Differential Diagnosis for Ongoing Congestion and Swallowing Difficulty

• Single most likely diagnosis:
  • Allergic Rhinitis: This is a common condition that can cause chronic congestion, especially if the patient has not tried any over-the-counter (OTC) medications. The symptoms of shortness of breath when eating and clogged ears are consistent with nasal congestion and Eustachian tube dysfunction often seen in allergic rhinitis.
• Other Likely diagnoses:
  • Chronic Sinusitis: This condition can cause prolonged congestion and difficulty swallowing due to postnasal drip. The feeling of ear pressure is also consistent with sinusitis, as the Eustachian tubes can be affected.
  • Nasal Polyps: These growths can cause chronic congestion and difficulty swallowing by obstructing the nasal passages and sinuses.
  • Gastroesophageal Reflux Disease (GERD): Although the patient does not report pain, GERD can cause difficulty swallowing (dysphagia) and may contribute to a feeling of congestion due to acid reflux potentially irritating the throat.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Nasopharyngeal Cancer: Although rare, this type of cancer can cause nasal congestion, difficulty swallowing, and ear fullness due to the tumor's location and potential to obstruct the Eustachian tubes.
  • Thyroid Cancer or Goiter: Enlargement of the thyroid gland can compress the esophagus, leading to difficulty swallowing, and may also cause respiratory symptoms if it compresses the trachea.
• Rare diagnoses:
  • Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can cause chronic sinusitis, nasal congestion, and difficulty swallowing due to granulomatous inflammation in the respiratory tract.
  • Relapsing Polychondritis: An autoimmune disorder that can cause cartilage inflammation, potentially affecting the ears, nose, and trachea, leading to symptoms like congestion and difficulty swallowing.