AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 68-year-old male presents with a gradual onset of difficulty hearing in both ears over the past several years. He reports particular trouble understanding speech in noisy environments. Otoscopic examination reveals clear ear canals and normal-appearing tympanic membranes. Weber test lateralizes to the better ear, and Rinne test shows air conduction greater than bone conduction (AC > BC) in both ears. What is the most likely diagnosis?
- AOtosclerosis
- BOtitis media
- CPresbycusis
- DCerumen impaction
Show answer & explanationAnswer & explanation
Correct answer: C. Presbycusis
The patient's age (68), gradual onset of bilateral hearing loss, difficulty with speech in noise, and normal otoscopic exam, coupled with Weber lateralizing to the better ear and AC > BC (indicating sensorineural loss), are classic for presbycusis.
Why the other options are wrong
- A. Otosclerosis causes conductive hearing loss, typically in younger adults, with BC > AC on Rinne, and often a normal otoscopic exam.
- B. Otitis media (middle ear infection) would cause acute conductive hearing loss, pain, and abnormal tympanic membrane findings.
- D. Cerumen impaction would cause conductive hearing loss, which would show BC > AC on Rinne and would be visible on otoscopy.
Presbycusis
Age-related sensorineural hearing loss, typically bilateral and symmetric, gradually progressing.
- Gradual onset, bilateral hearing loss.
- Difficulty understanding speech, especially in noisy environments.
- Loss of high-frequency sounds.
- Normal otoscopic exam; Weber lateralizes to better ear, Rinne AC > BC (sensorineural).
Memory trick: Presbycusis is 'Progressive' and 'Pervasive' for 'Older' ears.