Differential Diagnosis
- Single most likely diagnosis
- Herpes Zoster Oticus (Ramsay Hunt Syndrome): This diagnosis is likely due to the patient's severe ear pain, ruptured tympanic membrane, and subtle right-sided facial asymmetry (mild mouth droop). The absence of fever, otorrhea, and recent URTI symptoms also supports this diagnosis.
- Other Likely diagnoses
- Temporomandibular Joint (TMJ) Disorder: The patient's severe ear pain and tenderness over the right ear could be related to a TMJ disorder, especially considering the recent Botox injection to the face.
- Otalgia due to Referred Pain: Referred pain from the face or neck could be causing the patient's ear pain, and the mild mouth droop could be related to the Botox injection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cerebellopontine Angle (CPA) Tumor: Although unlikely, a CPA tumor could cause facial weakness, ear pain, and hearing loss (although the patient does not have hearing loss). It is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Stroke or Transient Ischemic Attack (TIA): The patient's mild mouth droop could be a sign of a stroke or TIA, and it is crucial to rule out this diagnosis to prevent further complications.
- Rare diagnoses
- Lyme Disease: Although rare, Lyme disease could cause facial palsy and ear pain, especially if the patient has been exposed to ticks.
- Sarcoidosis: This condition could cause facial weakness, ear pain, and other systemic symptoms, although it is a rare diagnosis.
- Multiple Sclerosis: Although unlikely, multiple sclerosis could cause facial weakness, ear pain, and other neurological symptoms, and it is essential to consider this diagnosis in the differential.