In a patient with an asymmetrical audiometric configuration, what is the appropriate next step?

• A. Osseointegrated cochlear stimulator trial
• B. Complete hearing handicap scale
• C. Refer for complete otological evaluation
• D. Obtain complete family history

Answer: (C)

Asymmetrical hearing across ears raises concern for potential pathology along the auditory pathway, including retrocochlear issues such as a vestibular schwannoma, or other ear disorders. The appropriate next step is to refer for a complete otological evaluation so a clinician can perform a thorough ear exam and decide if imaging (often MRI) or further medical workup is needed. This medical assessment must come before considering rehabilitative devices or other subjective measures.

Opting for a cochlear implant trial is premature until medical issues are ruled out and candidacy is established. A complete hearing handicap scale measures impact on daily life but does not address possible underlying pathology. While a family history can inform risk, it does not replace a medical evaluation when asymmetry is present.