Differential Diagnosis for Ear Pain

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 an infection of the middle ear and is a common cause of ear pain, especially in children. It often presents with fever, ear pain, and sometimes discharge if the eardrum has ruptured.
  • Otitis externa (swimmer's ear): An infection of the outer ear canal, often caused by bacterial or fungal infections, leading to pain, redness, and swelling of the ear canal.

• 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 feelings of fullness and pain in the ear.
  • Earwax impaction: A buildup of earwax can cause discomfort, hearing loss, and ear pain.
  • Temporomandibular joint (TMJ) disorder: Pain from the TMJ can radiate to the ear, causing ear pain without any actual ear disease.
  • Dental problems: Issues like 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 the skull and brain, particularly dangerous in diabetic or immunocompromised patients.
  • Mastoiditis: An infection of the mastoid bone, located behind the ear, which can lead to serious complications if not treated promptly.
  • Petrous apicitis: A rare but serious infection of the petrous part of the temporal bone, which can lead to severe neurological complications.
  • Ramsay Hunt syndrome: Caused by the varicella-zoster virus, it can lead to facial paralysis and ear pain.

• Rare Diagnoses

  • Relapsing polychondritis: A rare autoimmune disorder that can cause cartilage inflammation, including the cartilage in the ear.
  • Otosclerosis: A condition that affects the middle ear, causing hearing loss and sometimes pain, due to abnormal bone growth.
  • Cholesteatoma: A type of skin cyst located in the middle ear that can cause destruction of the surrounding bone and tissue, leading to hearing loss and other complications.
  • Acoustic neuroma: A non-cancerous tumor on the nerve connecting the inner ear to the brain, which can cause ear pain, hearing loss, and balance problems.