<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 72-year-old man presents to his primary care physician with progressively worsening hearing loss. He states that his trouble with hearing began approximately 7-8 years ago. He is able to hear when someone is speaking to him; however, he has difficulty with understanding what is being said, especially when there is background noise. In addition to his current symptoms, he reports a steady ringing in both ears, and at times experiences dizziness. Medical history is significant for three prior episodes of acute otitis media. Family history is notable for his father being diagnosed with cholesteatoma. His temperature is 98.6F 37C, blood pressure is 13888 mmHg, pulse is 14min, and respirations are 13min. On physical exam, when a tuning fork is placed in the middle of the patients forehead, sound is appreciated equally on both ears. When a tuning fork is placed by the external auditory canal and subsequently on the mastoid process, air conduction is greater than bone conduction. Which of the following is most likely the cause of this patients symptoms?? A: Accumulation of desquamated keratin debri, B: Eustachian tube obstruction secondary to nasopharyngeal inflammatory edema, C: Stapedial abnormal bone growth, D: Cochlear hair cell degeneration, E: Endolymphatic hydrops,  <response>: Based on the information provided in the question stem, this 72-year-old man has gradually worsening hearing loss over the past 7-8 years. He has difficulty understanding speech, especially with background noise, and experiences tinnitus and occasional dizziness. His history is significant for recurrent ear infections, and his father had cholesteatoma. The tuning fork exam shows air conduction greater than bone conduction. This presentation is most consistent with sensorineural hearing loss caused by damage to the cochlear hair cells. Choice D Cochlear hair cell degeneration matches this assessment.Choices A, B, and C can all cause conductive hearing loss, which would show bone conduction greater than air conduction on tuning fork exam. Choice E Endolymphatic hydrops refers to Menieres disease, which can cause fluctuating sensorineural hearing loss but does not match this gradual progressive history.D: Cochlear hair cell degeneration 