A 28-year-old woman presents with progressive bilateral hearing loss over 2 years, worse on the left. She reports low-pitched tinnitus and notes that she can hear better in noisy environments when she raises her voice. Otoscopy shows a normal, mobile tympanic membrane. Audiometry is shown in the diagram. The pattern marked **B** shows conductive hearing loss with a characteristic notch at 2 kHz on bone conduction. Which of the following best explains the pathophysiology underlying this audiometric finding in otosclerosis?
A 34-year-old woman presents with a 3-year history of gradually progressive bilateral hearing loss that worsened during her pregnancies. She reports paradoxical better hearing in noisy environments and speaks in a soft voice. Family history reveals her mother underwent bilateral stapedectomy in her 40s. Otoscopy shows a subtle pinkish blush (Schwartze sign) on the left. Weber test lateralizes to the left, and Rinne test shows bone conduction better than air conduction bilaterally. Pure-tone audiometry demonstrates the audiometric pattern marked **A** in the diagram. Which of the following BEST characterizes the pathognomonic finding at 2 kHz on bone conduction in this patient's audiogram?
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