A 57-year-old man presents to the office with a complaint of left ear drainage

Full Answer Section

• Medications: What medications is the patient currently taking?

Additional Objective Findings

• Otoscopy: A thorough examination of the ear canal and tympanic membrane should be performed to assess for any signs of infection, inflammation, or perforation.
• Neurological examination: A neurological examination should be performed to assess for any facial nerve weakness or other neurological deficits.
• Examination of the nose and throat: The nose and throat should be examined to assess for any underlying infections or conditions that may be contributing to the ear drainage.

Diagnostic Examination

• Culture of ear discharge: A culture of the ear discharge should be obtained to identify any potential pathogens, such as bacteria or fungi.

Differential Diagnoses

1. Acute otitis media: This is a common cause of ear pain and drainage. It is characterized by inflammation and infection of the middle ear.  
   1. Ear Infection (Otitis Media): Symptoms, Causes & Treatment - Cleveland Clinic

   

   my.clevelandclinic.org

   2. Acute Otitis Media in Adults - DynaMed

   

   www.dynamed.com
2. Chronic otitis media: This is a long-standing inflammation of the middle ear that can lead to persistent drainage and hearing loss.
3. External otitis: This is an infection of the outer ear canal, often caused by bacteria or fungi. It can be associated with pain, itching, and drainage.  
   1. Otitis Externa - StatPearls - NCBI Bookshelf

   

   www.ncbi.nlm.nih.gov

Rationales for Differential Diagnoses

• Acute otitis media: The patient's history of ear pain and recent onset of drainage are consistent with acute otitis media. The presence of white exudate in the ear canal is also a common finding in this condition.
• Chronic otitis media: If the patient has a history of recurrent ear infections or persistent ear drainage, chronic otitis media may be considered.
• External otitis: The presence of crusting and white exudate in the ear canal suggests the possibility of external otitis. However, the patient's lack of significant pain or itching makes this diagnosis less likely.

It is important to note that these are just a few possible differential diagnoses, and other conditions may also be considered based on the patient's clinical presentation and additional findings.

Sample Answer

To further understand the patient's condition, it would be helpful to obtain the following additional subjective data:

• History of ear infections: Has the patient experienced ear infections in the past?
• Recent upper respiratory infections: Has the patient had any recent colds, flu, or sinus infections?
• Allergies: Does the patient have any allergies, particularly to medications or environmental factors?
• Associated symptoms: Are there any associated symptoms, such as fever, hearing loss, dizziness, or facial weakness?