Differential Diagnosis for Unilateral Hearing Loss, Vertigo, Nausea, Vomiting, and Raised WCC

• Single Most Likely Diagnosis

  • Labyrinthitis: This condition, which involves inflammation of the inner ear, can cause unilateral hearing loss, vertigo, nausea, and vomiting. The raised white cell count (WCC) could be indicative of an infectious or inflammatory process, making labyrinthitis a plausible diagnosis given the combination of symptoms.

• Other Likely Diagnoses

  • Vestibular Neuronitis: Although typically not associated with hearing loss, some cases can present with unilateral hearing symptoms. It causes vertigo and nausea, and while the raised WCC might not be a direct correlation, it could be part of a broader inflammatory response.
  • Meniere's Disease: Characterized by episodes of vertigo, hearing loss, tinnitus, and ear fullness, Meniere's could fit the symptoms if the hearing loss is unilateral and the raised WCC is considered a secondary or unrelated finding.
  • Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause unilateral hearing loss and balance problems. However, acute symptoms like nausea and vomiting, along with a raised WCC, would be less typical and might suggest an alternative or additional diagnosis.

• Do Not Miss Diagnoses

  • Cerebellopontine Angle (CPA) Tumors: While similar to acoustic neuromas, these tumors are located at the cerebellopontine angle and can cause a range of symptoms including hearing loss, vertigo, and raised intracranial pressure, which might indirectly cause nausea and vomiting. A raised WCC could indicate an associated infection or inflammation.
  • Stroke or Transient Ischemic Attack (TIA): Although less likely to cause a raised WCC, a stroke or TIA in the posterior circulation can present with vertigo, nausea, vomiting, and unilateral hearing loss if the auditory pathways are involved. Given the potential for severe outcomes, it's crucial not to miss this diagnosis.
  • Multiple Sclerosis: An episode of vertigo, unilateral hearing loss, and raised WCC could be part of a demyelinating event in multiple sclerosis, especially if other neurological symptoms are present.

• Rare Diagnoses

  • Syphilis (Otosyphilis): A rare cause of hearing loss and vertigo, especially in the context of congenital or late-stage syphilis. The raised WCC could be part of the systemic infection.
  • Autoimmune Inner Ear Disease: This condition can cause rapidly progressive hearing loss, often bilateral but can be unilateral, and may be associated with vertigo. Systemic symptoms, including a raised WCC, can occur due to the autoimmune nature of the disease.
  • Sarcoidosis: Although rare, sarcoidosis can affect the inner ear and cause hearing loss, vertigo, and systemic symptoms including a raised WCC due to granulomatous inflammation.