Age:  60

Gender: Male

The patient reports longstanding problems with his hearing, which are now worse in the left ear.  He says he has been told in the past that he has hearing loss from noise exposure.  He says that now he cannot use the left ear on the phone, and he is not understanding well in noisy environments (restaurants, shopping centers).

The patient is a veteran, who was exposed to artillery noise. After leaving the army, he worked in construction.  He shoots guns at a target range.  Recently, he has used ear protection, but he reports that many years ago that was not the case.  He does some hunting annually as well, typically without ear protection.

He reports ringing in the ear, which he thinks is only in his left ear.  He says he’s not bothered by it; it has come on gradually and he has gotten use to it. It is a high-pitched sound.  He does not report any dizziness, but says he thinks he is more unsteady than he has been in the past.  When asked directly about aural fullness (feeling of fullness in the ear), he does say that, yes, his left ear does feel a bit “stuffy”.

• What part of the ear is damaged by noise exposure? What frequencies are most affected?  If searching on the internet, “noise-induced hearing loss” and “noise notch” are good search terms.

Otoscopy is similar to this picture.



• What parts of the tympanic membrane do A, B and C point to?