Differential Diagnosis for Ear Irritation in an 83-year-old Female
- Single most likely diagnosis
- External Otitis (also known as swimmer's ear): This condition is likely given the patient's history of scratching her ear, which probably led to an abrasion in the ear canal. The increasing discomfort, especially with movement of the ear, is consistent with external otitis. The absence of fever and drainage also supports this diagnosis, as external otitis can present without these symptoms, especially in the early stages.
- Other Likely diagnoses
- Contact Dermatitis: Given the patient's report of dry skin and scratching, contact dermatitis is a possible diagnosis. This could be due to an allergic reaction or irritant dermatitis from scratching or using certain products in the ear.
- Ear Canal Abrasion or Laceration: The patient believes she sustained an abrasion to the ear canal, which could be the primary cause of her discomfort. This would be a direct result of the trauma from scratching.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignant Otitis Externa: Although rare, this condition is a serious infection of the external ear and skull base, more commonly seen in diabetic or immunocompromised patients. It requires prompt recognition and treatment to prevent serious complications.
- Necrotizing Otitis Externa: Similar to malignant otitis externa, this is a severe infection that can lead to significant morbidity if not recognized and treated early.
- Rare diagnoses
- Relapsing Polychondritis: This is a rare autoimmune disorder that can cause inflammation of the cartilage in the ear, among other areas. It could potentially cause ear discomfort and irritation but is much less likely given the patient's presentation.
- Ear Canal Cholesteatoma: A type of skin cyst in the ear canal that can cause discomfort and other symptoms. However, it is less likely given the acute onset and the patient's history of scratching her ear.