88 Y/O male with chief c/o Decreased hearing in left ear and Aural fullness

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I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

CASE

This is a case of a 88 year old Male admitted in the ward, with a complaints of 

• Decreased hearing and fullness in left ear 
• Pain in Knee and distal phalanx

 History Of Presenting illness:

 Patient was apparently asymptomatic 4 years ago, after which he devloped pain in Knee joint and Distal Phalanx which was insidious in onset, Gradually progressive , Dull aching type in nature, not radiating , aggregated on physical activity and relieved temporarily on rest and medication.

3 months ago, pt. had complaints of decreased hearing and fullness in ear, which was insidious in onset, Gradually progressive, no aggravating or relieving factors

History of Past illness:

• H/o Abdominal surgery 20 years ago (omentoplasty?) Abdominal scar present 
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• H/o cataract surgery in left eye 1 year ago.
• No h/o HTN, DM, Epilepsy, asthma, CAD

Personal History:

• Diet- mixed
• Apetite- decreased since 15 days
• Seep- adequateo
• Bowel and bladder: Normal
• No Addictions

Family history:

 No Similar history 

Allergic history:

No known allergies

General physical examination-

Patient is C/C/C. 

Vitals 

PR: 74 bpm

BP - 124/80 mm Hg

RR - 16/min

Temp - Afebrile 

No Pallor, icterus , cyanosis , clubbing , lymphadenopathy ,edema

SYSTEMIC EXAMINATION

CVS 

Cardiac sounds :- S1 & S2 - Present

Cardiac murmurs :- NO 

RESP. SYSTEM

Dyspnoea : NO

Position of Trachea : Central

Breadth Sounds : Vesicular +

ABDOMEN

Shape of abdomen : flat

Tenderness : NO

Palpable Mass : NO

Liver : Not Palpable

Bowel sounds: Yes

C.N.S

Level of consciousness : Consciousness: Conscious / Alert 

Speech : Normal

Signs of Meningeal irritation a)Neck stuffiness: NO b)Kernig's sign: NO

Cranial nerves- Normal

Motor system

Power: 5/5 in both UL and LL

Tone- normal 

Bulk - decreased

Reflexes:

Biceps, Triceps Supinator Knee reflexes intact (++) 

No cerebellar signs noticed

Investigations:-

Probable Diagnosis:-

Senile Osteoarthritis?  

Age related hearing loss (Presbycusis?)