Differential Diagnosis for Patient with Fullness and Pulsatile Tinnitus in Left Ear
- Single most likely diagnosis:
- Cerumen impaction or external ear canal obstruction: The presence of three white bumps around the ear canal opening, which could be cerumen (earwax) or other debris, along with the symptoms of fullness and hearing the heartbeat in the ear (pulsatile tinnitus), suggests an obstruction in the ear canal. This condition can cause the sensation of hearing internal sounds, including heartbeat, more prominently.
- Other Likely diagnoses:
- Eczema or contact dermatitis: The small amount of redness around the ear canal could indicate an allergic reaction or irritation, possibly due to earrings, earbuds, or other products used in the ear. This could contribute to discomfort and potentially to the sensation of fullness.
- Otitis externa (swimmer's ear): An infection of the outer ear canal, which could be suggested by the redness and the presence of bumps or debris in the ear canal. However, the absence of more significant signs of infection (such as more pronounced redness, swelling, or discharge) makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Temporal arteritis or giant cell arteritis: Although less common, this condition can cause pulsatile tinnitus and should be considered, especially in older adults. It's a medical emergency due to the risk of vision loss.
- Carotid artery stenosis or other vascular abnormalities: Pulsatile tinnitus can be a symptom of vascular issues, including stenosis of the carotid artery. Identifying and treating these conditions is crucial to prevent stroke.
- Rare diagnoses:
- Glomus tumor: A rare, benign tumor of the middle ear that can cause pulsatile tinnitus due to its location near major blood vessels. It's less likely but should be considered if other diagnoses are ruled out.
- Patent eustachian tube or eustachian tube dysfunction: Abnormalities in the eustachian tube function can lead to a sensation of fullness and autophony (hearing internal sounds unusually loudly), but this would not directly explain the white bumps or redness around the ear canal.