Differential Diagnosis for Fever, Ear and Jaw Pain, Internal Draining in Ear, and Nausea

Single Most Likely Diagnosis

• Acute Otitis Media with Perforation: This condition is characterized by an infection of the middle ear that has led to a perforation of the eardrum, causing fever, ear pain, and discharge. The internal draining in the ear, especially with position changes, and nausea are consistent with this diagnosis.

Other Likely Diagnoses

• Mastoiditis: An infection of the mastoid bone, which is located behind the ear. It can cause fever, ear pain, and jaw pain due to the involvement of surrounding structures. Nausea can also be present due to the severity of the infection.
• Temporal Bone Osteomyelitis: An infection of the bone in the temporal region, which can cause fever, ear pain, and jaw pain. It might also lead to nausea and could result in drainage if there's an associated otitis media or externa.
• Eustachian Tube Dysfunction: While less likely to cause severe symptoms like fever and nausea, significant Eustachian tube dysfunction can lead to middle ear problems, including otitis media, which could explain some of the symptoms.

Do Not Miss Diagnoses

• Lateral Sinus Thrombosis: A potentially life-threatening complication of otitis media or mastoiditis, where a blood clot forms in the lateral sinus. It can present with fever, headache, and symptoms related to increased intracranial pressure, including nausea and vomiting.
• Intracranial Abscess: A collection of pus in the brain tissue, which can be a complication of otitis media or mastoiditis. Symptoms can include fever, headache, nausea, vomiting, and neurological deficits.
• Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, known as the meninges. This can be a complication of an ear infection and presents with fever, headache, stiff neck, and nausea.

Rare Diagnoses

• Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation of the cartilage in the ears, among other areas. It might lead to ear pain and could potentially cause some of the other symptoms if there's significant involvement of the Eustachian tube or surrounding structures.
• Cholesteatoma: A type of skin cyst located in the middle ear that can cause destruction of the surrounding bone and tissue. It might lead to chronic ear infections, discharge, and potentially some of the other symptoms listed, though it's less likely to cause acute fever and nausea.