Loratadine is an antihistamine that does not cause drowsiness. It works by targeting histamine H1 receptors to relieve allergy symptoms like sneezing and runny nose. As the patient is a heavy goods vehicle driver, it is advisable to recommend a non-sedating antihistamine like loratadine. Chlorphenamine, on the other hand, is a sedating antihistamine used in anaphylaxis treatment and is not suitable for the patient’s occupation. Cimetidine inhibits stomach acid production and does not help with allergy symptoms. Cinnarizine is a sedating antihistamine used for nausea and vomiting and may not be effective for the patient’s condition. Diphenhydramine is also a sedating antihistamine and not recommended for the patient.

Differentiating between lumps and bumps: A guide to common masses

When it comes to lumps and bumps on the body, it can be difficult to determine what they are and whether they require medical attention. Here are some common types of masses and their characteristics to help differentiate between them:

Sebaceous cysts: These small, smooth lumps are caused by a blocked hair follicle and have a central punctum. They are attached to the skin and may develop a horn. If infected, they can become tender and erythematous.

Lipomas: These deep masses are typically soft, doughy, and mobile. An ultrasound or biopsy may be needed to rule out sarcoma or liposarcoma.

Sternocleidomastoid tumors: This congenital lump appears within the first few weeks of life and is located beneath the sternocleidomastoid muscle. It restricts contralateral head movement.

Thyroid carcinoma: A hard, firm, non-tender mass close to the midline that moves up with swallowing may indicate thyroid cancer.

Thyroid goitre: A smooth or multi-nodular enlargement close to the midline that moves up with swallowing may indicate a thyroid goitre. Symptoms associated with thyroid diseases may also be present.

Knowing the characteristics of these common masses can help individuals determine when to seek medical attention.

Following thyroid surgery, a patient is experiencing paraesthesia, cramps, and spasms, which are likely due to hypocalcemia resulting from damage to the parathyroid glands. The most common ECG change associated with this condition is isolated QTc elongation, while dysrhythmias are rare. Alternating QRS amplitude is not associated with this condition and is instead linked to pericardial effusion. Isolated QTc shortening is also incorrect as it is typically associated with hypercalcemia, which can be caused by hyperparathyroidism and malignancy. The combination of T wave inversion, QTc prolongation, and visible U waves is associated with hypokalemia, which can be caused by vomiting, thiazide use, and Cushing’s syndrome. Similarly, the combination of tall, peaked T waves, QTc shortening, and ST-segment depression is associated with hyperkalemia, which can be caused by Addison’s disease, rhabdomyolysis, acute kidney injury, and potassium-sparing diuretics.

Complications of Thyroid Surgery: An Overview

Thyroid surgery is a common procedure that involves the removal of all or part of the thyroid gland. While the surgery is generally safe, there are potential complications that can arise. These complications can be anatomical, such as damage to the recurrent laryngeal nerve, which can result in voice changes or difficulty swallowing. Bleeding is another potential complication, which can be particularly dangerous in the confined space of the neck and can lead to respiratory problems due to swelling. Additionally, damage to the parathyroid glands, which are located near the thyroid, can result in hypocalcaemia, a condition in which the body has low levels of calcium. It is important for patients to be aware of these potential complications and to discuss them with their healthcare provider before undergoing thyroid surgery.

It is probable that the patient is suffering from malignant otitis externa, a condition that affects individuals with weakened immune systems like those with diabetes. This condition is characterized by osteomyelitis of the temporal bone. Despite receiving several rounds of antibiotic drops, the patient’s symptoms have not improved. It is recommended that the patient be referred to an ENT specialist for a CT scan of the temporal bones and treated with an extended course of intravenous antibiotics.

Understanding Otitis Externa: Causes, Features, and Management

Otitis externa is a common condition that often prompts patients to seek medical attention. It is characterized by ear pain, itch, and discharge, and is caused by various factors such as infection, seborrhoeic dermatitis, and contact dermatitis. Swimming is also a common trigger of otitis externa. Upon examination, the ear canal appears red, swollen, or eczematous.

The recommended initial management of otitis externa involves the use of topical antibiotics or a combination of topical antibiotics with a steroid. However, if the tympanic membrane is perforated, aminoglycosides are traditionally not used. In cases where there is canal debris, removal may be necessary, while an ear wick may be inserted if the canal is extensively swollen. Second-line options include oral antibiotics, taking a swab inside the ear canal, and empirical use of an antifungal agent.

It is important to note that if a patient fails to respond to topical antibiotics, referral to an ENT specialist may be necessary. Malignant otitis externa is a more serious condition that is more common in elderly diabetics. It involves the extension of infection into the bony ear canal and the soft tissues deep to the bony canal, and may require intravenous antibiotics.

Overall, understanding the causes, features, and management of otitis externa is crucial in providing appropriate care and preventing complications.

Common Causes of Hearing Loss in Children

Hearing loss in children can be caused by various factors. Two common causes are glue ear and otosclerosis. Glue ear, also known as otitis media with effusion, is the accumulation of fluid in the middle ear without acute inflammation. It can lead to conductive hearing loss, recurrent ear infections, speech delay, and behavioral problems. Children with Down syndrome and cleft palate are at higher risk of developing glue ear. On the other hand, otosclerosis is the abnormal growth of bone in the middle ear, resulting in gradual hearing loss in early adulthood.

It is important to note that speech delay alone may not indicate autistic spectrum disorder. Children with this disorder typically exhibit issues with social interactions, non-verbal communication, and restrictive behaviors. In contrast, selective mutism is an anxiety disorder that causes a child to be unable to speak in certain situations. Impacted ear wax can also cause hearing loss or speech delay, but it can be diagnosed through ear examination.

In summary, a child with recurrent earache and retracted tympanic membranes is more likely to have glue ear, especially if they have Down syndrome or cleft palate. It is important to monitor their development closely, especially if they also have a learning disability.

For patients with diabetes who present with otitis externa, it is important to consider the possibility of malignant otitis externa, which is a severe bacterial infection that can spread to the bony ear canal and cause osteomyelitis. Pseudomonas aeruginosa is the most common cause of this condition, so treatment should involve coverage for this bacteria. Intravenous ciprofloxacin is the preferred antibiotic for this purpose. It is also important to note that diabetic patients with non-malignant otitis externa should also be treated with ciprofloxacin due to their increased risk of developing malignant otitis externa. Clarithromycin and flucloxacillin are not appropriate choices for this condition, and leaving the infection untreated can lead to serious complications.

Malignant Otitis Externa: A Rare but Serious Infection

Malignant otitis externa is a type of ear infection that is uncommon but can be serious. It is typically found in individuals who are immunocompromised, with 90% of cases occurring in diabetics. The infection starts in the soft tissues of the external auditory meatus and can progress to involve the soft tissues and bony ear canal, eventually leading to temporal bone osteomyelitis.

When diagnosing malignant otitis externa, doctors will typically perform a CT scan. Key features in a patient’s medical history include diabetes or immunosuppression, severe and unrelenting ear pain, temporal headaches, and purulent otorrhea. In some cases, patients may also experience dysphagia, hoarseness, and/or facial nerve dysfunction.

If a patient presents with non-resolving otitis externa and worsening pain, they should be referred urgently to an ear, nose, and throat specialist. Treatment typically involves intravenous antibiotics that cover pseudomonal infections.

Overall, while malignant otitis externa is rare, it is important to be aware of its symptoms and risk factors, particularly in immunocompromised individuals. Early diagnosis and treatment can help prevent the infection from progressing and causing more serious complications.

Management of Meniere’s Disease

Meniere’s disease is a condition characterized by intermittent bouts of vertigo, tinnitus, and/or deafness in one or both ears, as well as a feeling of fullness or pressure in the affected ear. If a patient presents with these symptoms, a referral to an ear, nose, and throat (ENT) consultant is advisable to confirm the diagnosis and exclude other potential causes.

If the patient is experiencing an acute attack, self-care advice and medication may be warranted. Prochlorperazine is recommended for acute attacks, while betahistine is used for preventive treatment. Severe symptoms may require hospital admission for supportive treatment.

Long-term use of oral or buccal prochlorperazine is not recommended, and vestibular rehabilitation is not the most appropriate management for this condition. Instead, patients should be referred to a specialist for further evaluation and management.

Carbamazepine is not indicated for the management of Meniere’s disease. Patients should also be advised to inform the Driver and Vehicle Licensing Authority (DVLA) of their condition.

Perforated Tympanic Membrane: Causes and Management

A perforated tympanic membrane, also known as a ruptured eardrum, is a condition where there is a tear or hole in the thin tissue that separates the ear canal from the middle ear. The most common cause of this condition is an infection, but it can also be caused by barotrauma or direct trauma. When left untreated, a perforated tympanic membrane can lead to hearing loss and increase the risk of otitis media.

In most cases, no treatment is needed as the tympanic membrane will usually heal on its own within 6-8 weeks. During this time, it is important to avoid getting water in the ear. However, if the perforation occurs following an episode of acute otitis media, antibiotics may be prescribed. This approach is supported by the 2008 Respiratory tract infection guidelines from the National Institute for Health and Care Excellence (NICE).

If the tympanic membrane does not heal by itself, myringoplasty may be performed. This is a surgical procedure where a graft is used to repair the hole in the eardrum.

This woman is experiencing sialadenitis, which is inflammation of the salivary gland. It is likely caused by a stone blocking the duct. The submandibular gland is located below the jawline and its duct drains into the floor of the mouth. When there is a discharge from this duct, it can cause a bad taste in the mouth. There are three main salivary glands: the parotid glands, which are located in front of and below each ear, the submandibular glands, which are located below the jawline, and the sublingual glands, which are located beneath the tongue. Disorders of these glands can be caused by infection, inflammation, obstruction, or malignancy. Swelling of the submandibular gland can be caused by a stone or a tumor, which can be either benign or malignant.

Salivary Glands and Their Pathologies

Salivary glands are responsible for producing saliva, which aids in digestion and protects the mouth from harmful bacteria. There are three pairs of salivary glands: parotid, submandibular, and sublingual. The parotid gland is the most common site for tumors, while the submandibular gland is most commonly affected by stones.

Tumors in the salivary glands are rare, but when they do occur, 80% of them are found in the parotid gland. Of these, 80% are pleomorphic adenomas, which are benign. These tumors typically grow slowly and are painless, but surgical removal carries a risk of damage to the facial nerve (CN VII). Warthin’s tumor is another benign tumor that affects the salivary glands, but it is less common than pleomorphic adenomas.

Stones in the salivary glands can cause recurrent pain and swelling, especially when eating. They are most commonly found in the submandibular gland and can lead to infection if left untreated. Other causes of salivary gland enlargement include viral or bacterial infections, as well as autoimmune disorders like Sjogren’s syndrome. Proper diagnosis and treatment are important for managing these conditions and preventing complications.

Unilateral nasal polyps are a cause for concern and should be promptly referred to an ENT specialist as they may indicate nasal cancer. However, they can also be caused by other factors such as nose picking, foreign bodies, misapplication of nasal spray or cystic fibrosis. Treatment with antibiotics, oral steroids, nasal drops or cautery is unlikely to be effective and may delay the diagnosis of a serious condition.

Understanding Nasal Polyps

Nasal polyps are a relatively uncommon condition affecting around 1% of adults in the UK. They are more commonly seen in men and are not typically found in children or the elderly. There are several associations with nasal polyps, including asthma (particularly late-onset asthma), aspirin sensitivity, infective sinusitis, cystic fibrosis, Kartagener’s syndrome, and Churg-Strauss syndrome. When asthma, aspirin sensitivity, and nasal polyposis occur together, it is known as Samter’s triad.

The symptoms of nasal polyps include nasal obstruction, rhinorrhoea, sneezing, and a poor sense of taste and smell. It is important to note that any unusual symptoms, such as unilateral symptoms or bleeding, require further investigation. If nasal polyps are suspected, patients should be referred to an ear, nose, and throat (ENT) specialist for a full examination.

The management of nasal polyps typically involves the use of topical corticosteroids, which can shrink polyp size in around 80% of patients. Overall, understanding nasal polyps and their associations can help with early detection and appropriate management.

BPPV can be diagnosed using the Dix-Hallpike manoeuvre, while the Epley manoeuvre is used for treatment.

Understanding Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is a common condition that causes sudden dizziness and vertigo triggered by changes in head position. It typically affects individuals over the age of 55 and is less common in younger patients. Symptoms include vertigo triggered by movements such as rolling over in bed or looking upwards, and may be accompanied by nausea. Each episode usually lasts between 10-20 seconds and can be diagnosed through a positive Dix-Hallpike manoeuvre, which involves the patient experiencing vertigo and rotatory nystagmus.

Fortunately, BPPV has a good prognosis and often resolves on its own within a few weeks to months. Treatment options include the Epley manoeuvre, which is successful in around 80% of cases, and vestibular rehabilitation exercises such as the Brandt-Daroff exercises. While medication such as Betahistine may be prescribed, it tends to have limited value. However, it is important to note that around half of people with BPPV will experience a recurrence of symptoms 3-5 years after their initial diagnosis.

Overall, understanding BPPV and its symptoms can help individuals seek appropriate treatment and manage their condition effectively.

Medication and Tinnitus: Understanding the Association

Tinnitus, the perception of sounds in the ears or head without an external source, can be distressing and may indicate an underlying condition. While it is often considered a minor symptom, certain medications have been associated with tinnitus. Quinine, commonly used to treat malaria, is one such medication. Other medications that may cause tinnitus include aspirin, aminoglycosides, loop diuretics, and non-steroidal anti-inflammatory drugs. However, medications like spironolactone, salbutamol, metformin, and nifedipine are not associated with tinnitus. It is important to understand the potential side effects of medications and to consult with a healthcare provider if experiencing tinnitus or any other concerning symptoms.

The base of the skull is made up of three bony fossae: the anterior, middle, and posterior. These structures provide support for various internal structures within the cranium. If these bones are fractured, it can result in damage to associated neurovascular structures, which can have external manifestations in areas such as the nasal cavity or auditory canal. Bleeding from ruptured vessels can lead to haemotympanum or Battle’s sign in the mastoid area, while ruptured CSF spaces can cause CSF rhinorrhoea and otorrhoea. Stellwag’s sign, on the other hand, is not related to base of skull trauma and refers to reduced blinking.

Patients with head injuries should be managed according to ATLS principles and extracranial injuries should be managed alongside cranial trauma. There are different types of traumatic brain injuries, including extradural hematoma, subdural hematoma, and subarachnoid hemorrhage. Primary brain injury may be focal or diffuse, and secondary brain injury can occur due to cerebral edema, ischemia, infection, or herniation. Management may include IV mannitol/frusemide, decompressive craniotomy, and ICP monitoring. Pupillary findings can provide information on the location and severity of the injury.

To diagnose sensorineural hearing loss, Rinne and Weber tests can be used. In this type of hearing loss, air conduction will be louder than bone on Rinne test and Weber test will lateralise away from the affected ear. However, before making a diagnosis, it is important to correctly identify the symptoms. For example, sudden hearing loss accompanied by dizziness and pressure in the ear may indicate Meniere’s disease, which causes sensorineural hearing loss in the affected ear. If the symptoms suggest sensorineural hearing loss in the left ear, the results of the tests should show air conduction louder than bone on Rinne test and Weber test lateralising away from the left ear. If the results show different patterns, they may suggest conductive or mixed hearing loss in one or both ears.

Rinne’s and Weber’s Test for Differentiating Conductive and Sensorineural Deafness

Rinne’s and Weber’s tests are two diagnostic tools used to differentiate between conductive and sensorineural deafness. Rinne’s test involves placing a tuning fork over the mastoid process until the sound is no longer heard, then repositioning it just over the external acoustic meatus. A positive test indicates that air conduction (AC) is better than bone conduction (BC), while a negative test suggests conductive deafness if BC is greater than AC.

On the other hand, Weber’s test involves placing a tuning fork in the middle of the forehead equidistant from the patient’s ears and asking which side is loudest. In unilateral sensorineural deafness, sound is localized to the unaffected side, while in unilateral conductive deafness, sound is localized to the affected side.

To interpret the results of Rinne’s and Weber’s tests, a normal result indicates that AC is greater than BC bilaterally, and the sound is midline in Weber’s test. Conductive hearing loss is indicated by BC being greater than AC in the affected ear, while AC is greater than BC in the unaffected ear, and the sound lateralizes to the affected ear in Weber’s test. Sensorineural hearing loss is indicated by AC being greater than BC bilaterally, and the sound lateralizes to the unaffected ear in Weber’s test.

The patient is experiencing a conductive hearing loss on the right side, as evidenced by Rinne’s test showing bone conduction > air conduction in the affected ear and Weber’s test lateralizing to the right ear. The most likely diagnosis is cholesteatoma, which is associated with recurrent ear discharge and glue ear. Cholesteatoma occurs when squamous epithelium forms pockets on the tympanic membrane, leading to cyst-like growths that produce keratin and slough over time. This causes erosion in the middle ear, creating an environment for anaerobic bacterial growth.

Acoustic neuroma, on the other hand, causes sensorineural hearing loss, which is characterized by air conduction > bone conduction in both ears and Weber test lateralizing to the unaffected ear. It is associated with dizziness and typically causes unilateral hearing loss. As the tumor grows, patients may develop neurological symptoms that can be predicted by the affected cranial nerves.

Otitis externa is an acute infection of the outer ear that can cause conductive hearing loss, but as the patient has a chronic history and lacks ear pain, this diagnosis is less likely. Otosclerosis, which presents with progressive conductive hearing loss and tinnitus, is an autosomal dominant trait that typically affects individuals aged 20-40 years with a family history of early-onset hearing loss. As it does not typically present with smelly ear discharge, other diagnoses should be considered first.

Rinne’s and Weber’s Test for Differentiating Conductive and Sensorineural Deafness

Rinne’s and Weber’s tests are two diagnostic tools used to differentiate between conductive and sensorineural deafness. Rinne’s test involves placing a tuning fork over the mastoid process until the sound is no longer heard, then repositioning it just over the external acoustic meatus. A positive test indicates that air conduction (AC) is better than bone conduction (BC), while a negative test suggests conductive deafness if BC is greater than AC.

On the other hand, Weber’s test involves placing a tuning fork in the middle of the forehead equidistant from the patient’s ears and asking which side is loudest. In unilateral sensorineural deafness, sound is localized to the unaffected side, while in unilateral conductive deafness, sound is localized to the affected side.

To interpret the results of Rinne’s and Weber’s tests, a normal result indicates that AC is greater than BC bilaterally, and the sound is midline in Weber’s test. Conductive hearing loss is indicated by BC being greater than AC in the affected ear, while AC is greater than BC in the unaffected ear, and the sound lateralizes to the affected ear in Weber’s test. Sensorineural hearing loss is indicated by AC being greater than BC bilaterally, and the sound lateralizes to the unaffected ear in Weber’s test.

When wax builds up in the ear, it can lead to conductive hearing loss in that ear. This means that bone conduction is stronger than air conduction in the affected ear, and when performing the Weber test, the sound will be heard more in the affected ear. Other factors that can cause conductive hearing loss include having a foreign object in the ear, experiencing otitis media or otitis externa, having a perforated eardrum, or developing otosclerosis.

Rinne’s and Weber’s Test for Differentiating Conductive and Sensorineural Deafness

Rinne’s and Weber’s tests are two diagnostic tools used to differentiate between conductive and sensorineural deafness. Rinne’s test involves placing a tuning fork over the mastoid process until the sound is no longer heard, then repositioning it just over the external acoustic meatus. A positive test indicates that air conduction (AC) is better than bone conduction (BC), while a negative test suggests conductive deafness if BC is greater than AC.

On the other hand, Weber’s test involves placing a tuning fork in the middle of the forehead equidistant from the patient’s ears and asking which side is loudest. In unilateral sensorineural deafness, sound is localized to the unaffected side, while in unilateral conductive deafness, sound is localized to the affected side.

To interpret the results of Rinne’s and Weber’s tests, a normal result indicates that AC is greater than BC bilaterally, and the sound is midline in Weber’s test. Conductive hearing loss is indicated by BC being greater than AC in the affected ear, while AC is greater than BC in the unaffected ear, and the sound lateralizes to the affected ear in Weber’s test. Sensorineural hearing loss is indicated by AC being greater than BC bilaterally, and the sound lateralizes to the unaffected ear in Weber’s test.

Management of Otitis Externa: Recommended Actions and Guidelines

Otitis externa is a common condition that affects the outer ear canal. The management of this condition depends on the severity of the inflammation and the presence of other symptoms. Here are some recommended actions and guidelines for managing otitis externa:

1. Start topical antibiotic and steroid: This is recommended for patients with acute otitis externa who present with more severe inflammation. The treatment should last for seven days.

2. Start topical acetic acid 2% spray: This is recommended for patients with mild otitis externa who do not have hearing loss or discharge.

3. Refer to ENT urgently: This is not part of initial management but should be considered for patients with chronic diffuse otitis externa when treatment is prolonged beyond two to three months.

4. Start oral amoxicillin: Oral antibiotics are rarely indicated for otitis externa. They should only be considered for patients with severe infection or at high risk of severe infection.

5. Take an ear swab and start topical antibiotic: Ear swab is not recommended as first-line management. It should only be done if there is no response to initial treatment or in recurrent infections.

In summary, the management of otitis externa depends on the severity of the inflammation and the presence of other symptoms. Following these recommended actions and guidelines can help improve patient outcomes.

Loop diuretics have the potential to cause ototoxicity.

Loop Diuretics: Mechanism of Action and Indications

Loop diuretics, such as furosemide and bumetanide, are medications that inhibit the Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle. This reduces the absorption of NaCl and increases the excretion of water and electrolytes, making them effective in treating conditions such as heart failure and resistant hypertension. Loop diuretics act on NKCC2, which is more prevalent in the kidneys.

As loop diuretics work on the apical membrane, they must first be filtered into the tubules by the glomerulus before they can have an effect. This means that patients with poor renal function may require higher doses to achieve a sufficient concentration within the tubules.

Loop diuretics are commonly used in the treatment of heart failure, both acutely (usually intravenously) and chronically (usually orally). They are also effective in treating resistant hypertension, particularly in patients with renal impairment.

However, loop diuretics can have adverse effects, including hypotension, hyponatremia, hypokalemia, hypomagnesemia, hypochloremic alkalosis, ototoxicity, hypocalcemia, renal impairment (from dehydration and direct toxic effect), hyperglycemia (less common than with thiazides), and gout.

In summary, loop diuretics are effective medications for treating heart failure and resistant hypertension, but their use should be carefully monitored due to potential adverse effects. Patients with poor renal function may require higher doses to achieve therapeutic effects.

Acute viral labyrinthitis presents with sudden horizontal nystagmus, hearing issues, nausea, vomiting, and vertigo. It is typically preceded by a viral infection and can cause hearing loss. Unlike BPPV, it is not associated with hearing loss. A central cause such as a stroke is less likely as the nystagmus is unidirectional and the head impulse test is impaired. Vestibular neuritis has similar symptoms to viral labyrinthitis but does not result in hearing loss.

Labyrinthitis is a condition that involves inflammation of the membranous labyrinth, which affects both the vestibular and cochlear end organs. This disorder can be caused by a viral, bacterial, or systemic disease, with viral labyrinthitis being the most common form. It is important to distinguish labyrinthitis from vestibular neuritis, as the latter only affects the vestibular nerve and does not result in hearing impairment. Labyrinthitis, on the other hand, affects both the vestibular nerve and the labyrinth, leading to vertigo and hearing loss.

The typical age range for presentation of labyrinthitis is between 40-70 years old. Patients usually experience an acute onset of symptoms, including vertigo that is not triggered by movement but worsened by it, nausea and vomiting, hearing loss (which can be unilateral or bilateral), tinnitus, and preceding or concurrent upper respiratory tract infection symptoms. Signs of labyrinthitis include spontaneous unidirectional horizontal nystagmus towards the unaffected side, sensorineural hearing loss, an abnormal head impulse test, and gait disturbance that may cause the patient to fall towards the affected side.

Diagnosis of labyrinthitis is primarily based on the patient’s history and physical examination. While episodes of labyrinthitis are typically self-limiting, medications such as prochlorperazine or antihistamines may help reduce the sensation of dizziness. Overall, it is important to accurately diagnose and manage labyrinthitis to prevent complications and improve the patient’s quality of life.

For a man with a positive Rinne’s test and sound localization to the left ear on Weber’s testing, the diagnosis is likely to be right-sided sensorineural hearing loss. If the Rinne’s test had been negative, it would have indicated left-sided conductive hearing loss. Similarly, if the sound had been localized to the right ear, it would have suggested left-sided sensorineural hearing loss. In the case of bilateral hearing loss, the Rinne’s test would be negative on both sides, and the Weber test would not localize to either ear. Finally, if the man had right-sided conductive hearing loss, the Rinne’s test would be negative on the right side, and the Weber test would localize to the right side.