Differential Diagnosis for 18 YOF with Red, Warm Left Ear

Single Most Likely Diagnosis

• Acute Otitis Media with Secondary Infection: The patient's symptoms of red, warm ear, otorrhea, and otitis media following a "head cold" are classic for acute otitis media, which has likely become secondarily infected, explaining the prolonged fever and spread of pain to the jaw.

Other Likely Diagnoses

• Mastoiditis: Given the spread of pain to the jaw and cervical lymphadenopathy, mastoiditis is a possible complication of untreated or inadequately treated otitis media, where the infection spreads to the mastoid bone.
• Peritonsillar Abscess or Tonsillitis: Although the primary complaint is ear-related, the symptoms of fever, "head cold," and cervical lymphadenopathy could also suggest a peritonsillar abscess or tonsillitis, especially if the pain in the jaw is significant.
• Lymphadenitis: The cervical lymphadenopathy could be due to lymphadenitis, an infection of the lymph nodes, which could be related to the primary infection causing the otitis media.

Do Not Miss Diagnoses

• Lemierre's Syndrome: A rare but potentially life-threatening condition that starts with a sore throat and progresses to include high fever, swollen lymph nodes, and can lead to septicemia. It's crucial to consider this diagnosis due to the patient's prolonged fever and cervical lymphadenopathy.
• Meningitis: Although less likely given the specific ear symptoms, meningitis can present with fever, headache, and neck stiffness. The spread of infection from the ear or throat to the meninges is a possibility that should not be overlooked.
• Temporal Bone Osteomyelitis: A rare but serious infection of the temporal bone that could explain the patient's symptoms, especially if there's a history of otitis media or mastoiditis that has not been adequately treated.

Rare Diagnoses

• Relapsing Fever: Caused by Borrelia species, this could be considered if the patient has been exposed to ticks or lice, given the recurrent fever pattern.
• Gradenigo's Syndrome: A rare but serious infection of the petrous apex of the temporal bone, characterized by a triad of symptoms including otitis media, deep facial pain, and abducens nerve palsy. This diagnosis would be considered if the patient presents with additional neurological deficits.
• Eustachian Tube Dysfunction: While not typically presenting with such severe symptoms, chronic Eustachian tube dysfunction could contribute to recurrent otitis media and should be considered in the broader differential for chronic or recurrent ear infections.