Differential Diagnosis for White Ear Inner TM

• Single most likely diagnosis
  • Middle ear effusion: This is the most common cause of a white appearance of the inner tympanic membrane (TM), often due to fluid accumulation behind the eardrum, which can be a result of an upper respiratory infection, allergies, or Eustachian tube dysfunction.
• Other Likely diagnoses
  • Tympanic membrane perforation with cholesteatoma: A perforation in the eardrum can sometimes appear white due to the presence of a cholesteatoma, which is an abnormal skin growth in the middle ear.
  • Otosclerosis: This condition involves abnormal bone growth in the middle ear, which can cause a white appearance on the tympanic membrane due to the involvement of the ossicles or the eardrum itself.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Nasopharyngeal carcinoma: Although rare, this type of cancer can cause Eustachian tube obstruction leading to middle ear effusion, which might present with a white tympanic membrane. Early detection is crucial for treatment and prognosis.
  • Lymphoma: Similar to nasopharyngeal carcinoma, lymphoma can cause obstruction or direct involvement of the Eustachian tube or middle ear, leading to effusion and a white appearance of the tympanic membrane.
• Rare diagnoses
  • Otomycosis: A fungal infection of the external auditory canal can sometimes extend to the middle ear, causing a white appearance due to fungal growth.
  • Congenital cholesteatoma: A rare condition where a skin cyst is present in the middle ear at birth, which can appear as a white mass behind the tympanic membrane.