A 35-year-old man from rural India presents with a 2-year history of intermittent ear discharge and progressive hearing loss. Otoscopy reveals a central tympanic membrane perforation with mucoid discharge. Audiometry shows an air-bone gap of 35 dB at low frequencies with reduced bone conduction thresholds at high frequencies, creating the pattern marked **C** in the diagram. Which of the following best explains the audiological findings in this patient?
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