Differential Diagnosis

The patient presents with 2 days of constant ear pain, recent sore throat, and swollen lymph nodes. Here's a differential diagnosis based on the provided information:

• Single most likely diagnosis:
  • Otitis Media: The patient's symptoms of constant ear pain, recent sore throat, and swollen lymph nodes are consistent with otitis media, which is an infection of the middle ear. The absence of fever and jaw tenderness does not rule out this diagnosis.
• Other Likely diagnoses:
  • Otitis Externa: Also known as swimmer's ear, this condition is possible given the patient's surfing activities. However, the constant pain and recent sore throat make otitis media more likely.
  • Eustachian Tube Dysfunction: This condition can cause ear pain and is often associated with recent upper respiratory infections, such as a sore throat.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Mastoiditis: Although less likely, mastoiditis is a serious infection of the mastoid bone that can occur as a complication of otitis media. It requires prompt medical attention to prevent serious complications.
  • Lymphoma or other malignancies: Although rare, swollen lymph nodes can be a sign of a more serious underlying condition, such as lymphoma.
• Rare diagnoses:
  • Temporal Bone Fracture: Although the patient denied any significant impact or blow to the ear, a temporal bone fracture is possible, especially given the patient's history of falling while surfing.
  • Ramsay Hunt Syndrome: This rare condition is caused by the varicella-zoster virus and can cause ear pain, facial weakness, and other symptoms. However, the absence of other characteristic symptoms, such as facial weakness or rash, makes this diagnosis less likely.