Título Em Otorrinolaringologia Practice Questions - Título De Especialista Em Otorrinolaringologia E Cirurgia Cérvico-Facial (ABORL-CCF AMB) Exam

A 34-year-old woman presents with progressive bilateral hearing loss, more pronounced in the left ear, and low-pitched tinnitus for the past two years. She notes that her hearing noticeably deteriorated during her recent pregnancy. Otoscopic examination is normal, with a faint pinkish vascular hue visible over the promontory through a translucent tympanic membrane (Schwartze sign). Pure-tone audiometry demonstrates a bilateral conductive hearing loss with an air-bone gap of 35 dB in the speech frequencies and a distinct dip in bone-conduction thresholds at 2000 Hz (Carhart notch). Tympanometry reveals type As curves bilaterally with absent acoustic stapedial reflexes. What is the definitive pathophysiological mechanism and primary surgical treatment of choice for this condition?