A patient reports tinnitus in both ears but no major hearing loss on self-report. Which finding is most likely on pure-tone audiometry?

• A. Hearing within normal limits
• B. A moderate conductive hearing loss below 500 Hz and above 8000 Hz
• C. A hearing loss at frequencies above 8000 Hz
• D. A high-frequency sensorineural hearing loss

Answer: (D)

Tinnitus paired with little to no perceived difficulty in everyday listening often points to cochlear damage that mainly affects the high frequencies. In pure-tone testing, this shows up as normal thresholds in the low to mid frequencies, with elevated thresholds in the high-frequency range. That pattern—normal or near-normal low frequencies with loss at higher frequencies—is characteristic of high-frequency sensorineural hearing loss and fits a scenario where tinnitus is present but the person still feels they hear well in everyday situations.

This differs from a conductive pattern, which would show a gap between air and bone conduction and a more uniform loss that includes low frequencies. A loss restricted only to the very top end (above 8000 Hz) is possible but less typical as a standalone explanation, and standard PTA often captures the broader high-frequency range rather than isolating only the extreme high end. The link between tinnitus and high-frequency cochlear damage makes high-frequency sensorineural loss the best fit.