C

Improved hearing in noisy surroundings (paracusis Willisii) together with a negative Rinne test points to bilateral conductive loss; in young women, the classic cause is stapes fixation from otosclerosis, which on pure-tone audiogram shows a conductive gap with a 2-kHz Carhart notch [Quinn 2022, PMID 34619730; Job 2023, PMID 36707983].