Differential Diagnosis for Hearing Loss in a 5-year-old Boy
Single most likely diagnosis
- B. Chronic otitis media: This is the most likely diagnosis given the patient's age and symptoms. Chronic otitis media is a common cause of hearing loss in children, and the patient's history of difficulty hearing normal conversations over the past year is consistent with this diagnosis. The tuning fork tests also suggest a conductive hearing loss, which is consistent with chronic otitis media.
Other Likely diagnoses
- D. Foreign body: A foreign body in the ear canal could cause conductive hearing loss, and the patient's age makes it possible that he may have inserted an object into his ear.
- C. Congenital infection: Although the patient was born at 36 weeks gestation and was small for gestational age, a congenital infection such as congenital syphilis or toxoplasmosis could have caused hearing loss.
- E. Noise exposure: Although less likely, noise exposure could have caused sensorineural hearing loss, but the tuning fork tests suggest a conductive hearing loss.
Do Not Miss
- A. Cholesteatoma: A cholesteatoma is a serious condition that can cause conductive hearing loss and should not be missed. Although it is less common in children, it can have serious complications if left untreated.
- F. Otosclerosis: Otosclerosis is a rare condition in children, but it can cause conductive hearing loss. It is often associated with a family history, but it should be considered in the differential diagnosis.
Rare diagnoses
- Other congenital or genetic conditions: There are many rare congenital or genetic conditions that can cause hearing loss, such as Usher syndrome or Pendred syndrome. These conditions are often associated with other symptoms or physical findings, but they should be considered in the differential diagnosis if other causes are ruled out.
- Tumors or cysts: Although rare, tumors or cysts in the ear or temporal bone can cause hearing loss. These conditions are often associated with other symptoms such as pain or vertigo, but they should be considered in the differential diagnosis if other causes are ruled out.