusis appears to be associated with a disorder affecting cochlear structures, such as the stria vascularis, hair cells, and spiral ganglion.

Incorrect Answers:
Answer 1: Accumulation of desquamated keratin debris is suggestive of cholesteatoma, which results in conductive hearing loss.

Answer 2: Eustachian tube obstruction secondary to nasopharyngeal inflammatory edema can be seen in acute otitis media (AOM.) AOM results in a conductive hearing loss. Also, the absence of fever, otalgia, and upper respiratory symptoms makes AOM less likely.

Answer 3: Stapedial abnormal bone growth can be seen in otosclerosis, which results in a conductive hearing loss.

Answer 5: Endolymphatic hydrops can be seen in Meniere's disease, which results in sensorineural hearing loss. Typically, the sensorineural hearing loss is unilateral. Patient's with this disease classically present with a sense of ear fullness and/or ipsilateral tinnitus, vertigo, and hearing loss. These clinical findings are usually observed during attacks.

Bullet Summary:
Presbycusis results in bilateral sensorineural hearing loss that can result from cochclear hair cell degeneration.