Differential Diagnosis for 73-year-old Female with Ear Fullness
- Single most likely diagnosis
- Cerumen Impaction: The patient's symptoms of ear fullness and clogged sensation, along with the presence of discharge, suggest a possible blockage of the ear canal. The use of Debrox, an earwax dissolver, also points towards cerumen impaction as the primary diagnosis. The absence of pain, fever, or dizziness further supports this diagnosis.
- Other Likely diagnoses
- Eustachian Tube Dysfunction: The patient's complaint of ear fullness and the associated symptom of nasal congestion could indicate Eustachian tube dysfunction, which is common in older adults. This condition can lead to a feeling of fullness or pressure in the ear.
- Middle Ear Effusion: The presence of discharge on the pillow and the sensation of ear fullness could also suggest a middle ear effusion, which is a collection of fluid in the middle ear space. This condition can occur without significant pain or fever.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignant Otitis Externa: Although less likely, malignant otitis externa is a serious infection of the external ear canal that can be life-threatening, especially in older adults or those with compromised immune systems. The absence of pain does not rule out this diagnosis, as it can present atypically in this population.
- Petrous Apicitis: This is a rare but serious infection of the petrous portion of the temporal bone. It can present with ear fullness, discharge, and other nonspecific symptoms, making it a "do not miss" diagnosis due to its potential for severe complications.
- Rare diagnoses
- Relapsing Polychondritis: This is a rare autoimmune disorder that can affect the cartilage of the ear, leading to symptoms such as ear fullness and discharge. It is less likely but should be considered in the differential diagnosis due to its potential for significant morbidity.
- Nasopharyngeal Carcinoma: Although very rare, nasopharyngeal carcinoma can present with ear fullness and nasal congestion due to Eustachian tube obstruction. This diagnosis is important to consider due to its potential impact on prognosis and treatment.