Differential Diagnosis for Pain in the Mastoid in a Patient with Uncontrolled Diabetes

• Single Most Likely Diagnosis
  • Malignant Otitis Externa: This condition is a severe infection of the external auditory canal and surrounding tissues, often seen in patients with uncontrolled diabetes. The infection can spread to the mastoid, causing pain. The patient's uncontrolled diabetes status increases the risk for this condition due to impaired immune response and possible neuropathy, which can mask the early symptoms of infection.
• Other Likely Diagnoses
  • Mastoiditis: An infection of the mastoid bone, which can be acute or chronic. In patients with uncontrolled diabetes, the risk of developing infections, including those of the mastoid, is increased due to their compromised immune status.
  • Otitis Media: An infection of the middle ear that can cause mastoid pain, especially if it spreads to the mastoid bone (mastoiditis). Patients with diabetes are more prone to infections, including otitis media.
• Do Not Miss Diagnoses
  • Cavernous Sinus Thrombosis: Although rare, this condition can be a complication of facial or sinus infections and is more likely in immunocompromised patients, such as those with uncontrolled diabetes. It's a medical emergency that requires prompt diagnosis and treatment.
  • Intracranial Abscess: An abscess within the brain can be a complication of mastoiditis or other infections in the head and neck region. Given the patient's diabetes status, their risk for developing severe infections and their complications is elevated.
• Rare Diagnoses
  • Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation of the cartilage in the ears, among other areas, potentially leading to mastoid pain. While not directly related to diabetes, the differential diagnosis should consider autoimmune conditions, especially in patients with other chronic conditions.
  • Temporal Bone Osteomyelitis: A rare infection of the temporal bone that can cause mastoid pain. It's more likely to occur in patients with compromised immune systems, such as those with uncontrolled diabetes.