Differential Diagnosis
The patient presents with right-sided eye and ear discomfort, intermittent eye pressure, and recent onset of ear and sinus pain. The following differential diagnosis is organized into categories:
- Single most likely diagnosis:
- Sinusitis: The patient's symptoms of eye pressure, ear pain, and sinus pain, along with tenderness on palpation of the sinuses and jaw area, are consistent with a diagnosis of sinusitis. The recent history of getting water in the ear during water activities may have contributed to the development of sinusitis.
- Other Likely diagnoses:
- Migraine: The patient has a history of migraines, and the current episode of eye pressure and pain could be a migraine variant. However, the presence of ear and sinus pain makes sinusitis a more likely diagnosis.
- Temporomandibular joint (TMJ) disorder: The patient reports pain in the temporal region and along the gums on the right side, which could be consistent with a TMJ disorder.
- Eustachian tube dysfunction: The patient's history of getting water in the ear and subsequent ear pain could be related to Eustachian tube dysfunction.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Temporal arteritis: Although the patient does not have severe tenderness in the temporal region, temporal arteritis is a potentially deadly condition that can cause eye pain, headache, and jaw claudication. It is essential to consider this diagnosis, especially in patients over 50 years old.
- Orbital cellulitis: The patient's symptoms of eye pain, watering, and tenderness could be consistent with orbital cellulitis, a serious infection that requires prompt treatment.
- Cavernous sinus thrombosis: This rare but potentially life-threatening condition can cause eye pain, headache, and cranial nerve deficits.
- Rare diagnoses:
- Trigeminal neuralgia: The patient's symptoms of eye and facial pain could be consistent with trigeminal neuralgia, a rare condition characterized by sudden, severe facial pain.
- Sphenoid sinusitis: The patient's symptoms of eye and ear pain, along with sinus pain, could be consistent with sphenoid sinusitis, a rare condition that can cause severe headache and facial pain.