Differential Diagnosis for Mastoid Ache on the Right

The following differential diagnosis is organized into categories to help guide the thought process for a patient presenting with an aching mastoid on the right side.

• Single Most Likely Diagnosis

  • Mastoiditis: This is an infection of the mastoid bone, which is located behind the ear. It often occurs as a complication of otitis media (middle ear infection). Symptoms can include pain and tenderness in the mastoid area, fever, and discharge from the ear. Given the location of the pain, mastoiditis is a strong consideration due to its direct involvement of the mastoid bone.

• Other Likely Diagnoses

  • Otitis Media: An infection of the middle ear that can cause pain referred to the mastoid area due to the close proximity of the structures. It's a common condition, especially in children, but can occur in adults as well.
  • Otitis Externa (Swimmer's Ear): An infection of the outer ear canal. While it primarily causes pain in the ear canal, severe cases can radiate pain to the surrounding areas, including the mastoid.
  • Temporomandibular Joint (TMJ) Disorder: The TMJ is located near the mastoid process, and dysfunction or pain in this joint can radiate to the mastoid area, especially with jaw movement.

• Do Not Miss Diagnoses

  • Meningitis: Although less likely, meningitis (inflammation of the protective membranes covering the brain and spinal cord) can present with headache and ear pain, among other symptoms. It's a medical emergency requiring prompt treatment.
  • Petrous Apicitis: A rare but serious infection of the petrous part of the temporal bone, which can lead to severe complications if not treated promptly. It presents with deep-seated ear pain and can be associated with mastoid area pain.
  • Cavernous Sinus Thrombosis: A blood clot in the cavernous sinus, a group of veins located behind the eye. It's a rare but potentially life-threatening condition that can arise from facial or sinus infections, including those of the ear.

• Rare Diagnoses

  • Mastoid Osteoma: A benign bone tumor that can cause localized pain and swelling in the mastoid area.
  • Cholesteatoma: An abnormal skin growth in the middle ear behind the eardrum. It can be congenital or acquired and may cause destruction of the surrounding bone, including the mastoid, leading to pain and other complications.
  • Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation and destruction of cartilage in various parts of the body, including the ears. It might lead to pain in the mastoid area if the condition affects the ear cartilages.