Differential Diagnosis for Sudden Bilateral Hearing Loss
- Single most likely diagnosis
- Presbycusis with sudden onset: This is a common condition in the elderly, where age-related hearing loss can present suddenly due to various factors such as changes in the inner ear or auditory nerve. The patient's age and lack of trauma or infection make this a plausible explanation.
- Other Likely diagnoses
- Sudden sensorineural hearing loss (SSNHL): This condition is characterized by a sudden loss of hearing, often in one ear, but can be bilateral. It can be caused by viral infections, vascular disorders, or other factors. The patient's denial of fever or trauma does not rule out this condition.
- Earwax impaction: Although the patient denies placing anything in her ears, earwax can still accumulate and cause hearing loss. This is a common and easily treatable condition.
- Middle ear effusion: Fluid buildup in the middle ear can cause hearing loss, and the patient's denial of nasal congestion or rhinorrhea does not entirely rule out this condition, as it can be caused by other factors such as Eustachian tube dysfunction.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Stroke or cerebrovascular accident (CVA): Although less likely, a stroke can cause sudden hearing loss, especially if it affects the auditory pathways in the brain. Given the patient's age, this is a critical diagnosis to consider.
- Acoustic neuroma: A benign tumor on the auditory nerve can cause sudden hearing loss, and although rare, it is essential to rule out due to its potential impact on the patient's quality of life.
- Rare diagnoses
- Autoimmune inner ear disease: This is a rare condition where the immune system attacks the inner ear, causing hearing loss.
- Otosclerosis: A rare condition where abnormal bone growth in the middle ear causes hearing loss.
- Meniere's disease: A disorder of the inner ear that can cause sudden hearing loss, vertigo, and tinnitus, although the patient does not report the latter two symptoms.