Differential Diagnosis for 4-year-old Male with Transient Fevers and Bilateral Otalgia

Single Most Likely Diagnosis

• Acute Otitis Media (AOM): This is the most common cause of ear pain (otalgia) in children, often accompanied by fever and minor congestion, fitting the patient's symptoms closely.

Other Likely Diagnoses

• Viral Upper Respiratory Tract Infection (URTI): Given the symptoms of minor congestion and transient fevers, a viral URTI is a plausible diagnosis, as it can cause otalgia due to Eustachian tube dysfunction.
• Allergic Rhinitis: This condition can lead to congestion and potentially cause referred ear pain, especially if the Eustachian tubes are affected, though it's less likely to cause fever.

Do Not Miss Diagnoses

• Mastoiditis: Although less common, mastoiditis is a serious complication of AOM that can present with similar symptoms, including fever and ear pain. It requires prompt diagnosis and treatment to prevent serious complications.
• Lateral Sinus Thrombosis: A rare but potentially life-threatening complication of mastoiditis or other infections in the head and neck area, which could present with fever and otalgia among other symptoms.
• Intracranial Complications of Otitis Media: Conditions such as brain abscess or meningitis can occur as complications of AOM, though they are rare. These conditions are medical emergencies.

Rare Diagnoses

• Autoimmune Disorders: Certain autoimmune disorders can cause recurrent fevers and ear symptoms, though they would be unusual in this presentation and age group.
• Tuberculosis or Other Uncommon Infections: Though rare in many parts of the world, tuberculosis or other uncommon infections could potentially cause chronic or recurrent fevers and ear symptoms, including otalgia.