AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 65-year-old male presents to the clinic with progressive difficulty hearing in both ears over the last 5 years. He reports particular trouble understanding conversations in noisy environments and often asks people to repeat themselves. Otoscopic examination is unremarkable. Which of the following is the most likely diagnosis?
- AOtosclerosis
- BMénière's disease
- CPresbycusis
- DCerumen impaction
Show answer & explanationAnswer & explanation
Correct answer: C. Presbycusis
Presbycusis is age-related sensorineural hearing loss, typically bilateral and progressive, characterized by difficulty hearing high-frequency sounds and understanding speech in noisy environments, which perfectly matches the patient's presentation and age.
Why the other options are wrong
- A. Otosclerosis is conductive hearing loss and usually presents earlier in life, often with tinnitus, and is not typically bilateral and symmetrical in this manner of progression.
- B. Ménière's disease involves episodic vertigo, tinnitus, fluctuating hearing loss, and aural fullness, which are not described in the patient's symptoms.
- D. Cerumen impaction would cause a sudden or more acute onset of hearing loss and would be visible on otoscopic examination, which was unremarkable in this case.
Presbycusis
Presbycusis is a gradual, progressive, and bilateral sensorineural hearing loss associated with aging, primarily affecting high-frequency sounds and speech discrimination.
- Most common cause of hearing loss in older adults.
- Bilateral and symmetrical.
- Difficulty in noisy environments is a hallmark symptom.
Memory trick: Age-Related Hearing Loss: Getting older, sounds get lower.