Question:medium
A Female with mild CHL and tinnitus. The PTA is shown. What is the interpretation.
A Female with mild CHL and tinnitus. The PTA is shown. What is the interpretation.
Show Hint
Female + conductive loss + tinnitus + a bone-conduction dip (Carhart's notch) at 2 kHz.
Updated On: Jun 22, 2026
- Otosclerosis
- Meniere's disease
- NIHL
- None
Show Solution
The Correct Option is A
Solution and Explanation
Build the diagnosis from the triad in the stem plus the audiogram signature.
Clinical pattern: a female patient, mild conductive hearing loss, and tinnitus. This combination, especially in a young/middle-aged woman, strongly suggests otosclerosis - a disorder of abnormal bone remodelling that fixes the stapes footplate in the oval window, with a clear female predominance.
Audiogram reasoning: the pure-tone audiogram shows the bone-conduction line sitting above (better than) the air-conduction line - an air-bone gap that defines a conductive loss. Crucially, the bone-conduction curve dips down by ~15-20 dB at about 2 kHz and recovers on either side; this artefactual dip is Carhart's notch, the signature of stapedial fixation in otosclerosis (it disappears after successful stapedectomy).
Putting it together: conductive loss + Carhart notch at 2000 Hz + female + tinnitus = otosclerosis.
Why not the others: Ménière's disease is a sensorineural, low-frequency fluctuating loss accompanied by episodic vertigo and ear fullness - not a conductive Carhart pattern. Noise-induced hearing loss (NIHL) is sensorineural with a notch at 4 kHz and a noise-exposure history, so it cannot explain a conductive audiogram. "None" is wrong because the findings clearly fit one entity.
Hence the audiogram and history are diagnostic of Otosclerosis (option A).
Clinical pattern: a female patient, mild conductive hearing loss, and tinnitus. This combination, especially in a young/middle-aged woman, strongly suggests otosclerosis - a disorder of abnormal bone remodelling that fixes the stapes footplate in the oval window, with a clear female predominance.
Audiogram reasoning: the pure-tone audiogram shows the bone-conduction line sitting above (better than) the air-conduction line - an air-bone gap that defines a conductive loss. Crucially, the bone-conduction curve dips down by ~15-20 dB at about 2 kHz and recovers on either side; this artefactual dip is Carhart's notch, the signature of stapedial fixation in otosclerosis (it disappears after successful stapedectomy).
Putting it together: conductive loss + Carhart notch at 2000 Hz + female + tinnitus = otosclerosis.
Why not the others: Ménière's disease is a sensorineural, low-frequency fluctuating loss accompanied by episodic vertigo and ear fullness - not a conductive Carhart pattern. Noise-induced hearing loss (NIHL) is sensorineural with a notch at 4 kHz and a noise-exposure history, so it cannot explain a conductive audiogram. "None" is wrong because the findings clearly fit one entity.
Hence the audiogram and history are diagnostic of Otosclerosis (option A).
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