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 conversations in noisy environments and often asks people to repeat themselves. Otoscopic examination reveals clear ear canals and tympanic membranes. Weber test lateralizes to the better-hearing ear, and Rinne test shows air conduction greater than bone conduction bilaterally. What is the most likely diagnosis?
- AMeniere's disease
- BPresbycusis
- COtosclerosis
- DOtitis media
Show answer & explanationAnswer & explanation
Correct answer: B. Presbycusis
The patient's age (68 years), gradual bilateral hearing loss, difficulty understanding speech in noise, and normal otoscopic findings, along with sensorineural hearing loss indicated by Weber lateralizing to the better ear and AC > BC bilaterally, are all characteristic of presbycusis.
Why the other options are wrong
- A. Meniere's disease presents with episodic vertigo, fluctuating sensorineural hearing loss (often unilateral), tinnitus, and aural fullness, not just progressive bilateral hearing loss.
- C. Otosclerosis typically causes progressive conductive hearing loss, often starting in young adulthood, and would show BC > AC in the affected ear, which contradicts the Rinne findings.
- D. Otitis media would present with acute pain, effusions, and conductive hearing loss (BC > AC in affected ear), which is not seen here.
Presbycusis
Age-related sensorineural hearing loss, typically bilateral and progressive, affecting high frequencies first, leading to difficulty understanding speech, especially in noisy environments.
- Most common cause of hearing loss in older adults.
- Characterized by gradual, symmetrical, high-frequency sensorineural hearing loss.
- Diagnosis usually clinical, confirmed by audiometry showing high-frequency loss.
Memory trick: Presbycusis: 'Pressing' into old age, hearing 'Less' and 'Less'.