Differential Diagnosis for the Patient

The patient's symptoms of dizziness, feeling like he might pass out, and visual changes, along with his medical history, suggest several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by head movements, which could explain the patient's dizziness and transient visual changes. The fact that symptoms resolve within 30 minutes and are associated with positional changes supports this diagnosis. The patient's history of sensorineural hearing loss and chronic mastoiditis could also be related to inner ear issues, which might predispose him to BPPV.

• Other Likely Diagnoses

  • Vestibular Migraine: Given the patient's history of visual changes and occasional double vision, vestibular migraine is a plausible diagnosis. These migraines can cause vertigo, dizziness, and visual disturbances without the typical headache component.
  • Labyrinthitis: This is an inner ear disorder that could cause dizziness and visual disturbances. The patient's history of chronic mastoiditis and sensorineural hearing loss makes labyrinthitis a possible consideration, especially if there's an inflammatory component affecting the labyrinth.
  • Orthostatic Hypotension: Although the patient denies chest pain or shortness of breath, orthostatic hypotension could cause dizziness upon standing and might be considered, especially in the context of potential autonomic dysfunction or volume depletion.

• Do Not Miss Diagnoses

  • Stroke or Transient Ischemic Attack (TIA): Although the patient has no cardiac history, it's crucial not to miss a stroke or TIA, as these conditions can present with sudden onset of dizziness and visual changes. The absence of chest pain or shortness of breath does not rule out a vascular event.
  • Multiple Sclerosis: Given the patient's history of sensorineural hearing loss and now experiencing visual disturbances and dizziness, multiple sclerosis could be considered, especially if there are other neurological symptoms or signs.
  • Acoustic Neuroma: This is a type of tumor that affects the nerve connecting the inner ear to the brain, which could explain the patient's sensorineural hearing loss and current symptoms of dizziness and visual changes.

• Rare Diagnoses

  • Meniere's Disease: This disorder of the inner ear causes episodes of vertigo, ringing in the ears (tinnitus), hearing loss, and a feeling of fullness in the ear. While it could explain some of the patient's symptoms, the episodic nature and specific combination of symptoms might not fully align with Meniere's.
  • Superior Canal Dehiscence: A rare condition where there is an abnormal opening in the bone overlying the superior canal of the inner ear, leading to vertigo and hearing symptoms. This could be considered given the patient's history of inner ear issues, but it's less likely without specific auditory symptoms like sound-induced vertigo.