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A 35-year-old woman presented for evaluation of slowly progressive right-sided hearing loss. For the past 6 months, she noted when lying on her left side an inability to hear the television or her baby crying. She also noted right-sided aural fullness and occasional right-sided headache. She had no facial weakness, tinnitus, vertigo, otorrhea, or otalgia; and no history of prior ear surgery, ear infections, noise exposure, or ear or head trauma. She currently takes no medications. Otoscopic examination results were normal. A 512-Hz tuning fork examination showed a left-sided lateralization when the vibrating tuning fork was placed on the center of her forehead (Weber test) and bilateral air greater than bone conduction with the vibrating tuning fork placed in front of her ear canal vs her mastoid tip (Rinne test). Facial motor and sensory function were intact and symmetric. The rest of the head and neck examination was unremarkable. An audiogram was ordered (Figure).
Paul BC, Roland JT. An Abnormal Audiogram. JAMA. 2015;313(1):85-86. doi:10.1001/jama.2014.12418