Differential Diagnosis for Bruising on the External Acoustic Meatus with Pain while Chewing

• Single most likely diagnosis:
  • Temporomandibular Joint (TMJ) Disorder: This condition is characterized by pain in the jaw area, which can radiate to the ear, and is often exacerbated by chewing. The bruising on the external acoustic meatus could be related to trauma or inflammation in the surrounding area, possibly due to a TMJ disorder.
• Other Likely diagnoses:
  • Trauma to the Ear or Jaw: Direct trauma to the ear or jaw can cause bruising on the external acoustic meatus and pain while chewing due to the injury itself or subsequent inflammation.
  • Ear Infection (Otitis Externa): An infection of the outer ear canal can cause pain, especially when chewing, due to the movement of the jaw and its proximity to the ear. Bruising could be present if there was trauma or severe infection.
  • Dental Problems: Issues such as abscesses, impacted teeth, or severe tooth decay can cause referred pain to the ear area and discomfort while chewing. The bruising might be less directly related but could occur due to trauma from a dental procedure or severe infection.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Temporal Arteritis: Although less common, temporal arteritis (giant cell arteritis) can cause jaw claudication (pain when chewing) and could potentially lead to bruising if there's associated trauma or inflammation. Missing this diagnosis could lead to serious complications, including vision loss.
  • Malignancy: Rarely, pain while chewing and bruising on the external acoustic meatus could be signs of a malignancy affecting the jaw, ear, or surrounding structures. Early detection is crucial for effective treatment.
• Rare diagnoses:
  • Relapsing Polychondritis: A rare autoimmune disorder that can cause cartilage inflammation, potentially affecting the ear and leading to pain and bruising. It's a less common condition but should be considered in the differential diagnosis due to its potential for significant morbidity.
  • Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can affect various parts of the body, including the ears, and cause a wide range of symptoms, including pain and bruising. It's essential to consider this in the differential due to its potential severity and the need for prompt treatment.