Clinical Case · trainee

Asymmetric hearing loss and tinnitus

History

A 47-year-old describes one year of right-sided tinnitus and a sense that the phone is harder to use on the right. Audiometry shows an asymmetric high-frequency sensorineural loss, poorer on the right. Tympanometry is type A bilaterally.

Findings

Pure-tone audiogram

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

Acoustic reflex grid

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

Reflex decay (affected side)

0s2s4s6s8s10s0%50%100%50% criterion
Positive (abnormal) decay — amplitude reaches 50% at about 7.1 s.

Reflex decay at 1000 Hz shows the response falling below 50% within 6 seconds. The findings most suggest: