A 35 years old man presents with a 2-day history of rapid-onset severe ear pain and fullness. The patient complains of otorrhea and mild decreased hearing, which he reports began after swimming. On examination he is afebrile and the external ear canal is diffusely swollen and erythematous. He has tenderness of the tragus and pain with movement of the auricle. The tympanic membrane is only partially visualized due to the swelling. What are the most important differential diagnoses?

Of the relevant differential diagnoses, it is important to rule out cholesteatoma, otosclerosis, tympanosclerosis, tympanic membrane perforation and foreign body obstruction.

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This post was written by Omar Rifai