A 77-Year-Old Man With Difficulty Hearing

Introduction. A 77-year-old man presents with difficulty hearing for the past 6 months.

Patient history. The patient’s symptoms are subacute, specifically involving hearing difficulties during the past 6 months. His symptomatology involves significant difficulty with conversation in the presence of background noise. He speaks loudly, and he frequently asks his wife to speak louder as well. He noted that he must turn the TV volume from a former numerical volume of 18-20 to more than 30 now. He has tinnitus episodes several times a month compared with none in the past 2 years. There is no earache, headache, nor any drainage from either ear. There has been no dizziness or vertigo. When he compares ears using finger snaps, the right ear is somewhat worse than the left.

He is otherwise quite active and healthy for his age, with his only major medical diagnosis involving a well-controlled essential hypertension treated with losartan and a thiazide diuretic. There have been no new medications in the last 3 years. He had a diagnosis of a well-differentiated squamous cell carcinoma of the skin on the tragus area of the right ear 7 years earlier with resection for curative intent and no evidence of recurrence since. His patient history is negative for undue exposure to loud noises in his occupation or time in the Army.

Physical examination. His focused physical examination reveals cranial nerve function II-VII and IX-XII intact. The skin of both ears is normal without lesions or masses including the right earlobe, tragus, and antitragus areas. There is no nystagmus. There is diminished hearing in both ears, the right somewhat worse than left.