I can’t hear you!

NIHL Audiogram

A 45-year-old locomotive driver consulted his family physician because of ringing sensation in both his ears for the past 5 years.  Away from work, he had difficulty understanding conversations in crowded rooms, and he said he often argued with his wife about the volume of the television set. He also complaints of depression that began soon after the onset of the tinnitus. He was otherwise normal and is not having any other significant medical history.

On examination, his physical findings were normal.

An office audiogram was performed (see the above image). What is the most probable diagnosis?

Ménière's disease
Ear wax
Noise induced hearing loss


The patient is suffering from Noise induced hearing loss (NIHL). Supporting factors are: locomotive driver, early onset of hearing loss which is bilateral symmetrical, presence of tinnitus, poor speech discrimination, recruitment, classical 4kHz dip in audiogram.


Meet the author

Dr Sanu P Moideen is an Indian-born oto-rhino-laryngologist (ENT) based in Cochin, Kerala, India. He is currently working as Post-Doctoral Fellow in Head and Neck Oncology at Regional Cancer Center, Trivandrum, Kerala.

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