Acute Stroke: This is the most likely diagnosis given the combination of confusion (indicating possible cerebral involvement), facial twitch (which could be a sign of motor cortex or cranial nerve involvement), and unilateral hearing loss (suggesting involvement of the auditory pathway). Stroke can present with a wide range of neurological deficits depending on the area of the brain affected.

Multiple Sclerosis (MS): MS can cause a variety of neurological symptoms, including confusion, facial twitching, and hearing loss, due to demyelination in different parts of the central nervous system. The symptoms can be quite varied and depend on the location of the lesions.
Meningitis: Inflammation of the meninges can cause confusion, and depending on the extent and location of the inflammation, could potentially cause facial twitching and hearing loss, especially if cranial nerves are involved.
Brain Tumor: A tumor in the brain, depending on its location, could cause confusion, facial twitching (if it affects motor areas or cranial nerves), and unilateral hearing loss (if it affects the auditory pathway).

Cerebral Vasculitis: This is an inflammation of the blood vessels in the brain and can cause a wide range of neurological symptoms, including those mentioned. It's crucial to diagnose and treat promptly to prevent further brain damage.
Subarachnoid Hemorrhage: Bleeding into the space surrounding the brain can cause sudden onset of severe headache, confusion, and other neurological deficits. It's a medical emergency that requires immediate attention.
Encephalitis: Inflammation of the brain tissue, usually due to viral infections, can cause confusion, seizures, and other neurological symptoms. Prompt diagnosis and treatment are essential to prevent long-term damage.

Neurosyphilis: A late manifestation of syphilis infection that can cause a wide range of neurological symptoms, including confusion, hearing loss, and facial twitching, due to inflammation and damage to various parts of the brain and nervous system.
Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes (MELAS): A rare mitochondrial disorder that can cause stroke-like episodes, leading to a variety of neurological symptoms, including those mentioned.
Lyme Disease (Neuroborreliosis): In rare cases, Lyme disease can cause neurological symptoms, including meningitis, encephalitis, and cranial neuritis, which might present with confusion, facial twitching, and hearing loss.