Ear Pain Differential Diagnosis

The following is a differential diagnosis for ear pain, categorized for clarity and emphasis on potential severity.

• Single Most Likely Diagnosis

  • Otitis media: This is the most common cause of ear pain, especially in children. It is an infection of the middle ear that can be caused by bacteria or viruses.
  • Otitis externa (swimmer's ear): An infection of the outer ear canal, often related to water exposure or trauma to the ear canal, making it a common cause of ear pain in individuals who swim frequently or insert objects into their ears.

• Other Likely Diagnoses

  • Eustachian tube dysfunction: This condition affects the tube that connects the middle ear to the back of the nose and throat, leading to ear fullness and pain due to pressure imbalance.
  • Earwax impaction: A buildup of earwax can cause discomfort, hearing loss, and ear pain, especially if the wax is pushed further into the ear canal during attempts to clean it.
  • Temporomandibular joint (TMJ) disorder: Pain from the TMJ can radiate to the ear, causing ear pain without any actual ear pathology.
  • Dental issues: Problems such as tooth abscesses or gum disease can refer pain to the ear.

• Do Not Miss Diagnoses

  • Malignant otitis externa: A severe infection of the outer ear that can spread to surrounding bone and tissue, particularly dangerous in diabetic or immunocompromised patients.
  • Mastoiditis: An infection of the mastoid bone, located behind the ear, which can be a complication of untreated otitis media and requires prompt treatment to prevent serious complications.
  • Petrous apicitis: A rare but serious infection of the petrous part of the temporal bone, which can lead to severe neurological complications if not treated promptly.
  • Ramsay Hunt syndrome: A condition caused by the varicella-zoster virus that can lead to facial paralysis and ear pain, among other symptoms.

• Rare Diagnoses

  • Relapsing polychondritis: A rare autoimmune disorder that can cause cartilage inflammation, including the cartilage in the ears, leading to ear pain and other symptoms.
  • Otosclerosis: A condition in which there is abnormal bone growth in the middle ear, which can cause hearing loss and ear pain.
  • Cholesteatoma: A type of skin cyst located in the middle ear that can be destructive to surrounding bone and tissue, often presenting with ear pain and hearing loss.
  • Ear cancer: Although rare, cancer of the ear (either the outer ear, ear canal, or middle ear) can cause persistent ear pain and should be considered in the differential diagnosis, especially in patients with risk factors.