Which conditions should be considered in the differential diagnoses (DDx) of otitis externa (OE)?

Updated: Mar 09, 2020
  • Author: Ariel A Waitzman, MD, FRCSC; Chief Editor: Ravindhra G Elluru, MD, PhD  more...
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Failure to recognize necrotizing (ie, malignant) otitis externa (OE) is a significant pitfall. A patient who is diabetic or immunocompromised with severe pain in the ear should have necrotizing OE excluded by an otolaryngologist.

Problems to be considered include the following:

  • Ear canal trauma
  • Ear canal carcinoma
  • Otitis media with a perforation or ventilation tube present
  • Chondritis
  • Cranial nerve palsy
  • Hearing loss
  • Wisdom tooth eruption
  • Intracranial abscess
  • Cavernous sinus thrombosis
  • Ramsay Hunt syndrome
  • Furuncle
  • Skull base osteomyelitis
  • Preauricular cyst and fistula
  • Lacerations
  • Atopic dermatitis
  • Cerumen impaction
  • Exostosis and osteoma
  • Foreign body
  • Acute (bullous) and chronic (granular) myringitis

Although malignant tumors of the ear canal are rare, they do occur and sometimes are misdiagnosed as OE. [17] If the condition does not respond to treatment as expected, an otolaryngologist should evaluate the patient.

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