Differential Diagnosis

The patient presents with left ear pain, tinnitus, headaches, and vaginal pain. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Left Ear Infection (Otitis Externa): The patient's left ear pain, especially when touched, and the presence of erythema and some wax, suggest an external ear infection. The sharp pain and tinnitus episodes also support this diagnosis.
• Other Likely Diagnoses
  • Tension Headaches: The patient's headaches, which occur once weekly in the evening, affecting the back of the head and neck, and sometimes the frontal area, could be indicative of tension headaches.
  • Dysmenorrhea: The patient's history of severe dysmenorrhea, which causes school absence, and the recent episodes of sharp internal vaginal pain with walking or standing, suggest that dysmenorrhea could be a contributing factor to her symptoms.
  • Temporomandibular Joint (TMJ) Disorder: Although the patient does not have TMJ tenderness with palpation, the location of her headaches and ear pain could still suggest a TMJ disorder, especially if the pain is referred.
• Do Not Miss Diagnoses
  • Meningitis: Although the patient does not have fever or other typical symptoms of meningitis, it is crucial to consider this diagnosis due to the potential severity and the fact that some cases can present atypically.
  • Cervical Cancer or Other Gynecological Malignancies: Although the patient is young and not sexually active, any vaginal pain or abnormal bleeding (if present) warrants consideration of gynecological malignancies, however rare.
  • Ototoxicity or Inner Ear Disorders: The patient's tinnitus could be indicative of an inner ear disorder or ototoxicity, especially if she has been exposed to certain medications or substances.
• Rare Diagnoses
  • Endometriosis: Given the patient's age and symptoms of severe dysmenorrhea and sharp internal vaginal pain, endometriosis could be a rare but possible diagnosis.
  • Benign Paroxysmal Positional Vertigo (BPPV): The patient's episodes of tinnitus and sharp ear pain could, in rare cases, be related to BPPV, especially if the symptoms are positionally triggered.
  • Eustachian Tube Dysfunction: This condition could contribute to the patient's ear symptoms, including pain and tinnitus, especially if she has a history of allergies, colds, or other factors that could affect Eustachian tube function.