Differential Diagnosis for Throat Pain with Radiation to Ipsilateral Ear

Single Most Likely Diagnosis

• Tonsillitis: Given the duration of throat pain (20 days) and radiation to the ipsilateral ear, along with tenderness to touch, tonsillitis is a plausible diagnosis. It can cause significant pain, especially if it becomes chronic or recurrent, and the pain can radiate to the ear due to shared nerve pathways.

Other Likely Diagnoses

• Peritonsillar Abscess: This condition is a complication of tonsillitis where an abscess forms beside the tonsils. It can cause severe throat pain, fever, and difficulty swallowing. The pain can radiate to the ear, and the area is typically tender to touch.
• Strep Throat (Streptococcal Pharyngitis): Although it usually presents acutely, some cases can have a prolonged course. The infection can cause throat pain, fever, and lymphadenopathy, and the pain can radiate to the ear.
• Lymphadenitis: Inflammation of the lymph nodes in the neck can cause pain that radiates to the ear and can be tender to touch. It can be secondary to various infections, including those causing throat pain.

Do Not Miss Diagnoses

• Lemierre's Syndrome: A rare but potentially life-threatening condition that starts with pharyngitis and progresses to a jugular vein thrombosis and metastatic infections. Early recognition is crucial.
• Epiglottitis: Although more commonly associated with a severe, acute onset, epiglottitis can present with throat pain and radiation to the ear. It's a medical emergency due to the risk of airway obstruction.
• Malignancy (e.g., Oropharyngeal or Hypopharyngeal Cancer): While less common, especially in younger populations, throat pain that persists or worsens over time, especially with other symptoms like weight loss, hoarseness, or a neck mass, necessitates consideration of malignancy.

Rare Diagnoses

• Glossopharyngeal Neuralgia: A rare condition characterized by recurrent episodes of severe pain in the tongue, throat, ear, and area of the jaw, lasting from a few seconds to a few minutes. It can be triggered by swallowing.
• Eagle Syndrome (Stylohyoid Syndrome): Caused by an elongated styloid process or calcified stylohyoid ligament, leading to throat pain that can radiate to the ear, along with dysphagia and facial pain.