Differential Diagnosis for Acute Causes of Dizziness and Ear Pain
Single Most Likely Diagnosis
- Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, intense episodes of vertigo triggered by specific head movements, and it can be associated with ear pain due to the close anatomical relationship between the vestibular system and the ear structures. Its high prevalence among causes of vertigo and the potential for ear pain to accompany it make it a likely candidate.
Other Likely Diagnoses
- Acute Otitis Media: An infection of the middle ear that can cause ear pain and, if it affects the inner ear or the vestibular system, can lead to dizziness.
- Labyrinthitis: An inner ear disorder characterized by the inflammation of the part of the inner ear responsible for balance (labyrinth), which can cause dizziness and ear pain.
- Vestibular Neuritis: Inflammation of the vestibular nerve, which can cause severe vertigo and, less commonly, ear pain.
Do Not Miss Diagnoses
- Stroke or Transient Ischemic Attack (TIA): Although less common, a stroke or TIA can present with dizziness and, if the brainstem or cerebellum is involved, may also cause ear pain. Missing this diagnosis can be catastrophic.
- Meniere's Disease: A disorder of the inner ear that affects balance and hearing, causing episodes of vertigo, tinnitus, hearing loss, and ear fullness. While not immediately life-threatening, its impact on quality of life and the potential for severe vertigo episodes make it crucial not to miss.
- Temporal Bone Fracture: A fracture in the temporal bone, which houses critical structures of the ear and vestibular system, can cause severe dizziness and ear pain. It is a medical emergency due to potential complications.
Rare Diagnoses
- Perilymphatic Fistula: An abnormal connection (fistula) in the inner ear that can cause unexplained dizziness and ear fullness or pain, often after barotrauma, head injury, or intense physical exertion.
- Autoimmune Inner Ear Disease: A rare condition where the body's immune system attacks the inner ear, leading to hearing loss, vertigo, and ear pain.
- Ototoxicity: Certain medications or substances can damage the inner ear, leading to dizziness and ear pain, though this is more commonly associated with hearing loss and tinnitus.