Causes of fluctuant hearing loss in AAD

Conductive

1)      OME

2)      Acute on chronic infection

3)      Fluid collection in middle ear decreasing hearing

4)      Small fluid collection or flake blocking the perforation & improving the hearing

5)      Minimal ossicular discontinuity

6)      ET tube dysfunction

SNHL

1)      Peri labyrinthine fistula

2)      Labyrinthitis

3)      Associated Meniere disease