Clinician

A 60-year-old with one-sided hearing loss and poor word clarity

A 60-year-old describes gradual hearing loss in the right ear with disproportionately poor clarity of speech and occasional unsteadiness. Otoscopy is normal bilaterally.

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)

Normal type A tympanogram. Asymmetric high-frequency sensorineural loss with no air-bone gap. Acoustic reflexes elevated on the right with positive reflex decay.

What does this immittance picture most strongly suggest?