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Updated 22 September 2015

What's your diagnosis? – Case 28: painful ear

Mr T is a 32 year old mechanical engineer with a very painful left ear. See if you can figure out the cause of his problem.

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Mr T, a 32-year-old mechanical engineer, has had significant pain and discomfort in his left ear over the past week. At first he thought it might be due to a bout of flu he suffered a week before, but when he noticed a discharge from his ear, he decided to go to the doctor.

The following is a summary of the doctor's notes:

History:

One week history of progressively worsening pain in left ear. Associated with discharge.

Swam in a heated pool two weeks ago.

Pain not relieved by simple pain medication.

Reports decrease in hearing ability.

Had an upper respiratory tract infection about a week ago which cleared.

No other medical or surgical history.

Smoker, but does not use alcohol.

On examination:

Generally well. Temperature: 36,9

Large lymph node just below left ear.

All systems found to be normal om examination.

Right ear: normal examination

Left ear: red, irritated external ear. Some yellow fluid draining from ear canal. Patient reports increase in pain with touch to the pinna and tragus.

Otoscopy: very swollen, inflamed ear canal, so much so that the otoscope speculum can not be passed into the ear canal. Unable to see the eardrum.

In the light of the information above, what is the most likely cause of Mr T's condition?

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? -  Case 1: vomiting and weight loss

What's your diagnosis? -  Case 2: eye pain

What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

What's your diagnosis? - Case 6: runner with seizures

What's your diagnosis? - Case 7: swollen knee

What's your diagnosis? - Case 8: bloody semen

What's your diagnosis? - Case 9: confusing neurological signs

What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis? - Case 11: bruising with no apparent reason

What's your diagnosis? - Case 12: severe tummy pain

What's your diagnosis? - Case 13: severe sore throat

What's your diagnosis? - Case 14: abdominal pain and swelling

What's your diagnosis? - Case 15: the world is spinning

What's your diagnosis? - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? - Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

What's your diagnosis? – Case 20: chest pain next to breastbone

What's your diagnosis? – Case 21: burning sensation in vagina

What's your diagnosis? – Case 22: vomiting and headaches

What's your diagnosis? – Case 23: frequent urination

What's your diagnosis? – Case 24: painful and swollen leg

What's your diagnosis? – Case 25: swollen knee and fever

What's your diagnosis? – Case 26: swelling of face

What's your diagnosis? – Case 27: sudden, severe leg pain

 
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