Differential Diagnosis for Yellowish Amber Discharge from Both Ears

The patient presents with yellowish amber discharge from both ears, discomfort, more severe pain in the right ear, occasional hearing deficits, and no recent head cold or flu. Given these symptoms, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Otitis Externa (Swimmer's Ear): This condition is characterized by inflammation of the outer ear and ear canal, often presenting with discharge, pain, and sometimes hearing loss. The absence of preceding upper respiratory infection and the presence of visible discharge support this diagnosis.
• Other Likely Diagnoses
  • Chronic Suppurative Otitis Media: This condition involves a chronic infection of the middle ear and can present with discharge, hearing loss, and ear pain. The presence of discharge and hearing deficits makes this a plausible diagnosis.
  • Acute Otitis Media with Perforation: Although less likely given the absence of a recent upper respiratory infection, a perforated eardrum can lead to discharge and pain. The severity of pain, especially in the right ear, could suggest this possibility.
• Do Not Miss Diagnoses
  • Malignant Otitis Externa: A severe infection of the outer ear that can spread to surrounding bone and tissue, more common in diabetic or immunocompromised patients. Although rare, it's critical to consider due to its potential severity and complications.
  • Petrous Apicitis: A rare but serious infection of the petrous part of the temporal bone, which can present with ear pain, discharge, and neurological symptoms. Early diagnosis is crucial to prevent serious complications.
• Rare Diagnoses
  • Relapsing Polychondritis: An autoimmune disorder that can affect the cartilage of the ears, among other areas, leading to inflammation and potential discharge. This diagnosis would be considered if other, more common causes are ruled out and there are additional systemic symptoms.
  • Tuberculous Otitis Media: A rare form of tuberculosis that affects the middle ear, presenting with discharge, hearing loss, and sometimes facial paralysis. This would be a consideration in areas where tuberculosis is prevalent or in patients with known TB exposure.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and potentially, further diagnostic testing to determine the underlying cause of the symptoms.