Tina’s 76-year-old great aunt comes into the clinic for a visit and you find that she frequently asks you to repeat what you say. during the rinne test, you find that air conduction is greater than bone conduction in her left ear. what is your differential diagnosis? what additional assessments would you perform?

Based in the Rinne test that air conduction is greater than bone conduction, my differential diagnosis would include a punctured eardrum, a buildup of earwax, an ear infection, a fluid in the middle ear or a damage to the small bones within the middle ear. 

Moreover, I would perform Weber test on Tina’s aunt for additional assessment if there were any sensorineural hearing loss that lead to the damage of the auditory nerve, hair cells in the inner ear, or the cochlea, which can occur from sustained loud noise exposure or common aging process.

what are the choices?