• Complaints of progressive hearing loss in both ears

• Occasional tinnitus (ringing in the ears)

• No significant exposure to loud noises at work or home

• Audiogram showing bilateral moderate conductive hearing loss

• Tympanometry indicating normal middle ear pressure, absent stapedii reflexes bilaterally

• Otoscopy - normal appearance of external auditory canal, tympanic membrane

Abigail exhibits signs and symptoms consistent with bilateral conductive hearing loss, which might be due to pathologies outside the auditory nerve. Additional in-depth audiological assessments should be conducted to identify the specific cause.

• Recommend additional audiological tests: Auditory Brainstem Response (ABR), Otoacoustic emissions (OAEs), and High-resolution CT scan

• Consider consultation with an otologist for further evaluation

• Schedule follow-up in 1 month to review test results and formulate a detailed treatment plan