MEDizzy - In the patient described in Question 46 , which of the

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Cardinal Manifestations and Presentation of Diseases 2

In the patient described in Question 46 , which of the following should be the next suggested diagnostic test?

ExplanationOnce hearing loss is established, the next diagnostic test is pure tone audiometry that plots hearing threshold versus frequency. Pure tone audiometry establishes the severity, type, and laterality of hearing loss. In this gentleman, high-frequency hearing loss would be expected based on his complaints of inability to hear the alarm tone of his digital watch. Tympanometry measures the impedance of the middle ear to sound and is useful in diagnosis of middle ear efusions. Radiologic studies are indicated for suspected anatomic abnormalities. Axial and coronal CT of the temporal bone is ideal for determining the caliber of the external auditory canal, integrity of the ossicular chain, and presence of middle ear or mastoid disease; it can also detect inner ear malformations. CT is also ideal for the detection of bone erosion with chronic otitis media and cholesteatoma. MRI is superior to CT for imaging of retrocochlear pathology such as vestibular schwannoma, meningioma, other lesions of the cerebellopontine angle, demyelinating lesions of the brainstem, and brain tumors. Both CT and MRI are equally capable of identifying inner ear malformations and assessing cochlear patency for preoperative evaluation of patients for cochlear implantation. Schirmer test is a test for the evaluation of dry eyes to quantify adequate tear production.