Differential Diagnosis for 8-year-old Female with Ear Pain and Nasal Congestion
- Single most likely diagnosis:
- Acute Bacterial Sinusitis: The patient's symptoms of nasal congestion, rhinorrhea, and ear pain, along with the change in nasal drainage from clear to thick yellowish-green, are consistent with a bacterial sinus infection. The fever and recent worsening of symptoms also support this diagnosis.
- Other Likely diagnoses:
- Acute Viral Sinusitis: Although the patient's symptoms have been present for a few days, it's possible that the infection is still viral in nature, especially given the initial symptoms consistent with seasonal allergies.
- Acute Otitis Media: The patient's ear pain could be indicative of a middle ear infection, which is a common complication of upper respiratory tract infections.
- Allergic Rhinitis with Secondary Infection: The patient's history of seasonal allergies and daily use of cetirizine suggest that her symptoms could be exacerbated by an allergic reaction, with a possible secondary bacterial infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Orbital Cellulitis: Although less likely, orbital cellulitis is a serious infection that can occur as a complication of sinusitis, and it requires prompt medical attention.
- Intracranial Complications (e.g., meningitis, brain abscess): These are rare but potentially life-threatening complications of sinusitis or otitis media that should not be missed.
- Mastoiditis: An infection of the mastoid bone, which can occur as a complication of otitis media, and requires prompt medical attention.
- Rare diagnoses:
- Sinusitis caused by a fungal infection: This is a rare cause of sinusitis, but it should be considered in patients with underlying immunodeficiency or other risk factors.
- Wegener's Granulomatosis: A rare autoimmune disorder that can cause sinusitis and other respiratory symptoms.
- Nasal Foreign Body: Although more common in younger children, a nasal foreign body could cause symptoms similar to those presented by the patient.