A 60-Year-Old Man Comes to the Office Due to Problems

A 60-year-old man comes to the office due to problems with his right hearing aid.  The patient has worn hearing aids for many years but recently got fitted for new molds because his old ones were cracked and would scratch his ear canals on insertion.  Over the past 2 days, he has had drainage from the right ear that causes the aid to become clogged.  His right ear canal also feels swollen, itchy, and painful.  It is unclear if the patient's hearing has changed because he cannot wear his aid.  He is not dizzy and does not have a sore throat, rhinorrhea, or cough.  The patient has no chronic medical conditions or prior surgeries.  Temperature is 37.0 C (98.6 F) , blood pressure is 146/92 mm Hg, and pulse is 90/min.  The right ear examination elicits moderate pain.  The ear canal is swollen, is erythematous, and has purulent drainage.  There is no granulation tissue, and the tympanic membrane is clear.  Cranial nerve function is normal.  Which of the following is the most likely diagnosis?

A) Acute otitis externa
B) Allergic contact dermatitis
C) Cerumen impaction
D) Cholesteatoma
E) Necrotizing (malignant) otitis externa
F) Serous otitis media with effusion

Correct Answer:

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