Differential Diagnosis for Tinnitus in Left Ear
Single Most Likely Diagnosis
- Benign Tinnitus: The patient's symptoms of rapid pulsation and whooshing tinnitus in one ear, with an MRI that is reassuring, suggest a benign cause. The fact that it has been going on for years also points towards a chronic, non-life-threatening condition.
Other Likely Diagnoses
- Palatal Myoclonus: This condition involves abnormal movement of the muscles in the palate, which can cause a clicking or pulsating sound. It's a possible cause of the patient's symptoms, especially if the sound is synchronous with the patient's heartbeat.
- Eustachian Tube Dysfunction: Abnormal opening or closing of the Eustachian tube can cause a sensation of fullness or pressure in the ear, accompanied by tinnitus. The whooshing sound could be related to the abnormal movement of the tube.
- Middle Ear Myoclonus: Similar to palatal myoclonus, this condition involves abnormal muscle contractions in the middle ear, which can cause tinnitus.
Do Not Miss Diagnoses
- Glomus Tumor: Although rare, glomus tumors (also known as paragangliomas) can cause pulsatile tinnitus due to their location near the jugular bulb or middle ear. An MRI is often used to diagnose these tumors, but it's possible that a small tumor could be missed.
- Carotid Artery Stenosis: Severe stenosis of the carotid artery can cause turbulent blood flow, leading to pulsatile tinnitus. This condition is a medical emergency, as it increases the risk of stroke.
- Vascular Malformation: Abnormal blood vessels in the brain or ear can cause pulsatile tinnitus. While rare, this condition can be life-threatening if left untreated.
Rare Diagnoses
- Superior Semicircular Canal Dehiscence: This rare condition involves an abnormal opening in the bone overlying the superior semicircular canal, which can cause a variety of auditory symptoms, including tinnitus.
- Patulous Eustachian Tube: This condition involves an abnormally patent Eustachian tube, which can cause autophony (hearing one's own internal sounds) and tinnitus.
- Labyrinthine Fistula: An abnormal connection between the inner and middle ear can cause a range of symptoms, including tinnitus and vertigo.