Differential Diagnosis

The patient presents with sudden onset of hearing loss in the left ear, worse in the morning, accompanied by initial dizziness that improved as the day progressed. Here's a categorized differential diagnosis:

• Single most likely diagnosis
  • Meniere's Disease: Characterized by episodic vertigo, tinnitus, hearing loss (particularly low-frequency), and ear fullness. The symptoms can vary in severity and duration, and the hearing loss can fluctuate, especially worse in the morning due to increased endolymphatic pressure overnight.
• Other Likely diagnoses
  • Labyrinthitis: Inflammation of the inner ear, which can cause sudden hearing loss, vertigo, and dizziness. The symptoms can improve over time, but hearing loss may persist.
  • Vestibular Neuritis: Inflammation of the vestibular nerve, leading to severe vertigo, which can be accompanied by hearing loss if the cochlear nerve is also affected.
  • Sudden Sensorineural Hearing Loss (SSNHL): A sudden, unexplained loss of hearing, usually in one ear, which can be accompanied by vertigo and tinnitus. The cause is often unknown, but prompt treatment is crucial for recovery.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Stroke or Transient Ischemic Attack (TIA): Although less common, stroke or TIA can present with sudden hearing loss, especially if the brainstem or cerebellum is involved. Immediate diagnosis and treatment are critical.
  • Acoustic Neuroma: A benign tumor on the vestibulocochlear nerve, which can cause gradual hearing loss, tinnitus, and balance problems. Early detection is essential for effective management.
• Rare diagnoses
  • Autoimmune Inner Ear Disease: A rare condition where the immune system attacks the inner ear, leading to sudden hearing loss, vertigo, and tinnitus.
  • Cogan Syndrome: A rare disorder characterized by recurrent corneal inflammation and vestibular-auditory symptoms, including hearing loss and vertigo.
  • Syphilis: A bacterial infection that can cause a range of symptoms, including sudden hearing loss, especially in the secondary or tertiary stages of the disease.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and diagnostic tests to determine the underlying cause of the symptoms.