Which of the following does NOT typically contribute to hearing loss in an elderly patient?

• A. Deterioration of hair cells
• B. Excess deposition of bone cells which results in the fusion of the oval window and stapes
• C. Increase impactance of ear wax
• D. Sound conduction increases due to sclerosis

Answer: (D)

In aging, hearing loss comes from multiple mechanisms: loss of hair cells leading to sensorineural deficits (presbycusis), conductive factors like cerumen buildup, and conditions that impair bone conduction such as otosclerosis. Deterioration of hair cells is a classic sensorineural contributor, and excessive ear wax can block sound from reaching the eardrum, causing a conductive loss. Excess bone deposition that fuses the oval window and stapes (otosclerosis) also reduces sound transmission, another conductive mechanism. The statement describing sound conduction increasing due to sclerosis does not fit these typical aging changes; sclerosis tends to stiffen the auditory bones and decrease conduction, not increase it. Therefore, that option does not describe a typical contributor to age-related hearing loss.