A 35-year-old man complains of a sensation that his left ear is 'full of pressure' and that he hears his eyes move. Audiometry shows a 25 dB conductive-pattern loss in the left ear at 250 and 500 Hz with a normal tympanogram. Otoscopy is normal.

Investigations

What is the diagnostic significance of this VEMP pattern?

• AAugmented left oVEMP amplitude with a normal tympanogram strongly supports SCD as the cause of the apparent conductive loss — not middle ear disease
• BThe left ear has otosclerosis
• CThe augmented oVEMP is an artefact and should be ignored
• DGlue ear without effusion