Case 1: 70-Year-Old with Ear Pain
A 70-year-old patient presents with ear pain and has experienced yellowish discharge for 2 months without any odor or fever. Pain medication is ineffective, and there is decreased hearing on the right side, along with facial nerve changes suggesting compression. There are no enlarged lymph nodes, tenderness, or itching, but the patient experiences vertigo. The patient is diabetic and not well-controlled.
Differential Diagnosis:
- Otitis media or externa, differentiated by tympanic membrane involvement.
- Given the duration of more than 3 weeks, the condition is chronic. Chronic otitis media typically lacks pain.
- Most likely diagnosis: Malignant otitis externa (lasting >2 months), characterized by narrowing, redness, and discharge.
Investigations:
- CT scan, MRI, culture, ESR, CRP.
Management:
- Suction
- 6-week course of IV antibiotics targeting Pseudomonas.
Case 2: 30-Year-Old Swimmer with Ear Discharge
A 30-year-old swimmer presents with a one-week history of yellowish ear discharge, itching, and hearing loss, but no vertigo.
Most Likely Diagnosis:
- Fungal infection, as the discharge is acute and painless.
Examination:
- Narrowing of the external canal with black heading.
Treatment:
- Suction
- Topical antifungal medication.
Case 3: Ear Pain and Discharge
A patient presents with ear pain, discharge, and hearing loss for one week.
Examination:
- Intact tympanic membrane
- Presence of ulcers, with a history of diabetes.
Treatment:
- Acyclovir
Case 4: Recurrent Ear Discharge in a 3-Year-Old Boy
A 3-year-old boy presents with recurrent ear discharge, ear pain, fever, severe headache, hearing loss, limited movement, and decreased feeding.
Diagnosis:
- Consider lumbar puncture if not contraindicated; otherwise, rule out with a CT scan.
Treatment:
- Antibiotics based on culture sensitivity
- Ventilation tube insertion.