Differential Diagnosis
- Single most likely diagnosis
- A. Acute mastoiditis: This is the most likely diagnosis given the patient's history of recurrent acute otitis media, fever, fussiness, and the physical examination findings of a protruded auricle with tenderness and swelling behind the ear, and narrowing of the external ear canal. Acute mastoiditis is a complication of acute otitis media where the infection spreads to the mastoid bone.
- Other Likely diagnoses
- C. Necrotizing otitis externa: Although less common in this age group, necrotizing otitis externa is a possible diagnosis, especially given the narrowing of the external ear canal and the patient's history of recurrent ear infections. However, it is more commonly seen in immunocompromised patients or those with diabetes.
- E. Perichondritis: This is an infection of the perichondrium, the layer of tissue surrounding the cartilage of the ear. The patient's symptoms of a protruded auricle with tenderness and swelling behind the ear could be consistent with perichondritis, although it is less likely than acute mastoiditis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- None of the options provided fit perfectly into this category, but it's essential to consider other serious conditions such as intracranial complications of otitis media (e.g., meningitis, brain abscess) or sepsis, especially if the patient's condition worsens or does not improve with treatment.
- Rare diagnoses
- B. Cholesteatoma: This is a rare diagnosis in this clinical context, as cholesteatomas are typically associated with chronic otitis media and are less common in young children. They are abnormal skin growths in the middle ear behind the eardrum and can be a complication of recurrent ear infections, but the presentation would typically be different.
- D. Parotitis: This is inflammation of the parotid gland, which could present with swelling and tenderness in front of the ear, but the patient's symptoms and examination findings are more consistent with a condition affecting the ear itself rather than the parotid gland.