Differential Diagnoses for Bilateral Ear Impaction

Single Most Likely Diagnosis

• Cerumen Impaction: The patient's history of recurrent earwax impaction, symptoms of hardness and altered auditory perception, and the presence of dry earwax on examination make cerumen impaction the most likely diagnosis. The use of Debrox, an over-the-counter earwax removal aid, further supports this diagnosis.

Other Likely Diagnoses

• Ear Canal Irritation: The patient's symptoms of irritation and the presence of Debrox solution in the ear canal could also suggest ear canal irritation, possibly caused by the use of earwax removal products or other irritants.
• Hearing Loss: The patient's report of improved hearing in one ear and altered auditory perception in the other ear could indicate a hearing loss condition, such as presbycusis or other age-related hearing impairments.
• Eustachian Tube Dysfunction: The patient's history of ear problems and symptoms of fullness or hardness in the ears could also suggest Eustachian tube dysfunction, which can cause ear pressure and hearing changes.

Do Not Miss Diagnoses

• Middle Ear Infection: Although the patient does not report pain or fever, a middle ear infection (otitis media) could still be present, especially if the earwax impaction has led to a secondary infection. Missing this diagnosis could lead to serious complications, such as mastoiditis or hearing loss.
• Perforated Tympanic Membrane: The patient's history of ear problems and the presence of Debrox solution in the ear canal could increase the risk of a perforated tympanic membrane, which would require prompt medical attention to prevent further complications.
• Cholesteatoma: A rare but serious condition, cholesteatoma, could be present if the patient has a history of recurrent ear infections or earwax impaction. This condition requires prompt surgical intervention to prevent serious complications, such as brain abscess or meningitis.

Rare Diagnoses

• Ear Canal Tumor: Although rare, a tumor in the ear canal could cause symptoms of earwax impaction, hearing loss, or ear canal irritation. A thorough examination and diagnostic testing would be necessary to rule out this possibility.
• Relapsing Polychondritis: This rare autoimmune disorder could cause ear canal inflammation and destruction, leading to symptoms of earwax impaction or hearing loss. A thorough medical history and diagnostic testing would be necessary to diagnose this condition.