A 55 years old female presents with tinnitus, dizziness and h/o progressive deafness. Differential diagnosis includes all except:

Ans. is 'd' i.e. Histiocytosis X It is very well known that first 3 options i.e., Acoustic neuroma, endolymphatic hydrops (Miniers disease), and Meningioma can cause tinnitus and u/1 progressive deafness, (although Menier disease is usually b/l but initial presentation is u/l and the other ear is also involved in a few years).About Histiocytosis X, I have not read anywhere straight forward symptoms of tinnitus & u/l deafness. But in disseminated and Multifocal Langerhans cell histiocytosis, recurrent episodes of otitis media and mastoiditis are common (and these can cause tinnitus and progressive hearing loss )Leaving these complexities of symptoms, Histiocytosis X can be easily ruled out on age basis.All three -Acoustic neuroma, Endolymphatic hydrops and meningioma are common in middle age group i.e., 30-35 to 60 yrs.But Histiocytosis X is seen only in children and young adults.There are 3 forms of Histiocytosis X:Letterer Siwe disease - seen in young children upto 2 yrs of ageHand Schuller Christian disease- childrenEosinophilic granuloma - children and young adults