Differential Diagnosis

The patient presents with a plugged right ear, occasional ear pain, and a history of recurrent ear issues. The following differential diagnoses are considered:

• Single most likely diagnosis
  • Otitis media with effusion (OME): The patient's history of recurrent ear issues, recent cold-like symptoms, and the presence of a brownish-colored tympanic membrane (TM) with reduced visibility suggest a high likelihood of OME. The recent use of nasal spray and exposure to someone with strep throat may have contributed to the development of OME.
• Other Likely diagnoses
  • Acute otitis externa: The patient's history of ear issues, recent cold-like symptoms, and the presence of tenderness during inspection of the right ear canal suggest a possible diagnosis of acute otitis externa.
  • Eustachian tube dysfunction: The patient's symptoms of a plugged ear and occasional ear pain, particularly with the history of recurrent ear issues and recent cold-like symptoms, may indicate Eustachian tube dysfunction.
  • Tubal occlusion: Given the patient's history of tube placement and the recent symptoms, there is a possibility of tubal occlusion, which could be causing the plugged ear sensation.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Mastoiditis: Although less likely, mastoiditis is a serious condition that can arise from untreated or complicated otitis media. The patient's history of recurrent ear issues and recent symptoms warrant consideration of this diagnosis.
  • Petrous apicitis: This rare but serious condition can occur as a complication of otitis media. Although unlikely, it is essential to consider this diagnosis due to the potential for severe consequences if missed.
  • Lateral sinus thrombosis: This condition is a rare but potentially life-threatening complication of otitis media. Although unlikely, it is crucial to consider this diagnosis due to the potential for severe consequences if missed.
• Rare diagnoses
  • Cholesteatoma: Although rare, cholesteatoma can occur in patients with a history of recurrent ear issues and may cause symptoms similar to those presented by the patient.
  • Middle ear tumor: Although extremely rare, middle ear tumors can cause symptoms such as a plugged ear, ear pain, and hearing loss. This diagnosis is considered due to the patient's history of recurrent ear issues and the presence of a brownish-colored TM.