A 37 years old man presents with hearing loss and a painful intermittent purulent discharge from his right ear. He also reports intermittent dizziness, and tinnitus in the right ear. On otoscopy, he has an attic crust on his right tympanic membrane, Otoscopic examination reveals keratin in an attic retraction pocket. Sound localizes to his right ear on Weber test and Rinne test reveals that bone conduction one the right. What are the most important differential diagnoses?

Of the relevant differential diagnoses, it is important to rule out otitis (AOE, AOM, effusion) and foreign body obstruction.

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This post was written by Omar Rifai