Differential Diagnosis for Outer Ear Pain at Night

• Single Most Likely Diagnosis
  • Earwax Impaction: This is a common condition where the earwax blocks the ear canal, causing pain, especially if the earwax is pushed further into the canal while sleeping on the affected side. The pain can worsen at night due to increased pressure on the ear canal.
• Other Likely Diagnoses
  • Otitis Externa (Swimmer's Ear): An infection of the outer ear canal, often caused by bacterial or fungal infections. It can cause severe pain, especially at night, and is more common in individuals who swim frequently or have excessive moisture in the ear.
  • Eustachian Tube Dysfunction: This condition affects the tube that connects the middle ear to the back of the nose and throat. Dysfunction can lead to pain, especially if the individual is lying down, as it can cause or exacerbate middle ear pressure issues.
  • Temporomandibular Joint (TMJ) Disorder: While primarily affecting the jaw, TMJ disorders can radiate pain to the outer ear, especially at night if the individual clenches or grinds their teeth during sleep.
• Do Not Miss Diagnoses
  • Malignancy (e.g., Squamous Cell Carcinoma): Although rare, any persistent or severe ear pain, especially if accompanied by other symptoms like hearing loss, discharge, or a mass, should prompt an investigation for malignancy to avoid delayed diagnosis.
  • Necrotizing Otitis Externa: A severe infection of the outer ear that can spread to the skull base. It's more common in diabetic or immunocompromised patients and requires prompt treatment to prevent serious complications.
• Rare Diagnoses
  • Relapsing Polychondritis: A rare autoimmune disorder that can cause cartilage inflammation, including the cartilage of the outer ear, leading to pain and other symptoms.
  • Ramsay Hunt Syndrome Type 2: Caused by the varicella-zoster virus, this condition can lead to ear pain, usually accompanied by a rash and sometimes facial paralysis. It's a rare but important diagnosis to consider due to its potential for serious complications if not treated promptly.