Differential Diagnosis for Sensorineural Hearing Loss

The differential diagnosis for sensorineural hearing loss can be categorized into several groups based on the likelihood and potential impact of each condition. Here's a breakdown of the differential diagnoses:

• Single Most Likely Diagnosis

  • Presbycusis: This is the most common cause of sensorineural hearing loss in the elderly, resulting from the natural aging process. It typically affects high-frequency hearing first and is bilateral and symmetric.

• Other Likely Diagnoses

  • Ototoxic drugs: Certain medications, such as aminoglycoside antibiotics and cisplatin, can cause sensorineural hearing loss. The risk increases with higher doses and longer treatment durations.
  • Acoustic neuroma: A benign tumor growing on the cranial nerve running from the brain to the inner ear, which can cause hearing loss, usually unilateral and progressive.
  • Viral cochleitis: Inflammation of the cochlea due to viral infections, which can lead to sensorineural hearing loss.

• Do Not Miss Diagnoses

  • Meningioma: A type of tumor that can grow near the inner ear and affect hearing. Although less common, missing this diagnosis could have significant implications.
  • Vascular disease: Conditions affecting blood flow, such as stroke or vasculitis, can lead to sudden sensorineural hearing loss, which is a medical emergency.

• Rare Diagnoses

  • Barotraumas: Injury to the ear due to changes in pressure, which can cause sensorineural hearing loss, but this is less common in the context of gradual hearing loss in the elderly.
  • Exostosis: Bony growths in the ear canal, which are more commonly associated with conductive hearing loss but can rarely contribute to sensorineural loss if they affect the inner ear structures.
  • Osteoma: A benign bone tumor that can grow near the ear and potentially affect hearing, but this is a rare cause of sensorineural hearing loss.
  • Paget's disease: A condition that affects bone remodeling and can lead to various complications, including hearing loss, but it is a rare cause of sensorineural hearing loss.
  • Trauma: Physical injury to the head or ear can cause sensorineural hearing loss, but in the context of gradual onset in the elderly, this would be less likely unless there was a specific incident.