Clinical Cases / Clinician

One-sided hearing loss and tinnitus Clinician

Vignette

A 55-year-old reports gradually worsening hearing in one ear over a year, with constant tinnitus on the same side. They find that ear surprisingly poor on the telephone. Otoscopy is normal.

-100204060801001202505001k2k4k8kFrequency (Hz)Hearing level (dB HL)
  • O Right ear, air
  • X Left ear, air
  • < Right ear, bone
  • > Left ear, bone

Signature: Asymmetric high-frequency sensorineural loss in the affected ear; normal hearing on the other side.

Figure 1. The audiogram. Marked tone decay and a negative SISI in the affected ear. Speech discrimination is poorer than the pure-tone loss predicts.

Question

What is the most appropriate next step?

References

  1. [1] Carhart R (1957). Clinical determination of abnormal auditory adaptation.
  2. [3] Jerger J, Shedd JL, Harford E (1959). On the detection of extremely small changes in sound intensity.