Differential Diagnosis
The patient presents with a 6-month history of intermittent dizziness, tinnitus in the right ear, and progressive hearing loss. Based on the symptoms and examination findings, the differential diagnosis can be organized into the following categories:
- Single most likely diagnosis
- C. Ménière disease: This diagnosis is the most likely due to the combination of symptoms such as intermittent dizziness (vertigo), tinnitus, and progressive hearing loss, particularly affecting one ear. The duration of symptoms and the nature of the hearing loss also align with Ménière disease.
- Other Likely diagnoses
- B. eustachian tube dysfunction: Although less likely than Ménière disease, eustachian tube dysfunction could contribute to some of the patient's symptoms, such as hearing loss and possibly tinnitus, especially if there's an issue with middle ear pressure regulation.
- D. vestibular migraine: This condition could explain the dizziness and possibly the tinnitus, but it typically includes headache and other migraine-related symptoms, which the patient denies. However, some patients with vestibular migraine may not experience headache, making this a consideration.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acoustic neuroma: Although not listed among the options, it's crucial to consider in the differential diagnosis for any patient presenting with unilateral tinnitus and progressive hearing loss. This condition requires prompt diagnosis and treatment due to its potential to cause significant morbidity.
- Stroke or Transient Ischemic Attack (TIA): While the patient's examination does not strongly suggest a stroke or TIA at this moment, any new onset of dizziness, especially when combined with other neurological symptoms, warrants consideration of these diagnoses due to their high morbidity and mortality.
- Rare diagnoses
- Vestibular neuronitis (E): This condition typically presents with sudden onset of vertigo without hearing loss, making it less likely in this case. However, it could be considered if the patient's symptoms were more acute in onset.
- Benign positional vertigo (A): Characterized by brief episodes of vertigo triggered by specific head movements, this diagnosis does not fully align with the patient's symptoms of progressive hearing loss and constant tinnitus.