Differential Diagnoses for the Patient
The patient presents with a complex medical history and current complaints of bilateral ear impaction. Considering her symptoms and history, the following differential diagnoses are organized into categories:
- Single Most Likely Diagnosis
- Cerumen impaction: This is the most likely diagnosis given the patient's complaint of bilateral ear impaction and history of similar episodes. The use of Debrox, an over-the-counter earwax removal aid, further supports this diagnosis.
- Other Likely Diagnoses
- External otitis: Although the patient does not report pain, external otitis could be considered, especially if the ear impaction leads to infection or inflammation of the outer ear canal.
- Middle ear effusion: Given the patient's history of congestion and potential for Eustachian tube dysfunction, especially with her history of COPD and asthma, middle ear effusion could be a contributing factor to her symptoms.
- Presbycusis: As an 81-year-old, the patient is at risk for age-related hearing loss, which could be exacerbated by or contribute to her perception of ear impaction.
- Do Not Miss Diagnoses
- Malignant otitis externa: Although rare, this condition can be life-threatening, especially in diabetic or immunocompromised patients. While the patient does not have a documented history of diabetes, her complex medical history warrants consideration of this diagnosis.
- Cholesteatoma: A type of skin cyst in the middle ear, cholesteatoma can cause hearing loss, dizziness, and other symptoms. It is a serious condition that requires prompt medical attention.
- Acoustic neuroma: A benign tumor on the nerve connecting the inner ear to the brain, acoustic neuroma can cause hearing loss, balance problems, and other symptoms. Given the patient's age and symptoms, this diagnosis should not be missed.
- Rare Diagnoses
- Relapsing polychondritis: An autoimmune disorder that can cause cartilage inflammation, including in the ears, relapsing polychondritis is a rare condition that could potentially contribute to the patient's symptoms.
- Otosclerosis: A type of bone growth in the middle ear, otosclerosis can cause hearing loss and other symptoms. While rare, it should be considered in the differential diagnosis, especially if other causes are ruled out.