Differential Diagnosis for a 46-year-old Woman with Intermittent Episodes of Vertigo

• Single Most Likely Diagnosis

  • Meniere's Disease: This condition is characterized by episodic vertigo lasting from minutes to hours, accompanied by hearing loss, tinnitus, and aural fullness. The patient's symptoms of intermittent vertigo, decreased hearing, tinnitus, and aural fullness in one ear, along with the duration of episodes, are classic for Meniere's disease.

• Other Likely Diagnoses

  • Vestibular Migraine: Given the patient's history of chronic migraine, vestibular migraine could be a consideration. However, the lack of clear triggers, the specific combination of auditory symptoms, and the duration of vertigo episodes make Meniere's disease more likely.
  • Labyrinthitis: This condition involves inflammation of the inner ear, which could cause vertigo, hearing loss, and tinnitus. However, labyrinthitis typically presents with more severe and constant symptoms rather than episodic.

• Do Not Miss Diagnoses

  • Syphilis: Although less common, syphilis can cause otosyphilis, leading to symptoms similar to Meniere's disease, including hearing loss and vertigo. Given the potential severity and the importance of early treatment, syphilis should be considered, especially if other risk factors are present.
  • Acute Labyrinthitis: While the episodic nature of the patient's symptoms makes this less likely, acute labyrinthitis can present with sudden onset of vertigo, hearing loss, and tinnitus. It's crucial to distinguish this from Meniere's disease due to differences in management and prognosis.

• Rare Diagnoses

  • Vestibular Neuronitis: This condition typically presents with sudden onset of vertigo without hearing loss or tinnitus, which doesn't fit the patient's symptom profile as closely as Meniere's disease.
  • Other Inner Ear Disorders: There are several rare conditions affecting the inner ear that could mimic Meniere's disease, such as cochlear hydrops or perilymphatic fistula. These would be considered if the patient's symptoms do not respond to treatment for Meniere's disease or if additional diagnostic findings suggest an alternative diagnosis.