Differential Diagnosis
- Single most likely diagnosis
- Furunculosis (boil) of the outer ear canal: This is the most likely diagnosis given the patient's presentation of a small, swollen lump in the outer ear canal, which is tender to palpation and has been bleeding. The recent ear cleaning and infection also support this diagnosis.
- Other Likely diagnoses
- Otitis externa: This is an infection of the outer ear canal, which could be related to the ear cleaning and subsequent infection. The patient's symptoms of a tender ear and bleeding from the outer ear canal are consistent with this diagnosis.
- Allergic rhinitis: The patient's cough, which is worse at night and with exercise, could be related to allergic rhinitis, especially given the patient's exposure to mould in their rental property.
- Asthma: The patient's cough, which is worse with exercise, could also be related to asthma, although the lack of shortness of breath and wheeze on examination make this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Necrotizing otitis externa: This is a rare but serious infection of the outer ear canal that can be life-threatening if not treated promptly. Although the patient's symptoms do not currently suggest this diagnosis, it is important to consider it given the patient's recent infection and bleeding from the outer ear canal.
- Pulmonary embolism: Although the patient's symptoms do not currently suggest this diagnosis, a cough can be a presenting symptom of a pulmonary embolism, and it is important to consider this diagnosis in any patient with a cough, especially if they have risk factors for thromboembolism.
- Rare diagnoses
- Relapsing polychondritis: This is a rare autoimmune disorder that can cause inflammation of the cartilage in the ear, leading to symptoms such as ear pain and bleeding. Although the patient's symptoms do not currently suggest this diagnosis, it is a rare possibility to consider.
- Granulomatosis with polyangiitis: This is a rare autoimmune disorder that can cause inflammation of the blood vessels, leading to symptoms such as ear pain and bleeding. Although the patient's symptoms do not currently suggest this diagnosis, it is a rare possibility to consider.