Differential Diagnosis for Ear Pain

The following is a comprehensive differential diagnosis for ear pain, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Otitis media: This is the most common cause of ear pain, especially in children. It is an infection of the middle ear that can be acute or chronic, often resulting from bacterial or viral infections.
  • Otitis externa (swimmer's ear): An infection of the outer ear canal, commonly seen in individuals who swim frequently or have compromised ear canal defenses.

• Other Likely Diagnoses

  • Eustachian tube dysfunction: This condition affects the tube that connects the middle ear to the back of the nose and throat, leading to ear fullness and pain due to pressure imbalance.
  • Earwax impaction: A buildup of earwax can cause discomfort, hearing loss, and ear pain.
  • Temporomandibular joint (TMJ) disorder: Pain from the TMJ can radiate to the ear, causing ear pain without any actual ear pathology.
  • Dental issues: Toothaches, abscesses, or gum disease can refer pain to the ear.
  • Sinusitis: Inflammation of the sinuses can cause referred pain to the ears.

• Do Not Miss Diagnoses

  • Malignant otitis externa: A severe infection of the outer ear that can spread to the skull base, particularly dangerous in diabetic or immunocompromised patients.
  • Mastoiditis: An infection of the mastoid bone, which can be a complication of untreated or inadequately treated otitis media.
  • Petrous apicitis: A rare but serious infection of the petrous part of the temporal bone.
  • Ramsay Hunt syndrome (herpes zoster oticus): A viral infection that can cause ear pain, facial paralysis, and hearing loss.
  • Acoustic neuroma: A benign tumor on the nerve connecting the inner ear to the brain, which can cause ear pain, hearing loss, and balance problems.

• Rare Diagnoses

  • Relapsing polychondritis: A rare autoimmune disorder that can cause cartilage inflammation, including that in the ears.
  • Sarcoidosis: A condition that can cause inflammation in various parts of the body, including the ears.
  • Wegener's granulomatosis (granulomatosis with polyangiitis): A rare autoimmune disorder that can affect the ears among other areas.
  • Otosclerosis: A form of bone growth in the middle ear that can cause hearing loss and may lead to ear pain.

Each of these diagnoses has distinct clinical features and requires a thorough history, physical examination, and sometimes additional diagnostic tests for accurate identification and appropriate management.