Differential Diagnosis for 14-year-old with Dizziness, Nausea, Decreased Hearing, and Mastoid Tenderness
- The patient's symptoms and recent treatment for acute otitis media using amoxicillin are considered in the following differential diagnosis:
Single Most Likely Diagnosis
- Acute Mastoiditis: This is the most likely diagnosis given the patient's presentation with mastoid tenderness, dizziness, nausea, decreased hearing, and tympanic membrane rupture following treatment for acute otitis media. Acute mastoiditis is a complication of acute otitis media where the infection spreads to the mastoid bone.
Other Likely Diagnoses
- Cholesteatoma: A possible complication of chronic otitis media or a result of a tympanic membrane rupture, which could explain the patient's decreased hearing and mastoid tenderness.
- Labyrinthitis: An inner ear infection that could cause dizziness, nausea, and decreased hearing, potentially as a complication of otitis media.
- Petrous Apicitis: A rare complication of otitis media, but given the patient's symptoms, it is a possible diagnosis. It involves inflammation of the petrous portion of the temporal bone.
Do Not Miss Diagnoses
- Intracranial Complications (e.g., Brain Abscess, Subdural Empoura): Although less likely, these conditions are potentially life-threatening and could present with similar symptoms, especially if the infection spreads beyond the mastoid bone.
- Meningitis: Another serious condition that could result from the spread of infection, presenting with symptoms such as dizziness, nausea, and potentially decreased hearing if there is involvement of the cranial nerves.
Rare Diagnoses
- Relapsing or Resistant Otitis Media: The patient started antibiotics today, but if the causative organism is resistant or the patient has a condition leading to relapsing otitis media, this could explain the persistence or worsening of symptoms.
- Autoimmune Inner Ear Disease: A rare condition that could cause sudden hearing loss and vertigo, though it is less directly related to the recent otitis media treatment and mastoid tenderness.