History : HPI: 75 YO M COMPLAINS OF BILATERAL HEARING LOSS FOR 1 YEAR AND IT IS PROGRESSIVELY WORSENING. HE HAD REMOVED CERUMEN FROM HIS EAR WITH MODERATE IMPROVEMENT. HE NOTES OCCASIONAL TINNITUS. HE REPORTS WORDS JUMBLED IN CROWDED PLACES AND WHEN HE IS WATCHING TV. HE DENIES ANY TRAUMA AND FOREIGN BODY INSERTION TO EAR. NO EAR PAIN, EAR DISCHARGE, NO VERTIGO, OR LOSS OF BALANCE. NO DIFFICULTY COMPREHENDING, OR LOCATING THE SOURCE OF SOUND. ROS: NEGATIVE. ALL: PENICILLIN CAUSES RASH MEDS: HCTZ, ASPIRIN FOR 25 YEARS PMH: HTN. UTI 1 YEAR AGO, TREATED WITH ANTIBIOTIC. PSH: NONE SH: NO SMOKING, NO ALCOHOL, NO ILLICIT DRUGS. RETIRED VETERAN. SEXUALLY ACTIVE WITH WIFE. FH: NO HX OF HEARING LOSS. Physical Examination : PT IS NO ACUTE DISTRESS. HEENT: AT/NC. PRRELA, EOMI. NO NYSTAGMUS, NO PAPILLEDEMA. NO CERUMEN. TMs WITH LIGHT RELEX, NO STIGMATA OF INFECTION. NO REDNESS TO EAR CANAL. NO TENDERNESS OF AURICLE. NO LAD AND OROPHARYNX IS NORMAL. NORMAL RINNE TEST BILATERALLY AND WEBER TEST WITHOUT LATERALIZITION. CHEST: CLEAR BREATH SOUNDS BILATERALLY HEART: RRR, S1/S2 WNL. NO MURMUR OR RUB. NEURO: CRANIAL NERVE : 2-12 INTACT EXCEPT FOR DECREASED HEARING. MOTOR: STRENGTH 5/5 THROUGHOUT. GAIT: NORMAL, AND -VE HEEL SHIN TEST. Diagnosis 1 : PRESBYCUSIS History Findings Physical Exam Findings 1) BILATERAL PROGRESSIVE HEARING LOSS 1) NORMAL RINNE TEST 2) ADVANCED AGE 2) NORMAL WEBER TEST Diagnosis 2 : COCHLEAR NERVE DAMAGE Diagnosis 3 : Diagnostic Study/Studies - Labs 1) AUDIOMETRY 2) TYMPANOGRAPHY History Findings Physical Exam Findings 1) PRIOR EXPOSURE TO LOUD NOISE 2) BILATERAL HEARING LOSS History Findings Physical Exam Findings
