ENT Quiz – Painful swelling of ear in a middle aged man

relapsing polychondritis

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.

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).


  1. What is your provisional diagnosis?


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.


Dr. Sanu. P. Moideen, MBBS, MS (ENT), DNB (ENT), FHNOS, is an otolaryngologist (ENT surgeon), head and neck oncosurgeon practising in Muvattupuzha, Kerala, India. After finishing his postgraduate training, he pursued specialist training in paediatric ENT and head and neck oncosurgery from eminent institutions in India and the US.

2 thoughts on “ENT Quiz – Painful swelling of ear in a middle aged man

    1. Biopsy is rarely needed. According to McAdam Criteria, diagnosis can be established if at least three clinical features among auricular chondritis, nonerosive inflammatory polyarthritis, nasal chondritis, ocular inflammation, respiratory tract chondritis, audiovestibular damage exists.

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