# A nurse is assessing a 60-year-old client who reports gradual hearing loss over the past 2 years. Which assessment finding would be most characteristic of sensorineural hearing loss? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541651 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a 60-year-old client who reports gradual hearing loss over the past 2 years. Which assessment finding would be most characteristic of sensorineural hearing loss? ## 보기 1. Hearing improves in noisy environments 2. Bone conduction is greater than air conduction on Weber test 3. Tympanic membrane appears red and bulging 4. High-frequency sounds are more affected than low-frequency sounds **✔ 정답** **정답: 4** ## 해설 Sensorineural hearing loss characteristically affects high-frequency sounds more than low-frequency sounds due to cochlear hair cell damage. Option 4 correctly identifies this pattern, while other options are typical of conductive hearing loss or acute conditions. ## 심화 해설 The correct answer is 4. In sensorineural hearing loss (SNHL), particularly the most common form known as presbycusis, damage to the hair cells in the cochlea typically begins at the basal turn, which is responsible for processing high-frequency sounds. This results in a characteristic audiometric pattern where high-frequency hearing is disproportionately affected compared to low-frequency hearing. Analysis of the Correct Option Presbycusis, or age-related hearing loss, is defined as a bilateral sensorineural hearing impairment associated with the aging of the inner ear structures and auditory pathways [1]. The pathophysiological process involves the degeneration of sensory hair cells and neurons, initially affecting the perception of high-pitched sounds. A client with this condition will report that they can hear low-frequency vowel sounds but struggle to distinguish high-frequency consonant sounds like "s," "f," and "th," which significantly impacts speech clarity and communication [1]. Analysis of Incorrect Options 1. Hearing improves in noisy environments — This finding is paradoxical and characteristic of conductive hearing loss, not sensorineural. In conductive loss, the reduced ambient noise makes the speaker’s voice seem louder. In sensorineural loss, background noise typically worsens the ability to discriminate speech, a phenomenon known as the cocktail party effect. 2. Bone conduction is greater than air conduction on Weber test — The description refers to the Rinne test, not the Weber test. A finding where bone conduction (BC) is greater than air conduction (AC) indicates a conductive hearing loss in the tested ear. In sensorineural hearing loss, both AC and BC are diminished, but AC remains greater than BC. The Weber test, which assesses lateralization, would show sound lateralizing to the better-hearing ear in SNHL. 3. Tympanic membrane appears red and bulging — This otoscopic finding is indicative of acute otitis media, a middle ear infection causing conductive hearing loss. Presbycusis is a sensorineural disorder; the external auditory canal and tympanic membrane typically appear normal upon physical examination. The insidious, progressive nature of this condition over two years, combined with the specific pattern of high-frequency loss, is the hallmark of age-related sensorineural hearing loss. This condition is not merely a sensory deficit; it is a disabling condition that affects communication and quality of life and has been associated with poorer cognitive performance in older adults [1].References (research sources) - [1]The cognitive cost of age-related hearing loss.Research articleCrnojević M, Komazec Z, Lemajić-Komazec S, Denda N, Bugarski Ignjatović V. (2026) · DOI: 10.1186/s12877-026-07476-w ## 임상 시나리오 Distinguishing Sensorineural vs. Conductive Hearing LossKey Assessment Findings and Tuning Fork Tests In sensorineural hearing loss (SNHL), such as presbycusis, damage to cochlear hair cells causes a disproportionate loss of high-frequency sounds. Clients often report difficulty hearing consonants like "s" and "f" while vowel sounds remain audible. The Weber test lateralizes to the better-hearing ear in SNHL. The Rinne test will show air conduction > bone conduction (AC > BC), but both are diminished compared to normal. CautionDo not confuse the paradoxical effect of conductive loss (hearing improving in noise) with SNHL. In SNHL, background noise typically worsens speech discrimination, a phenomenon known as the cocktail party effect. ## 핵심 개념 - **Presbycusis** — Age-related, bilateral sensorineural hearing loss primarily affecting high-frequency sounds due to cochlear hair cell degeneration. - **Sensorineural Hearing Loss (SNHL)** — Hearing impairment resulting from damage to the inner ear (cochlea) or the vestibulocochlear nerve (CN VIII). - **Weber Test** — A tuning fork test placed on the midline of the skull; sound lateralizes to the better ear in SNHL and to the poorer ear in conductive loss. - **Rinne Test** — A tuning fork test comparing air conduction (AC) to bone conduction (BC); in SNHL, AC > BC, but both are reduced. - **Cocktail Party Effect** — The difficulty individuals with SNHL experience in understanding speech in the presence of background noise. ## 같은 주제 문제 - [A nurse is assessing a 65-year-old client who reports gradual hearing loss over the past 2…](https://mymerci.kr/pages/nclex_q.php?qn_id=541649) - [A nurse is assessing a 65-year-old client who reports gradual hearing loss over the past s…](https://mymerci.kr/pages/nclex_q.php?qn_id=541650) - [A 65-year-old client with sensorineural hearing loss is being discharged from the hospital…](https://mymerci.kr/pages/nclex_q.php?qn_id=541652) - [A nurse is caring for a client with sensorineural hearing loss. 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