Hearing Loss, Differential Diagnosis

DDx

Causes occurring within the Auditory System (Peripheral and Central) vs. Outside the Auditory System.

Presbycusis
Cerumen
Otitis media, otitis externa
Noise exposure
Acoustic neuroma
Meniere’s disease
Otosclerosis
Sudden sensorineural hearing loss
Viral Cochleitis (herpes, influenza, mumps, others)
Lyme disease
Syphilis
Meningitis
Drugs (aspirin, gentamicin, furosemide, cisplatin)
Stroke
Hereditary, congenital hearing loss
Trauma, barotrauma
Cholesteatoma
Neoplasm
Autoimmune hearing loss
Stroke, transient ischemic attack
Multiple sclerosis
Diabetes
Superior semicircular canal dehiscence

 

** Check out table 2 in the DAI 2011 article below, it gives a very orderly treatment of the differential for hearing loss.

The following table is an abridged version of Table 2 in that article.

Synopsis of the causes and clinical features of hearing impairment, with differential diagnoses for each hearing impairment syndrome
Conductive hearing loss Sensory hearing loss Neural hearing loss Central hearing loss
Cause
  • acoustic-mechanical disturbance of sound conduction in the external auditory canal, across the tympanic membrane, or in the ossicular chain
  • dysfunction of the hair cells or their synaptic connections to the cochlear nerve; if the outer hair cells are affected, loss of cochlear amplification and thus of recruitment of intermediate intensities
  • blurring of frequency resolution
  • reduction of temporal resolution
  • cochlear nerve dysfunction
  • delayed impulse conduction
  • disturbed neural encoding of the acoustic signal
  • dysfunction of the auditory pathway or auditory cortex (processing of bilateral auditory stimuli, synchronization, signal modulation, recognition, noise suppression)
Differential diagnosis Acute:

  • blockage by cerumen
  • tubular catarrh
  • tympanic effusion
  • traumatic eardrum perforation
  • acute otitis media or externa

Permanent:

  • canal stenosis/atresia
  • defect of eardrum or ossicular chain due to chronic purulent infection of the mucosa
  • cholesteatoma
  • malformation
  • otosclerosis
  • tympanosclerosis
 Acute:

  • idiopathic sudden sensorineural hearing loss
  • acute noise-induced trauma
  • blast trauma
  • explosion trauma
  • bacterial/viral labyrinthitis

Hereditary/permanent::

  • hereditary hearing impairment
  • presbycusis
  • noise-induced hearing impairment
  • toxic (incl, drug-induced) hearing impairment
  • idiopathic chronic progressive hearing impairment
  • drug side effects
  • lasting sequelae of infections and sudden hearing loss
  • acoustic neuroma (= vestibular schwannoma)
  • other tumors of the petrous bone or cerebellopontine angle (meningioma, chordoma, chondrosarcoma)
  • compression syndrome
  • infarction
  • hemorrhage
  • tumor
  • multiple sclerosis
  • auditory processing disorder

 

Further Reading

Dtsch Arztebl Int. 2011 Jun; 108(25): 433–444. The Differential Diagnosis of Hearing Loss. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139416/

Am Fam Physician. 2003 Sep 15;68(6):1125-1132. https://www.aafp.org/afp/2003/0915/p1125.html

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