Differential Diagnosis for 58-year-old Male with Muffled Hearing Loss
Single Most Likely Diagnosis
- Cerumen Impaction: This is a common cause of sudden, unilateral, or bilateral hearing loss, especially in the absence of infection or allergy symptoms. The intermittent nature of the hearing loss initially, which became constant, could be due to the gradual buildup of cerumen.
Other Likely Diagnoses
- Middle Ear Effusion: This condition can cause muffled hearing due to fluid accumulation in the middle ear, often without signs of acute infection. It could be a secondary effect of Eustachian tube dysfunction.
- Eustachian Tube Dysfunction: This condition can lead to hearing loss due to the inability of the middle ear to regulate air pressure, causing a feeling of fullness or muffled hearing.
- Presbycusis: Although typically bilateral and gradual, presbycusis (age-related hearing loss) could contribute to or exacerbate other conditions leading to noticeable hearing loss.
Do Not Miss Diagnoses
- Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause unilateral hearing loss, among other symptoms. Early detection is crucial for effective management.
- Stroke or Transient Ischemic Attack (TIA): Though less common, sudden hearing loss can be a symptom of a stroke or TIA, especially if accompanied by other neurological deficits.
- Meniere's Disease: An inner ear disorder that can cause vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. The hearing loss can be fluctuating, which might initially present as intermittent.
Rare Diagnoses
- Otosclerosis: A condition in which there is abnormal bone growth in the middle ear, which can cause hearing loss. It is less common and typically presents with progressive hearing loss.
- Autoimmune Inner Ear Disease: A rare condition where the body's immune system attacks the inner ear, leading to sudden hearing loss, often in both ears.
- Cogan's Syndrome: A rare disorder characterized by recurrent corneal inflammation and vestibular-auditory symptoms, including hearing loss.