Full history taking including personal, medical and otological history, otological examination to exclude external or middle ear disease, basic audio logical evaluation including pure tone audiometry including air conduction for octave frequencies 250Hz through 8000Hz and bone conduction for octave frequencies 500Hz through 4000Hz, speech audiometry including speech recognition threshold (SRT) test using Arabic Bisyllabic Words (Qasim et al., 2021) ,word discrimination score (WD) test using Arabic monosyllabic Phonetically Balanced Words (Najem and Marie, 2021) , immittancemetry including tympanometry at varying pressure ranging from +200 to - 400 mmH2O to evaluate the middle ear pressure and its compliance , and acoustic reflex thresholds determination ipsilaterally and contraletrally using pure tones of 500、1000、2000和4000Hz。