Rosh Pediatrics Practice Exam

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A 15-year-old boy has progressive hearing loss. What is the most likely cause of his hearing loss?

Cerumen obstruction
Noise exposure
Otitis media
Tympanic membrane perforation

The correct answer is: Noise exposure

In a 15-year-old boy with progressive hearing loss, noise exposure is the most likely cause. Adolescents are often exposed to loud sounds from various sources, such as music through headphones, concerts, or other recreational activities. Noise-induced hearing loss occurs gradually, and the effects can accumulate over time, leading to permanent damage to the hair cells in the cochlea. This type of hearing loss typically presents as a sensorineural hearing deficit, which aligns with the progressive nature noted in the question. Cerumen obstruction and otitis media usually present with more acute symptoms and do not typically cause progressive hearing loss in this age group. Additionally, while perforation of the tympanic membrane can lead to conductive hearing loss, it is unlikely to be progressive unless there are recurrent infections. Therefore, considering the age of the patient, the history of exposure to loud noises is a significant risk factor that makes noise exposure the most plausible explanation for his progressive hearing loss.