In a woman with left‑sided hearing loss, tinnitus, autophony, a normal tympanic membrane, and a preserved stapedial reflex, what is the most likely diagnosis?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 10, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Superior Semicircular Canal Dehiscence (SSCD)

The most likely diagnosis is C. Superior semicircular canal dehiscence (SSCD), based on the combination of autophony, hearing loss, tinnitus, and critically—a preserved stapedial reflex. 1

Key Diagnostic Reasoning

The preserved stapedial reflex is the critical distinguishing feature in this case:

  • SSCD preserves the stapedial reflex because the "third-window" effect does not interfere with middle ear mechanics or stapedius muscle function 1
  • Otosclerosis characteristically produces an absent or diminished stapedial reflex due to stapes fixation impairing reflex transmission 1
  • This single finding effectively rules out otosclerosis (option A) despite both conditions causing hearing loss

Why Not Patulous Eustachian Tube?

While patulous eustachian tube (PET) can present with autophony, several features make it less likely:

  • Autophony in SSCD includes voice sounds, which can be easily mistaken for PET autophony 2
  • 94% of SSCD patients experience voice autophony, creating diagnostic confusion with PET 2
  • PET typically shows tympanic membrane movement with respiration on otoscopy 3, 4, which is not mentioned in this case
  • PET patients often report improvement with head-dependent positioning (65%) and sniffing (28%) 4, features not described here
  • The normal tympanic membrane on examination makes PET less likely, as PET frequently shows an atrophic drum 3, 5

Confirming the Diagnosis

High-resolution CT of the temporal bone is the definitive test to directly visualize the superior semicircular canal dehiscence 1

Vestibular evoked myogenic potential (VEMP) testing shows abnormally reduced thresholds in SSCD, providing supportive objective evidence before imaging 1

Clinical Pitfall to Avoid

The most common diagnostic error is mistaking SSCD autophony for patulous eustachian tube, as both present with troublesome autophony of one's own voice 2. The preserved stapedial reflex and absence of tympanic membrane respiratory movement are key differentiators pointing toward SSCD rather than PET.

References

1
Guideline

Diagnostic Criteria and Evaluation for Superior Semicircular Canal Dehiscence (SSCD)

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Research

Diagnosis and management of the patulous eustachian tube.

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2007

3
Research

Autophony and the patulous eustachian tube.

The Laryngoscope, 1981

4
Research

Patulous Eustachian Tube Dysfunction: Patient Demographics and Comorbidities.

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2017

5
Research

[Patulous eustachian tube--diagnosis and therapy].

Wiener medizinische Wochenschrift (1946), 2000

Related Questions

What is the most likely diagnosis in a female patient with left‑sided hearing loss, tinnitus, autophony, a normal tympanic membrane, and a preserved stapedial reflex?
How does an anticholinergic (anticholinergic) spray help alleviate symptoms of a patulous Eustachian tube?
What are the implications of a patulous Eustachian tube (ET) following an adenoidectomy?
What causes a hypermobile eardrum?
What are the treatment options for ear crackling?
What is the appropriate management of a severe hemolytic crisis in an adult with warm autoimmune hemolytic anemia?
What are the first‑line and second‑line treatments for constipation?
How should I manage an 8-year-old female with a two‑week history of productive cough, nasal congestion, pleuritic chest pain, tachycardia, normal oxygen saturation, normal respiratory rate, afebrile temperature, and a past medical history of allergic rhinitis, suspected atypical bronchitis due to Mycoplasma pneumoniae (M. pneumoniae)?
In a 78‑year‑old man with an isolated elevated alkaline phosphatase, how can I determine whether the abnormality is due to bone disease or liver disease?
What is the first-line antibiotic regimen for an otherwise healthy adult with uncomplicated cystitis and no β‑lactam allergy?
Can hydromorphone extended‑release be started while a palliative care patient is already on a fentanyl transdermal patch?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question