Clinical Case · Clinician

An adult with progressive hearing loss and a family history

Vignette

A 40-year-old reports slowly progressive bilateral hearing loss with a family history of similar problems. Pure-tone audiometry shows an air–bone gap with a dip in bone-conduction thresholds in the mid frequencies. Air-conducted ASSR is performed as part of the work-up.

Audiogram

-10020406080100120500 Hz1k Hz2k Hz4k HzHearing level (dB HL)
O Right earX Left ear
Estimated thresholds by ear. O = right, X = left.

ASSR finding

Air-conducted ASSR shows a moderate, fairly flat elevation of estimated thresholds; it reflects the total (air-conducted) hearing level only.

Diagnostic question

What does air-conducted ASSR contribute to this presentation, and what does it miss?