Differential Diagnosis for 15-year-old Female with Ear Symptoms
- Single most likely diagnosis
- Otitis externa (recurrent): Given the patient's history of otitis externa, recent increase in ear pain after showering, and presence of ear canal swelling with erythema, this diagnosis is the most likely. The fact that symptoms resolved with antibiotics previously but have now recurred suggests a possible recurrence or incomplete treatment.
- Other Likely diagnoses
- Eustachian tube dysfunction: The sensation of water in the ear and intermittent ear pain could be related to Eustachian tube dysfunction, especially if the patient has a history of autism, which may affect sensory processing and lead to unusual perceptions of ear fullness.
- Middle ear effusion: Although the patient denies fever or URI symptoms, a middle ear effusion could still be present, causing ear pain and a sensation of fullness, especially if the effusion is chronic.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignant otitis externa: Although rare, this condition can be life-threatening, especially in immunocompromised patients. The patient's history of recurrent otitis externa and presence of significant ear pain warrants consideration of this diagnosis.
- Petrous apicitis: This is a rare but serious complication of otitis media that can present with ear pain and other neurological symptoms. Although unlikely, it is crucial to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Rare diagnoses
- Cholesteatoma: A rare condition where a skin cyst grows in the middle ear, potentially causing ear pain, fullness, and other symptoms. The patient's history of recurrent ear infections increases the risk of developing a cholesteatoma.
- Labyrinthitis: Inflammation of the inner ear can cause ear pain, vertigo, and hearing loss. Although rare, this condition should be considered in patients with persistent ear symptoms and no clear diagnosis.