Differential Diagnosis for Right Ear Pain
The patient presents with right ear pain, a feeling of ear blockage, intermittent head pain, hearing loss, and a need to pop the ear. The symptoms started two weeks ago and have been exacerbated by swimming in the ocean. Here is a differential diagnosis organized into categories:
- Single Most Likely Diagnosis
- Otitis Externa (Swimmer's Ear): This is the most likely diagnosis given the patient's history of swimming in the ocean and using OTC ear drops with some relief. Otitis externa is an inflammation of the outer ear and ear canal, often caused by bacterial or fungal infections, and is common in individuals who swim frequently.
- Other Likely Diagnoses
- Middle Ear Effusion: The patient's symptoms of ear blockage, hearing loss, and the need to pop the ear suggest a possible middle ear effusion, which is a collection of fluid in the middle ear space. This can be caused by a variety of factors, including upper respiratory infections or eustachian tube dysfunction.
- Eustachian Tube Dysfunction: The patient's symptoms of ear blockage and the need to pop the ear suggest possible eustachian tube dysfunction, which can be caused by a variety of factors, including allergies, colds, or sinus infections.
- Do Not Miss Diagnoses
- Mastoiditis: Although less likely, mastoiditis is a serious infection of the mastoid bone that can cause symptoms similar to those presented by the patient, including ear pain and headache. It is a potential complication of untreated or inadequately treated otitis media.
- Temporal Arteritis: This is a condition characterized by inflammation of the temporal arteries, which can cause headache, ear pain, and hearing loss. Although it is less common, it is a "do not miss" diagnosis due to the potential for serious complications, including vision loss.
- Rare Diagnoses
- Ramsay Hunt Syndrome: This is a rare condition caused by the varicella-zoster virus, which can cause ear pain, hearing loss, and facial weakness. Although it is less likely, it should be considered in the differential diagnosis, especially if the patient presents with additional symptoms such as facial weakness or vesicles in the ear.
- Cholesteatoma: This is a rare condition characterized by a skin cyst in the middle ear, which can cause symptoms such as ear pain, hearing loss, and discharge. Although it is less likely, it should be considered in the differential diagnosis, especially if the patient presents with persistent or recurrent symptoms.