Differential Diagnosis for a 38-year-old Woman with Progressive Left-Sided Hearing Loss
Single Most Likely Diagnosis
- Otosclerosis: This condition is characterized by abnormal bone growth in the middle ear, which can cause conductive hearing loss, often with a significant air-bone gap, as seen in this patient. The absence of acoustic reflexes bilaterally and the specific audiogram findings (elevated bone threshold and significant air-bone gap on the left) are consistent with otosclerosis. The Weber test lateralizing to the left and the Rinne test demonstrating bone conduction greater than air conduction on the left also support this diagnosis.
Other Likely Diagnoses
- Middle Ear Effusion or Chronic Otitis Media: Although the patient does not report a history of ear infections, chronic middle ear conditions could lead to conductive hearing loss. However, the absence of vertigo, normal examination findings, and specific audiogram results make otosclerosis more likely.
- Ossicular Chain Discontinuity: This could result from trauma or infection, leading to conductive hearing loss. However, the patient denies any history of head trauma or significant ear infections, making this less likely.
Do Not Miss Diagnoses
- Acoustic Neuroma: Although less likely given the conductive nature of the hearing loss and the absence of vertigo or balance issues, acoustic neuromas can present with unilateral hearing loss. The lack of other neurological symptoms and the specific audiogram findings make this less probable, but it should be considered due to its potential impact.
- Cholesteatoma: A type of skin cyst in the middle ear that can cause conductive hearing loss. It is less likely given the patient's presentation and the absence of a history of recurrent ear infections, but it's a condition that should not be missed due to its potential for serious complications.
Rare Diagnoses
- Fibrous Union of the Incudostapedial Joint: This is a rare condition that could lead to conductive hearing loss but is less common than otosclerosis.
- Superior Semicircular Canal Dehiscence: Typically presents with sound-induced vertigo, autophony, and a low-frequency conductive hearing loss, which does not match this patient's presentation.
- Asecular Discontinuity: This refers to a disruption in the otic capsule and is an uncommon cause of hearing loss. The presentation would likely include more significant symptoms than those described by the patient.