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Vertigo & Ear Pain

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A female in her 60’s with a history of diabetes presents to the UCC with 4 days of progressive left ear pain, nausea and dizziness.?She denies any vertigo, facial weakness or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal.  Physical exam is otherwise normal except for right beating nystagmus on rightward gaze, mild left facial weakness not noticed by patient and the external ear finding shown below

What is the most likely diagnosis:

  • A) Malignant otitis externa
  • B) Perichondritis
  • C) Labrynthitis
  • D) Ramsay-Hunt Syndrome
  • E) Herpes Oticus

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DIAGNOSIS, 1-MINUTE CONSULT and CASE CONCLUSION:

The diagnosis is: D) Ramsay-Hunt Syndrome

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CASE CONCLUSION: We’ll just have to see

CASE LESSONS & OTHER OPTIONS:

  • A) Malignant otitis externa – can cause facial weakness and occurs in diabetes, but shouldn’t cause vertigo or vesicles
  • B) Perichondritis – shouldn’t cause any neuro symptoms nor vesicles
  • C) Labrynthitis – can cause vertigo and nystagmus but not pain or ear findings
  • D)
  • E) Herpes Oticus – Not a known entity
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