Differential Diagnoses for Ear Impaction in an 81-Year-Old Female

Given the complex medical history of the patient, the differential diagnoses for ear impaction can be categorized as follows:

• Single Most Likely Diagnosis
  • Cerumen impaction: This is the most straightforward cause of ear impaction, especially in elderly patients who may have difficulty cleaning their ears properly or have a history of using cotton swabs, which can push cerumen deeper into the ear canal.
• Other Likely Diagnoses
  • External otitis: Given the patient's history of chronic conditions and potential for compromised immune status, external otitis (swimmer's ear) could be a consideration, especially if there's a history of recent water exposure or trauma to the ear canal.
  • Eustachian tube dysfunction: This condition can lead to a feeling of fullness in the ear and could be related to the patient's history of respiratory issues, such as COPD and asthma, which might affect Eustachian tube function.
• Do Not Miss Diagnoses
  • Malignancy (e.g., squamous cell carcinoma): Although less common, it's crucial not to miss a potential malignancy, especially in an elderly patient with a history of multiple chronic conditions. Unusual or persistent symptoms should prompt further investigation.
  • Foreign body: Especially if the patient has dementia or lives with someone who has, there's a possibility of an unnoticed foreign body in the ear, which could cause impaction or infection.
  • Nasopharyngeal carcinoma: This rare condition can cause Eustachian tube obstruction leading to ear symptoms. Given the patient's complex medical history, it's essential to consider rare but serious conditions.
• Rare Diagnoses
  • Relapsing polychondritis: An autoimmune condition that can affect the cartilage of the ear, leading to symptoms that might mimic ear impaction.
  • Granulomatosis with polyangiitis (formerly Wegener's granulomatosis): A rare autoimmune disorder that can affect various parts of the body, including the ears, and might cause symptoms similar to ear impaction.

Each of these diagnoses should be considered in the context of the patient's overall health status, medical history, and the specific symptoms presented. A thorough examination and potentially further diagnostic testing may be necessary to determine the exact cause of the ear impaction.