Differential Diagnosis for a Kid with Tympanostomy Tubes having Pain and Drainage out of Left Ear

Single Most Likely Diagnosis

• Otitis Media with Effusion (OME) or Acute Otitis Media (AOM): The presence of tympanostomy tubes increases the risk of otorrhea (ear drainage) due to the direct communication between the external environment and the middle ear. Pain and drainage are common symptoms of an infection in the middle ear.

Other Likely Diagnoses

• Tuberculosis Otitis Media: Although less common, tuberculosis can infect the middle ear, especially in areas where TB is prevalent. Symptoms can include ear pain and discharge.
• Cholesteatoma: A type of skin cyst that can occur in the middle ear, often as a result of chronic otitis media or after insertion of tympanostomy tubes. It can cause destruction of the surrounding bone and tissue, leading to symptoms like pain and discharge.
• Foreign Body in the Ear: Children often insert objects into their ears, which can cause pain, discomfort, and sometimes discharge if the object causes an infection or injury to the ear canal.

Do Not Miss Diagnoses

• Malignant Otitis Externa: A severe infection of the external auditory canal that can spread to the skull base and cause significant morbidity and mortality, especially in immunocompromised patients. Early recognition and treatment are crucial.
• Petrous Apicitis: An infection of the petrous part of the temporal bone, which can be a complication of otitis media. It's a serious condition that requires prompt diagnosis and treatment to prevent severe complications.
• Lateral Sinus Thrombosis: A rare but potentially life-threatening complication of otitis media, where an infection spreads to cause a blood clot in the lateral sinus. Symptoms can be non-specific but may include headache, fever, and ear pain.

Rare Diagnoses

• Ramsay Hunt Syndrome Type 2: Caused by the varicella-zoster virus, this condition can lead to facial paralysis, ear pain, and sometimes discharge if the middle ear is involved.
• Eosinophilic Otitis Media: A condition characterized by the presence of eosinophils in the middle ear, often associated with allergies or asthma. It can cause chronic otitis media with effusion and sometimes discharge.
• Middle Ear Cancer: Although extremely rare, cancer of the middle ear can present with symptoms like ear pain, hearing loss, and discharge. It's essential to consider this in the differential diagnosis, especially in adults or in cases where symptoms persist despite appropriate treatment.