American Board of Internal Medicine (ABIM) Certification Practice Exam

Which condition is characterized by gradual onset conductive hearing loss and difficulty hearing low-pitched sounds?

1. Otosclerosis

2. Acoustic neuroma

3. Presbycusis

4. Cholesteatoma

The correct answer is: Otosclerosis

The condition characterized by gradual onset conductive hearing loss and difficulty hearing low-pitched sounds is otosclerosis. Otosclerosis is a bone remodeling disorder affecting the middle ear, where abnormal bone growth around the stapes bone leads to its fixation and hampers its ability to transmit sound vibrations effectively. This results in conductive hearing loss, which often develops gradually over time. Individuals with otosclerosis specifically experience difficulty hearing low-pitched sounds, as the condition primarily affects the transmission of sound rather than the sensing of it. This is distinct from other conditions like presbycusis, which affects high-frequency sounds, or acoustic neuroma, which would typically present with other neurological symptoms. Cholesteatoma, meanwhile, is associated with chronic ear infections and can lead to different types of hearing loss as well as possible discharge, making it less consistent with the symptom profile of otosclerosis.