Question

A 77 year old male patient comes to the clinic with complaints of hearing loss in his right ear. He states that it has worsened over the past month. His past medical history includes diabetes, GERD, and CAD. After assessment with Rinne test, the NP documents that BC is greater than AC. The following diagnoses are associated with this finding except:

a. Presbycusis Meniere's disease
b. Serous otitis media
c. Ceruminosis
d. Perforation of tympanic membrane

Answer 1

The finding of BC greater than AC in a Rinne test suggests a conductive hearing loss. The diagnoses associated with this finding are presbycusis, serous otitis media, ceruminosis, but not perforation of the tympanic membrane.

Step-by-step explanation:

The Rinne test is a diagnostic test that evaluates hearing loss by comparing bone conduction (BC) with air conduction (AC). In a normal hearing individual, AC should be greater than BC. In this case, the nurse practitioner (NP) documents that BC is greater than AC, indicating a conductive hearing loss. The diagnoses associated with this finding are:

1. Presbycusis: This is age-related hearing loss and usually affects both ears. It is not specific to the right ear and would not cause BC to be greater than AC.
2. Serous otitis media: This is inflammation and fluid build-up in the middle ear. It could cause BC to be greater than AC and is a possible diagnosis for this patient.
3. Ceruminosis: This is the excessive accumulation of earwax, which can cause conductive hearing loss. It could cause BC to be greater than AC and is a possible diagnosis for this patient.
4. Perforation of the tympanic membrane: This refers to a hole or tear in the eardrum. It would lead to BC being equal to or less than AC, not greater than AC. Therefore, this diagnosis is not associated with the finding in this case.

Based on these options, the correct answer is d. Perforation of the tympanic membrane.