Differential Diagnosis for Female Patient with Left Hearing Loss (HL) and Tinnitus

Single Most Likely Diagnosis

• B. Patulous Eustachian Tube: This condition is characterized by the abnormal patency of the Eustachian tube, leading to autophony (hearing one's own internal sounds unusually loudly), which matches the patient's symptoms. The presence of a normal tympanic membrane and preserved stapedial reflex also supports this diagnosis, as patulous Eustachian tube does not typically affect the tympanic membrane's appearance or the reflexes of the middle ear.

Other Likely Diagnoses

• C. Superior Semicircular Canal Dehiscence (SSCD): This condition involves an abnormal opening in the bone overlying the superior semicircular canal of the inner ear. It can cause autophony, hearing loss, and tinnitus, among other symptoms. The preserved stapedial reflex does not rule out SSCD, but the diagnosis often requires specific imaging (e.g., CT scan of the temporal bone) for confirmation.
• A. Otosclerosis: Although otosclerosis can cause hearing loss and tinnitus, it typically affects the stapedial reflex, leading to its absence or reduction due to fixation of the stapes bone. The presence of a preserved stapedial reflex makes otosclerosis less likely but does not entirely rule it out, especially if the disease process is early or not significantly affecting stapes mobility.

Do Not Miss Diagnoses

• Middle Ear or Inner Ear Tumors: Although rare, tumors such as acoustic neuromas or other lesions affecting the middle or inner ear could potentially cause the described symptoms. These conditions are critical to diagnose early due to their potential impact on hearing, balance, and even life if left untreated. The normal appearance of the tympanic membrane does not exclude the possibility of a tumor, especially if it is located deeper in the ear or in the inner ear structures.

Rare Diagnoses

• Other Inner Ear Abnormalities: Conditions such as enlarged vestibular aqueduct syndrome or other congenital inner ear anomalies could potentially cause similar symptoms. These are less common and might require specific diagnostic tests, including imaging and possibly genetic testing, for identification.
• Perilymphatic Fistula: This is a rare condition involving an abnormal connection (fistula) in the inner ear, which can cause a variety of symptoms including hearing loss, tinnitus, and autophony. It is often associated with trauma, barotrauma, or intense physical exertion.