Differential Diagnosis for a 16-year-old with Possible Foreign Body in the Ear
- Single most likely diagnosis:
- Middle ear effusion: This is the most likely diagnosis given the patient's recent diagnosis of otitis media and improvement with antibiotics, but persistent decreased hearing. The middle ear effusion can cause decreased hearing and is a common complication of otitis media.
- Other Likely diagnoses:
- Cerumen impaction: The patient's concern about pushing a cotton ball into the ear canal could have caused a cerumen impaction, which can also lead to decreased hearing.
- Foreign body in the ear canal: Although the patient denies pain, a foreign body in the ear canal is still a possibility, especially if the patient did indeed push a cotton ball into the ear canal.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Mastoiditis: Although the patient has been taking antibiotics and reports improvement, mastoiditis is a potential complication of otitis media that can be life-threatening if not recognized and treated promptly.
- Intracranial complications of otitis media: Conditions such as meningitis, brain abscess, or lateral sinus thrombosis are rare but potentially deadly complications of otitis media that should not be missed.
- Rare diagnoses:
- Cholesteatoma: A rare condition where a skin cyst grows in the middle ear, which can cause decreased hearing and other complications.
- Otosclerosis: A rare condition where there is abnormal bone growth in the middle ear, which can cause decreased hearing.
- Eustachian tube dysfunction: A rare condition where the Eustachian tube is blocked, which can cause decreased hearing and other complications.