Differential Diagnosis
- Single most likely diagnosis
- E. Tympanic membrane epithelium and keratin debris accumulation: This is likely due to the patient's history of tympanostomy tubes and the presence of a pearly white mass behind the intact tympanic membrane, suggesting a cholesteatoma. Cholesteatomas are known to occur in patients with a history of chronic ear infections, ear trauma, or previous ear surgery, and can cause persistent ear discharge, hearing loss, and other complications.
- Other Likely diagnoses
- A. Acute middle ear effusion with concurrent tympanic membrane inflammation: Although the patient has been treated with antibiotics, a persistent middle ear effusion could still be present, causing the immobile tympanic membrane and conductive hearing loss.
- C. External ear canal epithelial maceration and inflammation: The presence of scant, yellow, malodorous discharge in the right ear canal could suggest an external ear canal infection, which could be contributing to the patient's symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D. Schwannoma formation with cochlear nerve injury: Although rare, a schwannoma (a type of tumor) could be causing the patient's symptoms, including hearing loss and ear discharge. It is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Rare diagnoses
- B. Chronic foreign body impaction with external ear canal abrasion: This diagnosis is less likely, as there is no history of foreign body insertion, and the patient's symptoms do not suggest an external ear canal abrasion.
- Other rare diagnoses, such as a middle ear tumor or a congenital abnormality, could also be considered, but are less likely given the patient's history and presentation.