A 76 years old man complains of decreased hearing in his right ear for the past 2 weeks associated with a full feeling in that ear. He has been wearing hearing aids for the past 10 years and tried changing the battery, but his symptoms persisted. He reports occasional sticky yellow drainage from the right east for the last few weeks, which he attempted to clean using cotton-tipped applicators. On physical exam the left tympanic membrane cannot be visualized due to the presence of sticky yellow wax in the ear canal. Only a minimal amount of cerumen is present in the left ear canal. What are the most important differential diagnoses?

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

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This post was written by Omar Rifai