Differential Diagnosis for 30-year-old Female with Ear Pain
- Single most likely diagnosis
- Otitis Externa: This condition, also known as swimmer's ear, is characterized by inflammation of the outer ear canal. The patient's symptoms of ear pain, clogged sensation, and pain with movement of the pinna (the outer part of the ear) are classic for otitis externa. The presence of canal swelling and tenderness with movement of the pinna further supports this diagnosis. The lack of systemic symptoms such as fever and the absence of erythema surrounding the ear also point towards a localized infection like otitis externa.
- Other Likely diagnoses
- Earwax Impaction: This could cause a clogged sensation in the ear and might lead to discomfort or pain, especially if the wax is pushing against the eardrum or the ear canal is irritated. However, the presence of canal swelling and tenderness, along with lymph node swelling, makes otitis externa more likely.
- Middle Ear Infection (Otitis Media): Although less likely given the absence of symptoms like nasal congestion, rhinorrhea, or fever, otitis media could present with ear pain. The key distinguishing feature here is the pain with movement of the pinna and the specific location of the lymph node swelling, which is more suggestive of an external ear issue.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Mastoiditis: This is an infection of the mastoid bone in the skull, located behind the ear. It can arise as a complication of untreated or inadequately treated otitis media. Although the patient does not have typical symptoms of mastoiditis like fever, headache, or signs of more severe illness, any infection in the ear area warrants consideration of this potentially serious condition due to its proximity and potential for severe complications.
- Temporal Bone Osteomyelitis: A rare but serious infection of the temporal bone, which could present with ear pain and swelling. The absence of systemic symptoms and specific findings like cranial nerve palsies makes this less likely, but it remains a critical diagnosis not to miss due to its potential severity.
- Rare diagnoses
- Relapsing Polychondritis: An autoimmune disorder that can cause cartilage inflammation, including the cartilage of the ear. While it could explain the ear pain and swelling, it is a rare condition and would typically be associated with other systemic symptoms or involvement of other cartilaginous structures.
- Necrotizing Otitis Externa: A severe form of otitis externa that can progress to involve the temporal bone and surrounding structures. It is more common in diabetic or immunocompromised patients and presents with severe pain and systemic symptoms, which are not described in this case.