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NR 569/ NR569
NR 569/ NR569 FINAL EXAM STUDY GUIDE:
DIFFERENTIAL DIAGNOSIS IN ACUTE CARE | QS & AS|
GRADE A| (NEW 2026/ 2027) CHAMBERLAIN
1. Otitis barotrauma: aggravated by URI hay fever middle ear effusions stuffy
nose decent in airplane
2. Eustachitis: inflammation of the eustachian tube
Tympanic membrane shows decreased mobility
Decreased conductive hearing
Impedance
3. Ramsay Hunt Syndrome (RHS): Herpes zoster with vesicular rash,
ipsilateral facial paralysis, ear pain with vesicles in auditory canal, auricle.
May cause vertigo, headache, fever, malaise.
Risk factors: past varicella infection, age, immunocompromised, autoimmune
disorders.
4. Malignant otitis externa (MOE): Necrotizing external otitis.
NR 569/ NR569
,Severe otalgia and otorrhea unresponsive to topical treatment. Pain worse at
night and with chewing.
Risk factors: age, DM, immunocompromised.
5. Auricle Hematoma: Collection of blood within the outer ear cartilage.
Also referred to as "cauliflower ear".
Typically occurs due to blunt trauma/sports.
Ear swelling with or without pain.
6. cholesteatoma: Abnormal non-cancerous skin growth behind TM.
keratinized mass in the mastoid or middle ear which can be associated with
intracranial complications.
Patients suspected of having a cholesteatoma should be assessed for
facial nerve palsy and intracranial abscess. Causes: repeated AOM. Pain,
foul-smelling drainage, hearing loss, pressure, vertigo. May cause facial
muscle paralysis.
7. ROS: EAR
, 3
NR 569/ NR569
Have you noticed any drainage or blood coming from the ear?: Purulent
drainage is a commonly reported finding with AOE and cholesteatoma but
may not be present.
Drainage is not associated with AOM and OME unless the TM has ruptured.
8. Ear pain/infection: Differentials:
9. Otitis media with effusion (OME): Otitis media with effusion (OME) is fluid
in the middle ear, without the presence of infection.
Causes: URI, barotrauma, allergies, or a recent AOM infection. Mild pain,
conductive hearing loss may be present.
Air bubbles are seen behind the TM.
10. Ear pain/infection: Management: ear pain may be treated with OTC
analgesics
avoid scratching, tugging, or inserting anything in the
ear, including cotton-tipped swabs reinforce water
precautions with TM ruptured avoid getting water in
NR 569/ NR569
, the ear during bathing/shower avoid submerging ear
under water
11. Acute Mastoiditis: *Bacterial infection of the mastoid process*
presents clinically with the same signs and symptoms as acute otitis medial
with the addition of *inflammation and palpatory tenderness over the
mastoid*, hearing loss is commonly associated with it,
tympanic membrane is red, bulging, and immobile bc associated otitis media,
should be suspected when discharge from middle ear is continuous for >10
days
12. TMJ Dysfunction: referred ear pain acute: pain with opening mouth
extremely wide chronic: malocclusion (from enlarged masseter
muscles)/arthritis of TMJ clicking
palpable crepitus
13. impacted cerumen: rarely bilateral recurrent problem normal otologic
findings
NR 569/ NR569
NR 569/ NR569 FINAL EXAM STUDY GUIDE:
DIFFERENTIAL DIAGNOSIS IN ACUTE CARE | QS & AS|
GRADE A| (NEW 2026/ 2027) CHAMBERLAIN
1. Otitis barotrauma: aggravated by URI hay fever middle ear effusions stuffy
nose decent in airplane
2. Eustachitis: inflammation of the eustachian tube
Tympanic membrane shows decreased mobility
Decreased conductive hearing
Impedance
3. Ramsay Hunt Syndrome (RHS): Herpes zoster with vesicular rash,
ipsilateral facial paralysis, ear pain with vesicles in auditory canal, auricle.
May cause vertigo, headache, fever, malaise.
Risk factors: past varicella infection, age, immunocompromised, autoimmune
disorders.
4. Malignant otitis externa (MOE): Necrotizing external otitis.
NR 569/ NR569
,Severe otalgia and otorrhea unresponsive to topical treatment. Pain worse at
night and with chewing.
Risk factors: age, DM, immunocompromised.
5. Auricle Hematoma: Collection of blood within the outer ear cartilage.
Also referred to as "cauliflower ear".
Typically occurs due to blunt trauma/sports.
Ear swelling with or without pain.
6. cholesteatoma: Abnormal non-cancerous skin growth behind TM.
keratinized mass in the mastoid or middle ear which can be associated with
intracranial complications.
Patients suspected of having a cholesteatoma should be assessed for
facial nerve palsy and intracranial abscess. Causes: repeated AOM. Pain,
foul-smelling drainage, hearing loss, pressure, vertigo. May cause facial
muscle paralysis.
7. ROS: EAR
, 3
NR 569/ NR569
Have you noticed any drainage or blood coming from the ear?: Purulent
drainage is a commonly reported finding with AOE and cholesteatoma but
may not be present.
Drainage is not associated with AOM and OME unless the TM has ruptured.
8. Ear pain/infection: Differentials:
9. Otitis media with effusion (OME): Otitis media with effusion (OME) is fluid
in the middle ear, without the presence of infection.
Causes: URI, barotrauma, allergies, or a recent AOM infection. Mild pain,
conductive hearing loss may be present.
Air bubbles are seen behind the TM.
10. Ear pain/infection: Management: ear pain may be treated with OTC
analgesics
avoid scratching, tugging, or inserting anything in the
ear, including cotton-tipped swabs reinforce water
precautions with TM ruptured avoid getting water in
NR 569/ NR569
, the ear during bathing/shower avoid submerging ear
under water
11. Acute Mastoiditis: *Bacterial infection of the mastoid process*
presents clinically with the same signs and symptoms as acute otitis medial
with the addition of *inflammation and palpatory tenderness over the
mastoid*, hearing loss is commonly associated with it,
tympanic membrane is red, bulging, and immobile bc associated otitis media,
should be suspected when discharge from middle ear is continuous for >10
days
12. TMJ Dysfunction: referred ear pain acute: pain with opening mouth
extremely wide chronic: malocclusion (from enlarged masseter
muscles)/arthritis of TMJ clicking
palpable crepitus
13. impacted cerumen: rarely bilateral recurrent problem normal otologic
findings
