Clinical Case · foundation

A child who failed a school hearing screen

History

A 6-year-old failed a school hearing screen and has had several recent colds. The parents report the television is turned up loud. Otoscopy shows a dull, retracted left eardrum with a visible fluid level. Tympanometry on the left is flat (type B) with a normal ear-canal volume.

Findings

Pure-tone audiogram

0204060801002505001k2k4k8kFrequency (Hz)Hearing level (dB HL)
○ Right ear✕ Left ear

Acoustic reflex grid

Stim. Right
Stim. Left
Probe Right
Present
Present
Probe Left
Absent
Absent

Reflexes are absent with the probe in the left ear. What is the most likely explanation?