Differential Diagnosis for Sudden Hearing Loss

The patient presents with a history of complete deafness in the left ear and significant hearing loss in the right ear, now having only 1/3 of normal hearing. This condition requires a thorough evaluation to determine the underlying cause. The differential diagnoses can be categorized as follows:

• Single Most Likely Diagnosis
  • Presbycusis with Superimposed Sudden Sensorineural Hearing Loss (SSNHL): Given the progressive nature of hearing loss, especially if the patient is of advanced age, presbycusis could be a baseline condition. The sudden worsening in the right ear could be due to SSNHL, which is an emergency requiring prompt treatment.
• Other Likely Diagnoses
  • Meniere's Disease: This condition affects the inner ear, leading to vertigo, tinnitus, and hearing loss, which can fluctuate and worsen over time. The patient's symptoms could be consistent with advanced Meniere's disease affecting both ears at different stages.
  • Ototoxicity: Exposure to certain drugs or chemicals can cause hearing loss. If the patient has been exposed to such substances, ototoxicity could be a likely cause, especially if the hearing loss is bilateral and progressive.
  • Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain can cause hearing loss, usually starting in one ear. While less common, it's a possible explanation for the patient's symptoms, especially if there's a history of tinnitus or balance issues.
• Do Not Miss Diagnoses
  • Stroke or Cerebrovascular Accident (CVA): Although less common, a stroke affecting the auditory pathways can cause sudden hearing loss. Given the potential for severe consequences if missed, stroke must be considered, especially if there are other neurological symptoms.
  • Multiple Sclerosis: This autoimmune disease can affect any part of the brain and spinal cord, including areas responsible for hearing. While rare, hearing loss can be a presenting symptom, and missing this diagnosis could lead to delayed treatment of a potentially disabling condition.
  • Cerebellopontine Angle (CPA) Tumors: Similar to acoustic neuromas but can include other types of tumors in the CPA, these can cause hearing loss, among other symptoms. Early detection is crucial for effective management.
• Rare Diagnoses
  • Autoimmune Inner Ear Disease: A rare condition where the body's immune system attacks the inner ear, leading to hearing loss. It can be bilateral and progressive.
  • Cogan Syndrome: A rare disorder characterized by recurrent corneal inflammation and vestibular-auditory symptoms, including hearing loss. It's an important consideration in patients with atypical features or systemic symptoms.
  • Sjögren's Syndrome: An autoimmune disorder that can affect various parts of the body, including the ears, leading to hearing loss. It's more commonly associated with dry eyes and mouth but can have systemic manifestations.

Each of these diagnoses requires a different approach to management and treatment, emphasizing the need for a comprehensive diagnostic evaluation.