What is the diagnosis for a 16-year-old patient presenting with a cough, congestion, and right ear pain for 4 days, with minimal relief from Mucinex (guaiifenesin) and over-the-counter (OTC) cold medications?

Differential Diagnosis for 16 y/o Patient with Cough, Congestion, and Right Ear Pain

Single Most Likely Diagnosis

• Acute Otitis Media (AOM): The patient's symptoms of right ear pain, cough, and congestion, along with minimal relief from over-the-counter cold medications, suggest AOM as the most likely diagnosis. The presence of ear pain is a strong indicator of this condition.

Other Likely Diagnoses

• Acute Sinusitis: The patient's symptoms of cough and congestion could be indicative of acute sinusitis, especially if the symptoms have persisted for 4 days with minimal relief from over-the-counter medications.
• Acute Pharyngitis: Although not directly mentioned, the patient's symptoms could also be consistent with acute pharyngitis, particularly if the cough and congestion are accompanied by a sore throat.
• Influenza or Upper Respiratory Infection (URI): Given the time of year and the patient's symptoms, influenza or a URI could also be considered, especially if the patient has been exposed to others with similar illnesses.

Do Not Miss Diagnoses

• Mastoiditis: Although less likely, mastoiditis is a serious complication of AOM that requires prompt diagnosis and treatment to prevent serious complications, including hearing loss and intracranial infections.
• Lemierre's Syndrome: This rare but potentially life-threatening condition is characterized by a bacterial infection of the throat, which can lead to sepsis and other complications if not promptly treated.
• Peritonsillar Abscess: If the patient has a severe sore throat, peritonsillar abscess should be considered, as it requires urgent medical attention to prevent airway compromise.

Rare Diagnoses

• Tuberculosis (TB): Although unlikely, TB could present with chronic cough and other respiratory symptoms, and it is essential to consider this diagnosis, especially if the patient has been exposed to someone with TB or has risk factors for the disease.
• Histoplasmosis or Other Fungal Infections: In endemic areas, fungal infections like histoplasmosis could cause similar symptoms, and it is crucial to consider these diagnoses, especially if the patient has been exposed to birds or bats.