Differential Diagnosis for Intermittent Right Ear Pain
- Single most likely diagnosis
- External ear canal trauma or abrasion: The patient's history of using a Q-tip to clean his ear, followed by the onset of pain and initial bleeding, strongly suggests a traumatic cause to the external ear canal. This is a common issue due to the delicate nature of the ear canal and the ease with which it can be damaged by objects like Q-tips.
- Other Likely diagnoses
- Cerumen impaction: Although the patient was cleaning his ear, it's possible that instead of removing earwax, he might have pushed it further into the ear canal, causing an impaction. This can lead to pain and potentially some bleeding if the ear canal is scratched.
- Otitis externa (swimmer's ear): This is an infection of the outer ear canal and can be precipitated by trauma to the canal, which could have been caused by the Q-tip. However, the absence of discharge and fever makes this less likely but still a consideration.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Temporal bone fracture: Although the trauma was described as minor, any head or ear trauma warrants consideration of a temporal bone fracture, especially if there are other symptoms such as hearing loss (which is not present in this case) or neurological deficits. This condition is critical and requires immediate medical attention.
- Perforated eardrum (tympanic membrane perforation): Direct trauma to the ear, such as with a Q-tip, can cause a perforation of the eardrum. While the patient does not report hearing loss, a perforation could still occur without significant auditory symptoms initially.
- Rare diagnoses
- Relapsing polychondritis: This is a rare autoimmune disorder that can cause cartilage inflammation, including that of the ear. It might present with ear pain and could potentially follow minor trauma, although it is much less common.
- Ear canal cholesteatoma: A type of skin cyst in the ear canal that can cause destruction of the surrounding bone and tissue. It is rare and usually presents with more chronic symptoms, including hearing loss and discharge, which are not mentioned in this scenario.