ETS Form 1 Practice Exam 2026 - Free ETS Form 1 Practice Questions and Study Guide

Fluid in the middle ear from recurrent otitis media with effusion disrupts the mechanical transmission of sound through the middle ear structures. This causes conductive hearing loss, which is characterized by reduced air conduction while the inner ear remains functioning, so bone conduction is typically normal and an air–bone gap appears on testing.

In this scenario, the problem lies with the transmission of sound through the outer and middle ear, not with the inner ear or auditory nerve, which is why this isn’t sensorineural hearing loss. A central auditory processing disorder affects how the brain interprets sound rather than how sound is heard at the ear itself, so it wouldn’t be described as a primary hearing loss. Normal hearing would imply no deficit at all, which isn’t the case when middle-ear fluid dampens movement of the eardrum and ossicles.