Differential Diagnosis
- Single most likely diagnosis
- Acute Otitis Media (AOM): The patient's symptoms of ear aching, erythema, and bulging of the tympanic membrane, along with a fever of 102.9°F, are consistent with AOM. The lack of significant relief from initial treatment also suggests a possible resistant or complicated infection.
- Other Likely diagnoses
- Otitis Media with Effusion (OME): Although the patient has symptoms of AOM, the presence of a bulging tympanic membrane could also indicate a middle ear effusion, which may not have fully resolved with initial treatment.
- Cochlear Implant Infection: Given the patient's history of bilateral cochlear implant surgery, there is a possibility of an infection related to the implant, which could be contributing to her symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Meningitis: Although the patient is not in acute distress, the presence of a fever and ear infection raises the possibility of meningitis, especially in a patient with a history of cochlear implant surgery, which may increase the risk of meningitis.
- Brain Abscess: A brain abscess is a rare but potentially life-threatening complication of otitis media or cochlear implant infection, and should be considered in the differential diagnosis.
- Petrositis: Inflammation of the petrous portion of the temporal bone, which can be a complication of otitis media, and may lead to serious complications if not recognized and treated promptly.
- Rare diagnoses
- Relapsing Otitis Media: Although not as likely, the patient's history of recurrent ear infections could suggest a relapsing otitis media, which may require further evaluation and treatment.
- Cholesteatoma: A rare condition where a skin cyst forms in the middle ear, which can be a complication of chronic otitis media, and may require surgical intervention.