Differential Diagnosis for 71 yo male patient with left ear issues
- Single most likely diagnosis
- Eustachian tube dysfunction: The patient's symptoms of hissing in the left ear when blowing his nose suggest an issue with the Eustachian tube, which connects the middle ear to the back of the nose and throat. The history of sinusitis with MRSA in 2016 and similar symptoms at that time support this diagnosis, as Eustachian tube dysfunction can be a complication of sinusitis.
- Other Likely diagnoses
- Patulous Eustachian tube: This condition, where the Eustachian tube remains open, can cause autophony (hearing internal sounds, such as breathing or chewing) and could be related to the hissing sound the patient experiences.
- Middle ear effusion: The patient's history of sinusitis and current symptoms could suggest a middle ear effusion, which is a buildup of fluid in the middle ear.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Nasopharyngeal carcinoma: Although rare, nasopharyngeal carcinoma can cause Eustachian tube obstruction and should be considered, especially given the patient's age and history of sinusitis.
- Skull base osteomyelitis: This is a rare but serious condition that can occur as a complication of sinusitis or other infections and can affect the Eustachian tube and surrounding structures.
- Rare diagnoses
- Superior semicircular canal dehiscence: This is a rare condition where there is an abnormal opening in the bone over the superior semicircular canal, which can cause autophony and other auditory symptoms.
- Otosclerosis: This is a rare condition where there is abnormal bone growth in the middle ear, which can cause hearing loss and other symptoms, including autophony.