Case of the Month #23: Ear Pain by Dr Lorraine de Gray

Published: 03/01/2023


The patient described the pain as a constant drone in the background with lancinating episodes of severe pain interspersed in between. It had stopped responding to Paracetamol and the GP had prescribed Oramorph, of which the patient was taking 2.5mg at a time, five times per day with some relief.

Mr P had significant other co-morbidities, including AF for which he was on Edoxaban, he was very frail and had a history of recurrent falls. He suffered from Chronic Obstructive Pulmonary disease for which he was on inhalers. He had had intermittent courses of steroid in the past. He was sleeping poorly due to the pain and becoming quite withdrawn as a result, losing weight as he felt unable to eat due to pain exacerbated by swallowing. 

He had no teeth but had well fitting dentures which he did not report any issues with.

Mr P suffered from long standing spinal pain affecting his neck and lower back but reported that this was not different to the norm, and in fact the Oramorph was helping with that pain too.
The ENT Surgeon had arranged for CT scan imaging of the area as well as an MRI of the Internal Auditory Meatus.

Make a list of differential diagnosis that the ENT surgeon may have considered.