Differential Diagnosis
- Single most likely diagnosis
- Conductive hearing loss in the left ear: The Weber test lateralizing to the right suggests that the patient has better bone conduction in the right ear, which could be due to a conductive hearing loss in the left ear. The positive Rinne test bilaterally indicates that air conduction is better than bone conduction in both ears, which is consistent with conductive hearing loss.
- Other Likely diagnoses
- Sensorineural hearing loss in the left ear: Although less likely, a sensorineural hearing loss in the left ear could also cause the Weber test to lateralize to the right. However, this would typically result in a negative Rinne test, so it's less likely given the positive Rinne test bilaterally.
- Middle ear pathology (e.g., otosclerosis, middle ear effusion): These conditions can cause conductive hearing loss, which could lead to the observed test results.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acoustic neuroma: Although rare, an acoustic neuroma could cause sensorineural hearing loss and should be considered, especially if there are other symptoms such as vertigo, tinnitus, or facial weakness.
- Otosclerosis with a cochlear component: This condition can cause mixed hearing loss (both conductive and sensorineural) and should be considered if the patient has a history of hearing loss or other symptoms.
- Rare diagnoses
- Superior canal dehiscence: This rare condition can cause conductive hearing loss and should be considered if the patient has other symptoms such as vertigo or sound-induced vertigo.
- Patulous Eustachian tube: This condition can cause autophony and hearing symptoms, but it's less likely to cause the observed test results.