Final answer:
The suggested next steps for a patient with hearing loss and no indication of conductive hearing loss are to perform the Rinne and Weber tuning fork tests to evaluate for sensorineural hearing loss, followed by audiometry and potentially further specialist evaluation.
Step-by-step explanation:
Work-up for Sensorineural Hearing Loss
When a patient presents with hearing loss and no physical signs of conductive hearing loss, the next steps in the work-up typically involve performing specialized hearing tests such as the Rinne test and the Weber test. The Rinne test compares bone conduction (through the mastoid process) to air conduction (next to the ear canal) of sound. If the sound is conducted better through the temporal bone than through air, indicating conductive hearing loss is unlikely. The Weber test assesses unilateral conductive hearing loss versus sensorineural hearing loss by placing a tuning fork on the top of the patient's skull. In sensorineural hearing loss, the damaged ear will perceive the sound as quieter.
If these tests suggest sensorineural hearing loss, further evaluation by an audiologist would be warranted. This might include audiometry, which provides a more detailed assessment of hearing ability across different frequencies and intensities. Depending on the results, additional studies such as imaging or referral to an otolaryngologist for further evaluation might be necessary.