This 69 year old female patient, presents with a history of bilaterally progressive hearing loss since the age of 20+. Diagnosed as bilateral otosclerosis, six otosurgical procedures or revisions were performed on the right ear and three procedures on the left ear over a thirty year period. At time of evaluation, the patient was using full concha custom hearing aids, bilaterally, Class II (vented) on AD and Class III (unvented) on AS. Pure tone audiometry (27k) revealed a moderately severe, bilateral mixed loss of hearing. The significant sensorineural component is presumptive evidence of cochlear otosclerotic involvement. Tympanometry AS ( 8k) shows a Type A with PVT of 1.2 ml. Could not seal (CNS) AD with PVT > 6.0 ml.

Video Oto-Endoscopy (VOE; inline images below) of AD reveals a transparent, monomeric TM with a posterior, crescent-shaped tear (perforation). A light reflection can be seen from the most recent stainless steel stapedectomy prosthesis. AS presents an intact TM with a large. posterior superior bony exposure, surgically denuded of squamous epithelial cover.