Differential Diagnosis
- Single most likely diagnosis
- Gastroesophageal reflux disease (GERD): The feeling of needing to burp that never goes away and excessive burping without relief are classic symptoms of GERD. The condition can also lead to ear symptoms due to Eustachian tube dysfunction, which could explain the blocked ear and crackly sounds.
- Other Likely diagnoses
- Laryngopharyngeal reflux (LPR): Similar to GERD, LPR can cause excessive burping and ear symptoms due to the reflux of stomach acid into the throat and Eustachian tube.
- Eustachian tube dysfunction: This condition can cause ear fullness, blockage, and crackly sounds, and can be related to the burping symptoms if the Eustachian tube is not functioning properly.
- Sinusitis or allergies: These conditions can cause Eustachian tube dysfunction and ear symptoms, and may also contribute to burping if there is associated swallowing of air.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Esophageal rupture or perforation: Although rare, this condition can cause severe chest pain, difficulty swallowing, and burping, and requires immediate medical attention.
- Otitis media or mastoiditis: If the ear symptoms are due to an infection, it is essential to diagnose and treat promptly to avoid complications such as hearing loss or brain abscess.
- Gastric cancer: Although unlikely, gastric cancer can cause symptoms similar to GERD, and it is essential to rule out this diagnosis, especially in older adults or those with a family history.
- Rare diagnoses
- Achalasia: A rare motility disorder of the esophagus that can cause difficulty swallowing, regurgitation, and burping.
- Zenker's diverticulum: A rare condition where a pouch forms in the pharynx, which can cause difficulty swallowing, regurgitation, and burping.
- Patulous Eustachian tube: A rare condition where the Eustachian tube remains open, causing ear fullness, hearing loss, and autophony (hearing one's own breathing sounds).