Clinician

A 45-year-old with progressive hearing loss

A 45-year-old describes slowly progressive hearing loss, worse in one ear, with no pain or discharge. Otoscopy is unremarkable. Audiometry shows a conductive loss with a notch in the bone-conduction line near 2 kHz.

Investigations

Audiogram

0204060801001202505001k2k4k8kFrequency (Hz)Hearing level (dB HL)[[[[[[ air conduction[ bone conduction

Tympanogram

-400-300-200-10001002000.00.51.01.52.02.53.0Ear-canal pressure (daPa)Admittance (mmho)

Shallow peak at normal pressure, absent acoustic reflexes, conductive loss with a Carhart notch.

Which diagnosis best fits this combination?