Differential Diagnosis for Ear Fullness and Pain with Normal Exam

• Single most likely diagnosis
  • Eustachian tube dysfunction: This condition is a common cause of ear fullness and pain, often related to issues with the Eustachian tube's ability to regulate air pressure in the ear. It can be triggered by allergies, colds, or sinus infections, and a normal exam does not rule out this functional issue.
• Other Likely diagnoses
  • Middle ear effusion: Although the exam is normal, a middle ear effusion (fluid behind the eardrum) can sometimes be difficult to detect without specific tests like tympanometry. It can cause ear fullness and pain.
  • Temporomandibular joint (TMJ) disorder: TMJ disorders can refer pain to the ear area and cause a sensation of fullness, even if the ear exam itself is normal.
  • Sinusitis: Sinus infections can cause referred pain to the ears, especially if the Eustachian tube is affected, leading to ear fullness.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Acoustic neuroma: A rare tumor on the nerve connecting the inner ear to the brain, which can cause ear fullness and pain, among other symptoms. Early detection is crucial.
  • Mastoiditis: An infection of the mastoid bone in the skull, which can be life-threatening if not treated promptly. It might not always present with obvious signs on a basic ear exam.
  • Petrous apicitis: A rare but serious infection of the petrous part of the temporal bone, which requires prompt diagnosis and treatment to prevent serious complications.
• Rare diagnoses
  • Meniere's disease: A disorder of the inner ear that affects balance and hearing, causing symptoms like ear fullness, vertigo, and tinnitus. It's less common but should be considered in the differential.
  • Otosclerosis: A type of bone growth in the middle ear that can cause hearing loss and ear fullness. It's relatively rare and might not be immediately suspected with a normal ear exam.