History of Present Illness (HPI)

The patient reports an acute injury to the left ear and face due to being punched with full force approximately one week ago. Since the incident, the patient has experienced a change in hearing and severe sinus congestion for the past seven days.

Differential Diagnosis

• Single Most Likely Diagnosis
  • Traumatic Hearing Loss: Given the history of a direct blow to the ear, the most likely cause of the patient's change in hearing is traumatic hearing loss, which could be due to a middle ear injury such as a perforated eardrum or ossicular disruption.
• Other Likely Diagnoses
  • Middle Ear Hematoma: A collection of blood in the middle ear space could cause hearing changes and is a plausible consequence of the trauma described.
  • Serous Otitis Media: The trauma could lead to an inflammatory response in the middle ear, resulting in fluid accumulation and hearing loss.
  • Sinusitis: The severe sinus congestion could be related to the facial trauma, leading to an infection or inflammation of the sinuses.
• Do Not Miss Diagnoses
  • Temporal Bone Fracture: Although less common, a fracture of the temporal bone is a serious condition that could result from significant trauma to the ear and requires prompt diagnosis and treatment to prevent complications such as facial nerve paralysis or cerebrospinal fluid leak.
  • Perforated Tympanic Membrane with CSF Leak: A perforation of the eardrum with an associated leak of cerebrospinal fluid is a potentially life-threatening condition that necessitates immediate medical intervention to prevent meningitis.
• Rare Diagnoses
  • Otosclerosis: While not directly related to trauma, otosclerosis (a condition of abnormal bone growth in the middle ear) could potentially cause hearing loss, though it would be an unusual coincidence in this context.
  • Eustachian Tube Dysfunction: Trauma could potentially lead to dysfunction of the Eustachian tube, affecting middle ear pressure regulation and leading to hearing changes, though this would be less common compared to other diagnoses listed.