Ans. is 'a' i.e., Otosclerosis FINDINGS IN OTOSCLEROSISSymptoms of otosclerosiso Hearing loss Bilateral conductive deafness which is painless and progressive with insidious onset. In cochlear otosclerosis sensorineural hearing loss also occur along with conductive deafness,o Paracusis willissii An otosclerotic patient hears better in noisy than quiet surroundings.o Tinnitus More common in cochlear otosclerosis.o Speech Monotonous, well modulated soft speech,o Vertigo is uncommon.Signs in otosclerosiso Tympanic membrane is quite normal and mobile.o In 10% of cases flamingo - pink blush is seen through the tympanic membrane called as Schwartze sign,o Various tests show conductive hearing loss.Tuning fork tests in otosclerosiso As otosclerotic patients have conductive deafness, the tuning fork tests results will be as followsRinnes NegativeWebers Lateralized to the ear writh greater conductive loss.Absolute bone conduction (ABC) Normal (can be decreased in cochlear otosclerosis).4) Gelles testNo change in the hearing through bone conduction when air pressure of ear canal is increased by Siegle's speculum.Audiometry in otosclerosiso Audiometry is one of the important tools in evaluation of a patient of otosclerosis. Various audiometric tests are1) Pure tone audiometry# Shows loss of air conduction. more for lower frequencies with characteristic rising pattern. Bone conduction is normal. However in some cases, there is a dip in bone conduction curve which is maximum at 2000 Hz (2 KHz) and is called the Carhart's notch.Remembero Dip in bone conduction in otosclerosis (Carhart's notch)o Dip in noise induced hearing loss (Acoustic dip)- 2000 Hz- 4000 Hz2) Impedance audiometry# Impedance audiometry showsTympanometryo Patient with early disease may show type A tympanogram (because middle ear areation is not affected) Progressive stapes fixation results in classical As type tympanogram.Acoustic (stapedial reflex)o It is one of the earliest sign of otosclerosis and preceedes the development of airbone gap. In early stage, diphasic on-off pattern is seen in which there is a brief increase in compliance at the onset and at the termination of stimulus occurs. This is pathognomonic of otosclerosis. In later stage the reflex is absent.