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Audiometry Report & Medical Record - Shareefa K (60F)

Here is a complete explanation of both documents from Koyili Hospital's Department of Audiology.

Document 1: Pure Tone Audiometry (PTA) Report

What the Test Measures

Pure Tone Audiometry measures hearing thresholds at different sound frequencies (250 Hz to 8000 Hz) for both Air Conduction (AC) - how sound travels through the outer/middle ear to the cochlea - and Bone Conduction (BC) - how sound travels directly to the cochlea via skull vibration. The gap between AC and BC thresholds tells the clinician where the hearing problem is located.

Right Ear Findings

TestValue
Pure Tone Average (PTA)50 dB HL (Moderate hearing loss)
Speech Recognition Threshold (SRT)45 dB HL
Speech Discrimination Score70%
Audiogram pattern: Air conduction at 60-70 dB across frequencies, with bone conduction (dotted line) around 10-20 dB - meaning a large air-bone gap.
Diagnosis: Moderate Conductive Hearing Loss with a mixed component at 2 kHz and 4 kHz
  • The bulk of the loss is conductive - the problem is in the outer or middle ear (in this case, likely the ear canal due to otomycosis and debris)
  • At 2 kHz and 4 kHz, there is also a sensorineural component (the inner ear/cochlea is slightly affected too), making it "mixed" at those frequencies
  • A PTA of 50 dB = moderate hearing loss (normal is 0-25 dB)

Left Ear Findings

TestValue
Pure Tone Average (PTA)75 dB HL (Severe hearing loss)
Speech Recognition Threshold (SRT)70 dB HL
Speech Discrimination Score60%
Audiogram pattern: Air conduction at 85-90 dB (squares on graph), bone conduction at 10-30 dB - a massive air-bone gap with additional sensorineural involvement.
Diagnosis: Severe Mixed Hearing Loss
  • Both conductive AND sensorineural components are present
  • The "2 MAS db" notation likely refers to a masking level used during testing
  • A PTA of 75 dB = severe hearing loss - speech must be very loud to be heard

What "Mixed Hearing Loss" Means

As explained in Shambaugh Surgery of the Ear:
"A hearing loss comprising both sensorineural and conductive components is termed a mixed hearing loss. A mixed hearing loss indicates that a disordered outer or middle ear attenuates the sound delivered to an impaired cochlea."
In simple terms:
  • Conductive component = ear canal/middle ear blockage (treatable - often reversible with medicine/surgery)
  • Sensorineural component = inner ear (cochlear) damage (often permanent)
  • Mixed = both problems exist together

Document 2: Medical Record (Diagnosis & Prescriptions)

Patient: Shareefa K, 60-year-old female Doctor: Dr. Arun Divakar, MBBS, MS

Condition 1: (R) Otomycosis - Right Ear Fungal Infection

What it is: A fungal infection of the external ear canal (EAC). According to Shambaugh Surgery of the Ear: "Otomycosis refers to an acute fungal infection of the EAC. Candida and Aspergillus are the most common fungal species implicated. Intense pruritus (itching) is the most common complaint."
Symptoms typically include:
  • Severe itching in the ear
  • A feeling of fullness/blockage
  • Discharge - often cheesy, white, gray, or black with fungal filaments
  • Mild-moderate hearing loss (from debris blocking the canal - this explains the large conductive component in the RIGHT ear)
  • Less pain compared to bacterial infection
Why it causes conductive hearing loss: The fungal debris accumulates in the ear canal, physically blocking sound transmission - this is a completely treatable, reversible cause of hearing loss.

Condition 2: Granular Myringitis - Inflammation of the Eardrum

What it is: According to Shambaugh Surgery of the Ear: "Granular myringitis is characterized by chronic inflammation of the tympanic membrane leading to the replacement of its epithelial surface and, occasionally, adjacent deep meatal skin with proliferating granulation tissue."
Symptoms include:
  • Unilateral scant, constant, or recurrent, often malodorous (foul-smelling) discharge
  • Itching and aural fullness
  • Usually painless
  • Mild conductive hearing loss
Why it happens: An acute infection or mechanical trauma disrupts the normal epithelial (skin) lining of the eardrum. Organisms like Pseudomonas and Staphylococcus then prevent healing, causing persistent granulation (scar-like) tissue to form over the eardrum surface.

Prescribed Medications

The handwritten prescription reads:
  1. Loxof 250 (Levofloxacin 250 mg) - 1-0-1 for 10 days - a fluoroquinolone antibiotic to fight bacterial infection
  2. Zureold (likely Zofer/Ondansetron or an antifungal) - 1-0-1 for 10 days
  3. Famotidine 40 mg - 0-0-1 for 5 days - antacid (to protect the stomach from the antibiotics)
  4. Dexobar C (2-2-0) - likely Dexamethasone + Vitamin C combination - anti-inflammatory
  5. Ofloxacin (2-2-0) - another antibiotic (likely ear drops in this context)
  6. Histal-9 (antihistamine) - for itching/allergy
  7. Pure Tone Audiogram - referred for (this is the audiometry test in Document 1)

Overall Clinical Picture

Shareefa has two simultaneous ear problems:
EarProblemSeverityType
RightOtomycosis + Granular Myringitis (the source documents)ModerateConductive + some mixed at 2-4 kHz
LeftSevere Mixed Hearing LossSevereBoth conductive AND sensorineural damage
Key points for the patient:
  • The right ear hearing loss is largely reversible - clearing the fungal infection with antifungals and treating the myringitis can restore significant hearing
  • The left ear has a sensorineural component (inner ear damage) which is permanent - the conductive portion may improve with treatment, but a hearing aid may eventually be needed for the left ear
  • The low speech discrimination scores (70% right, 60% left) mean understanding speech in noise will remain difficult even after treatment
Follow-up with the ENT specialist is essential, and a repeat audiogram after completing the medication course is advisable to assess improvement.
(Sources: Shambaugh Surgery of the Ear; Cummings Otolaryngology Head and Neck Surgery)

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Here is everything explained in very simple, plain language:

🧑‍⚕️ Who is the patient?

Name: Shareefa K Age: 60 years old, Female Doctor: Dr. Arun Divakar at Koyili Hospital, Kannur

👂 What is the problem?

She has hearing problems in BOTH ears. The doctor did a hearing test (called Pure Tone Audiometry) to find out exactly how bad the hearing loss is and why.

📊 What the Hearing Test Showed

Think of hearing like this - normal hearing = 0 to 25 dB. The higher the number, the worse the hearing.

Right Ear:

  • Hearing level: 50 dB → This is moderate hearing loss
  • Imagine someone talking to you normally - you can only hear them if they speak quite loudly
  • The problem is mainly in the ear canal and middle ear (like a blocked pipe) - this is called Conductive Hearing Loss
  • This type is often treatable and reversible

Left Ear:

  • Hearing level: 75 dB → This is severe hearing loss
  • You would need someone to almost shout for you to hear them
  • The problem is in BOTH the ear canal AND the inner ear (cochlea) - this is called Mixed Hearing Loss
  • The inner ear part is permanent, but the blocked canal part can improve with treatment

🦠 What is Causing the Problem?

1. Otomycosis (Right Ear) - Fungal Infection in the Ear Canal

  • Simply put: A fungus (like the one that causes ringworm or athlete's foot) has grown inside the ear canal
  • The fungus grows as white, black, or gray fluffy material that blocks the ear canal
  • Symptoms: Severe itching inside the ear, feeling of fullness, foul-smelling discharge, reduced hearing
  • Good news: This is fully treatable with antifungal medicines and ear cleaning. Once the fungus is cleared, hearing in the right ear should improve significantly.

2. Granular Myringitis - Inflamed Eardrum

  • Simply put: The thin skin on the eardrum has been damaged and instead of healing normally, it is forming rough, lumpy scar tissue (called granulation tissue)
  • This is like a wound that keeps getting infected and cannot heal properly
  • Symptoms: Constant mild discharge from the ear, itching, ear feels blocked, usually no pain
  • Treatment: Antibiotic + steroid ear drops, ear cleaning, sometimes silver nitrate cauterization (burning the scar tissue to help it heal)
  • This condition can recur and needs follow-up

💊 Medicines Prescribed (In Simple Terms)

MedicineWhat It Does
Levofloxacin (Loxof) 250 mg - twice daily for 10 daysAntibiotic tablet - kills the bacteria in the ear
Antifungal tablet (Zureold) - twice daily for 10 daysKills the fungus causing otomycosis
Famotidine - once at night for 5 daysProtects the stomach from the other medicines
Dexobar C - morning and afternoonSteroid + Vitamin C - reduces swelling and inflammation
Ofloxacin (ear drops likely) - morning and afternoonMore antibiotic action for the ear
Histal-9 (antihistamine)Reduces itching and allergic reaction in the ear

🔑 The Most Important Points to Remember

  1. Right ear: Hearing loss is mainly due to the fungal infection blocking the canal. After treatment, hearing should come back significantly.
  2. Left ear: Hearing loss is more serious - part of it is permanent (inner ear damage). The doctor may suggest a hearing aid for the left ear in the future.
  3. Complete the full course of medicines - do not stop early even if you feel better.
  4. Do NOT put water in the ears while on treatment - keep ears dry.
  5. Come back for a follow-up hearing test after treatment is complete - to see how much hearing has improved.
  6. Do NOT insert cotton buds or fingers into the ear - this worsens both conditions.
Is there any specific part you want me to explain further, or would you like this in Malayalam (since the patient is from Kannur, Kerala)?
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