Differential Diagnosis for the Patient's Concerns

The patient presents with progressive hearing loss, tinnitus, ear fullness, sound distortion, and persistent vertigo after a stapedectomy. The following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Reparative Granuloma: This condition is a known complication of stapedectomy, characterized by the formation of granulation tissue in the middle ear, which can lead to the symptoms described. The presence of a thickened tympanic membrane with erythema and the patient's symptoms of progressive hearing loss and vertigo support this diagnosis.

• Other Likely Diagnoses

  • Loosening or Displacement of the Prosthesis: This is a possible complication of stapedectomy, which can cause the symptoms the patient is experiencing. However, the normal findings on fistula testing with pneumatic otoscopy make this less likely.
  • Bacterial Labyrinthitis: Although less common, bacterial labyrinthitis can occur after a stapedectomy and cause the patient's symptoms. The presence of erythema and a thickened tympanic membrane could suggest an infectious process.

• Do Not Miss Diagnoses

  • Perilymph Fistula: Although the fistula testing with pneumatic otoscopy was normal, a perilymph fistula is a critical diagnosis not to miss due to its potential for significant morbidity. The patient's symptoms of vertigo and hearing loss could be consistent with a perilymph fistula, especially if the fistula is small or intermittent.

• Rare Diagnoses

  • Other Infectious Causes: Other rare infectious causes, such as viral labyrinthitis or otosyphilis, could potentially cause the patient's symptoms but are less likely given the context of recent stapedectomy.
  • Tumors: Although extremely rare, tumors such as a acoustic neuroma could cause similar symptoms but would be unusual in the context of recent surgery and the specific findings on examination.