Differential Diagnosis for a School-Age Child with Chronic Otitis Media, Vertigo, and a Pearly-White Lesion on the Tympanic Membrane
Single Most Likely Diagnosis
- b. Cholesteatoma: The presence of a pearly-white lesion on the tympanic membrane, along with a history of chronic otitis media and symptoms like vertigo, strongly suggests a cholesteatoma. Cholesteatomas are known to cause chronic infections, hearing loss, and in some cases, vertigo due to their potential to erode bone and affect the inner ear structures.
Other Likely Diagnoses
- a. Mastoiditis: Given the history of chronic otitis media and the presence of purulent otorrhea, mastoiditis is a possible diagnosis. Mastoiditis can occur as a complication of otitis media when the infection spreads to the mastoid bone. However, the specific finding of a pearly-white lesion is more indicative of a cholesteatoma.
- c. Otitis Media with Effusion: While this condition is common in children and can follow an episode of acute otitis media, the presence of vertigo and a pearly-white lesion on the tympanic membrane makes it less likely than cholesteatoma.
Do Not Miss Diagnoses
- Meningitis or Intracranial Complications: Although less likely, given the symptoms of vertigo and the potential for complications from chronic otitis media or a cholesteatoma, it's crucial not to miss diagnoses like meningitis or other intracranial complications that could arise from the spread of infection. These conditions are medical emergencies.
- Petrous Apicitis: A rare but serious complication of otitis media, petrous apicitis involves infection of the petrous part of the temporal bone and can present with a variety of symptoms including vertigo, hearing loss, and cranial nerve palsies.
Rare Diagnoses
- Otogenic Brain Abscess: A rare but potentially life-threatening complication of otitis media or mastoiditis, where the infection spreads to the brain, forming an abscess.
- Labyrinthitis: An inner ear disorder characterized by inflammation of the part of the inner ear responsible for balance (labyrinth), which could explain the vertigo but would not account for the pearly-white lesion.