Differential Diagnosis for Ear Pain and Pressure without Infection, Non-Responsive to Flonase

Single Most Likely Diagnosis

• Eustachian Tube Dysfunction: This condition is characterized by the inability of the Eustachian tube to open and close properly, leading to ear pressure and pain. The lack of response to Flonase, a nasal steroid, suggests that the issue may not be solely related to nasal congestion or allergies, making Eustachian tube dysfunction a plausible explanation.

Other Likely Diagnoses

• Middle Ear Effusion: Fluid accumulation in the middle ear without signs of acute infection can cause ear pain and pressure. The condition might not respond to nasal steroids like Flonase if the effusion is not directly related to nasal congestion or allergies.
• Temporomandibular Joint (TMJ) Disorder: TMJ disorders can refer pain to the ear, causing discomfort and pressure. The lack of response to Flonase could indicate that the ear symptoms are not primarily related to nasal or sinus issues.
• Earwax Impaction: While not typically associated with pressure, significant earwax impaction can cause discomfort and might be perceived as pressure or pain, especially if the ear canal is irritated.

Do Not Miss Diagnoses

• Acoustic Neuroma: A rare, benign tumor on the nerve connecting the inner ear to the brain. Although unlikely, it's crucial to consider due to its potential impact on hearing and neurological function.
• Multiple Sclerosis: In rare cases, multiple sclerosis can present with ear pain or pressure as part of its neurological symptoms. Given its potential for significant morbidity, it should not be overlooked.
• Petrous Apicitis: A rare but serious infection of the petrous part of the temporal bone, which can present with ear pain and might not initially show signs of external infection.

Rare Diagnoses

• Relapsing Polychondritis: An autoimmune disorder that can affect cartilage, including that in the ears, leading to pain and other symptoms.
• Cholesteatoma: An abnormal skin growth in the middle ear behind the eardrum, which can cause ear pain and pressure, though it's more commonly associated with a history of recurrent ear infections.
• Otosclerosis: A condition in which there is abnormal bone growth in the middle ear, which can cause hearing loss and might be associated with ear pain or pressure in some cases.