Differential Diagnosis for Acute Left Back Cervical Pain with Left Ear Pain

Single Most Likely Diagnosis

• Musculoskeletal strain or sprain: This is the most common cause of acute cervical pain and can radiate to the ear due to the complex innervation of the cervical spine and the ear. The absence of systemic symptoms such as fever or chills supports this diagnosis.

Other Likely Diagnoses

• Cervical spondylosis or disc herniation: These conditions can cause cervical pain that radiates to the ear due to nerve root compression or irritation. The pain can be acute if there's a sudden disc herniation or worsening of spondylosis.
• Temporomandibular joint (TMJ) disorder: TMJ disorders can cause ear pain and, if severe, can radiate pain to the cervical region due to the shared nerve supply.
• Tension headache or cervicalgia: Tension in the neck muscles can lead to referred pain in the ear and is a common cause of acute cervical pain.

Do Not Miss Diagnoses

• Carotid artery dissection: Although less common, carotid artery dissection can present with acute cervical pain and is a medical emergency due to the risk of stroke. The absence of fever or chills does not rule out this condition.
• Meningitis: While typically associated with fever and chills, atypical presentations of meningitis, especially in immunocompromised patients or those with partially treated infections, can occur without these symptoms. Severe cervical pain and ear pain could be part of the presentation.
• Cervical spine infection (e.g., osteomyelitis, discitis): These infections can cause severe cervical pain and, although typically associated with fever, can occasionally present without systemic symptoms, especially in the early stages or in immunocompromised patients.

Rare Diagnoses

• Ramsay Hunt syndrome (Herpes zoster oticus): This condition involves the reactivation of varicella-zoster virus in the geniculate ganglion and can cause ear pain, facial weakness, and sometimes cervical pain, but it's less common and usually accompanied by a rash.
• Glossopharyngeal neuralgia: A rare condition characterized by severe pain in the throat and ear, which can occasionally radiate to the cervical region, but it's much less common than other causes of cervical and ear pain.
• Cervical spine tumor: Tumors of the cervical spine can cause pain that radiates to the ear, but they are rare and usually have a more gradual onset.