QuestionSBA
QuestionChoice
Tympanosclerosis is a cause of bilateral conductive hearing loss, and usually shows signs of scarring of the tympanic membrane with whitish discolouration
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b
Tympanosclerosis
QuestionChoice
Chronic suppurative otitis media would typically present with chronic inflammation of the middle ear and mastoid cavity with recurrent otorrhoea through a tympanic membrane. It produces a bilateral conductive hearing loss, although otoscopy would show an oedematous auditory canal, discharge, and granulation tissue in the medial canal with possible perforation of the tympanic membrane
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c
Chronic suppurative otitis media
QuestionChoice
Presbycusis is the leading cause of bilateral sensorineural hearing loss and is characterised by age-related loss of hearing acuity, predominantly at high frequencies. The examination would be Rinne's positive bilaterally in this case with non-localisation in Weber's test
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d
Presbycusis
QuestionChoice
Multiple sclerosis can rarely present with hearing loss, although it would unlikely produce bilateral hearing loss. It would produce sensorineural hearing loss and so would the patient would be Rinne's positive in one or both ears
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e
Multiple sclerosis
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This patient has presented with history and examination findings consistent with bilateral conductive hearing loss and tinnitus. The most common cause of this in young patients is ear wax, although otosclerosis is an important cause, particularly when otoscopy is unremarkable. It is treated with hearing aids and consideration of stapedectomy
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a
Otosclerosis
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why is this in the ophthal section....
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Because you didn't see it coming!
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Axillary Dermis
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# Summary

Otosclerosis is a common cause of progressive deafness among young adults, typically manifesting as a conductive hearing loss due to abnormal bone growth around the stapes bone in the middle ear. It is an autosomal dominant condition often with significant family histories. Key signs and symptoms include progressive hearing loss, tinnitus and sometimes vertigo. Diagnosis is usually based on the patient's history, audiometric testing and sometimes CT scan. Initial management may involve hearing amplification through hearing aids or surgical intervention via a stapedectomy.

# Definition

Otosclerosis is a pathological condition of the ear where abnormal bone growth occurs around the stapes bone in the middle ear, impeding its function as a piston onto the cochlea. This can result in progressive conductive hearing loss.

# Epidemiology

Otosclerosis is the most common cause of progressive deafness in young adults. 

# Aetiology

Otosclerosis is an autosomal dominant condition, meaning that the majority of patients have significant family histories of the disease.

# Signs and symptoms

Patients with otosclerosis typically present with the following symptoms:

- Progressive hearing loss, often starting unilaterally and then affecting both ears
- Tinnitus, often associated with the hearing loss
- Sometimes vertigo, although this is less common

# Differential diagnosis

The major differentials for otosclerosis include:

- Presbycusis: The most common type of sensorineural hearing loss caused by natural aging of the auditory system. Key symptoms include gradual hearing loss in both ears, difficulty hearing in noisy environments, and trouble distinguishing high-pitched sounds.
- Meniere's disease: A disorder of the inner ear causing severe dizziness (vertigo), tinnitus, hearing loss, and a feeling of fullness or congestion in the ear. 
- Acoustic neuroma: A slow-growing tumour of the nerve that connects the ear to the brain. Main symptoms are hearing loss, tinnitus, and imbalance.

# Investigations

Diagnosis of otosclerosis typically involves:

- History taking, which often reveals a gradual onset of hearing loss
- Audiometric testing, which usually shows a conductive hearing loss
- CT scan may be used in some cases to confirm the diagnosis and evaluate the extent of the disease.

# Management

Initial treatment for otosclerosis may involve:

- Hearing amplification through hearing aids, which can be beneficial in managing the hearing loss associated with otosclerosis
- Surgical replacement of the stapes bone through a stapedectomy, which can restore hearing in many cases.

# References

[Click here for NICE CKS on hearing loss in adults](https://cks.nice.org.uk/topics/hearing-loss-in-adults/)
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A 38-year old pregnant woman presents with gradual-onset bilateral painless hearing loss with tinnitus. Otoscopy is unremarkable with a normal tympanic membrane. Weber's test shows no localisation and she is Rinne's negative bilaterally.

Which of the following is the most likely diagnosis?
a