A 76-YEAR-OLD woman with a history of otosclerosis presented with progressive hearing loss in her left ear. She had undergone a stapedectomy 40 years previously and 3 revision stapedectomies over the years. After each procedure, her hearing would initially improve, but would then decline over months to years. The last revision had been performed 11 years earlier, and since that time her hearing has been diminishing in her left ear. Three years ago she was evaluated and fitted for a hearing aid, which initially brought her some relief. In the last 2 years, however, her hearing loss has made it increasingly difficult to perform the activities of daily living. There were no complaints of otalgia, otorrhea, vertigo, tinnitus, or facial palsy. She denied any history of head trauma or exposure to ototoxic drugs. Physical examination revealed a normal tympanic membrane in the right ear and a well-healed poststapedectomy drum in the left ear (the posterosuperior scutum was absent). There was lateralization to the left on Weber testing, and negative results on a Rinne test (256 and 512 Hz) on the left. Audiological testing was completed using insert phones. Results revealed a severe mixed hearing loss in her left ear (80 dB), with a maximal conductive component. There was normal hearing in her right ear. Word recognition scores were 100% on the right and 92% at 90-dB hearing level on the left. Tympanometry indicated normal middle ear pressure bilaterally. Computed tomographic scans of the temporal bone are shown in Figure 1 and Figure 2.
Shah SI, Niparko JK. Imaging Quiz Case 1. Arch Otolaryngol Head Neck Surg. 1999;125(1):106. doi:10.1001/archotol.125.1.106