Differential Diagnosis for Right Ear Pain
The patient's history of recent mastoiditis surgery and ear pain when lying down suggests several possible diagnoses. Here's a categorized list of potential causes:
- Single most likely diagnosis
- Recurrent or persistent otitis media: Given the patient's recent history of acute otitis media and mastoiditis, it's possible that the infection has not fully resolved or has recurred, causing ongoing ear pain.
- Other Likely diagnoses
- Eustachian tube dysfunction: The patient's ear pain when lying down could be related to Eustachian tube dysfunction, which can occur after ear surgery or infection.
- Serous otitis media: The patient may have developed serous otitis media, a condition characterized by fluid accumulation in the middle ear, which can cause ear pain and discomfort.
- Retained foreign body or tube fragment: The incident in jail where a doctor pulled out a "little tube" from the patient's ear raises the possibility that a fragment of the tube or another foreign body is still present in the ear, causing pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cerebrospinal fluid (CSF) leak: Although unlikely, a CSF leak is a potentially life-threatening complication of mastoiditis surgery, and the patient's ear pain could be a symptom of this condition.
- Meningitis: Another rare but potentially deadly complication of mastoiditis or ear surgery, meningitis should be considered in the differential diagnosis, especially if the patient exhibits other symptoms such as fever, headache, or stiff neck.
- Rare diagnoses
- Cholesteatoma: A rare but possible complication of chronic otitis media or mastoiditis, cholesteatoma is a type of skin cyst that can grow in the middle ear and cause ear pain, discharge, and other symptoms.
- Petrous apicitis: A rare infection of the petrous portion of the temporal bone, petrous apicitis can cause ear pain, headache, and other symptoms, and is a potential complication of mastoiditis or ear surgery.