Painful swelling of ear in a middle aged man

A 35-year-old man presented to the ear, nose, and throat outpatient department with a 1-week history of painful swelling of the right ear. He was having recurrent episodes of similar illness in both ears, for the past 5 years, for which he was treated multiple times with antibiotics and analgesics. These episodes used to subside themselves or with the above medications.

He also complaints of a 3-months history of weight loss, fatigue, and generalized aches.

relapsing polychondritis

On examination

  • Right pinna was tender, edematous and erythematous. Ear lobule was spared. The tympanic membrane was appearing normal.
  • No significant positive finding in the left ear.
  • Nose: Saddle-nose deformity present.
  • Oral cavity: Normal
  • Oropharynx: Normal
  • Throat: Normal
  • The costochondral joints were tender on palpation, and the right knee was swollen and tender.

Lab studies

  • Routine lab investigation values were within normal limits, except for an elevated ESR of more than 120 mm per hour (reference range, 0 to 15).

Questions

  1. What is your provisional diagnosis?
Otitis Externa
Cauliflower Ear
Relapsing polychondritis
Wegener's

Explanation

Provisional diagnosis is Relapsing polychondritis.

Relapsing polychondritis, a systemic autoimmune condition that affects cartilaginous structures, particularly of the ears, nose, joints, larynx, and large airways.

Meet the author

Dr Sanu P Moideen is an Indian-born oto-rhino-laryngologist (ENT) based in Cochin, Kerala, India. He is currently working as Post-Doctoral Fellow in Head and Neck Oncology at Regional Cancer Center, Trivandrum, Kerala.

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