What characteristic of audiometric configurations is concerning for ear disease?

Asymmetric and unilateral hearing loss is particularly concerning for ear disease because it may suggest a specific underlying pathology affecting one ear more than the other. Conditions such as acoustic neuroma, unilateral otosclerosis, or other forms of conductive or sensorineural hearing loss can manifest in this way. The asymmetry in hearing loss can indicate a greater likelihood of a localized issue, which warrants further diagnostic evaluation to determine the cause and appropriate treatment.

In contrast, symmetrical hearing loss generally points to systemic issues, such as aging or environmental exposure, and is less likely to indicate an ear disease. Low-frequency hearing loss that is predominantly in one ear could suggest a localized issue, but the combined factors of asymmetry and being unilateral typically raise more concern for ear disease. High-frequency hearing loss without other symptoms often relates to noise exposure or age-related changes and may not be indicative of disease in the same way that asymmetric loss is. Therefore, the presence of asymmetric and unilateral hearing loss stands out as a red flag for potential ear disease.