Differential Diagnosis

The patient's symptoms of a "wet and yeasty" ear, pain on palpation, increased ringing, itchiness, and pain upon pressure suggest an ongoing or unresolved ear condition. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Chronic Otitis Externa: This condition is characterized by inflammation of the outer ear canal, often caused by bacterial or fungal infections. The patient's description of her ear feeling "wet and yeasty" and itchy, along with pain on palpation, aligns with symptoms of otitis externa, particularly if the initial antibiotic and steroid treatment did not fully resolve the infection or if the condition has become chronic.

• Other Likely Diagnoses

  • Fungal Otitis Externa: Given the "wet and yeasty" description, a fungal infection of the outer ear canal is possible, especially if the patient has been in a humid environment or has a history of fungal infections.
  • Allergic Contact Dermatitis: The itchy sensation could be indicative of an allergic reaction to something in the ear canal, such as ear drops or a hearing aid.
  • Eustachian Tube Dysfunction: This condition could lead to a feeling of fullness or pressure in the ear, potentially causing discomfort or pain, especially if the patient has a history of allergies or colds.

• Do Not Miss Diagnoses

  • Malignant Otitis Externa: Although rare, this condition is a severe infection of the outer ear and skull cartilage, often seen in diabetic or immunocompromised patients. It requires prompt diagnosis and treatment to prevent serious complications.
  • Necrotizing Otitis Externa: A severe form of otitis externa that can lead to significant tissue damage and spread to surrounding bone and cartilage, particularly in immunocompromised individuals.
  • Middle Ear Pathology (e.g., Cholesteatoma): Conditions affecting the middle ear, such as a cholesteatoma, could cause similar symptoms and require urgent attention to prevent further complications like hearing loss or neurological issues.

• Rare Diagnoses

  • Relapsing Polychondritis: An autoimmune disorder that can cause cartilage inflammation, potentially affecting the ear and leading to pain and other symptoms.
  • Sarcoidosis: A condition that can affect multiple parts of the body, including the ears, leading to inflammation and potentially causing the symptoms described.
  • Ear Canal Tumors: Benign or malignant tumors in the ear canal could cause a range of symptoms, including pain, itching, and a feeling of fullness, although these are relatively rare.