Differential Diagnosis for 16-month-old Female with Nasal Congestion and Ear Symptoms
- Single most likely diagnosis:
- Acute Otitis Media (AOM) - The patient's symptoms of nasal congestion, rhinorrhea, cough, and pulling at her cheeks and ears, along with the physical examination finding of a retracted and red right ear, are highly suggestive of AOM. The absence of fever does not rule out this diagnosis, as not all children with AOM present with fever.
- Other Likely diagnoses:
- Viral Upper Respiratory Tract Infection (URTI) - The symptoms of nasal congestion, rhinorrhea, and cough are common in viral URTIs, and the patient's age and presentation are consistent with this diagnosis.
- Allergic Rhinitis - Although less likely given the acute onset, allergic rhinitis could present with similar symptoms, especially if the patient has been exposed to new allergens.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Bacterial Meningitis - Although the patient is afebrile and does not have other classic symptoms of meningitis, such as neck stiffness or altered mental status, bacterial meningitis can present atypically in young children, and the diagnosis should be considered in any child with severe or worsening symptoms.
- Retropharyngeal Abscess - This condition can present with similar symptoms, including neck pain and ear pain, and is a medical emergency that requires prompt diagnosis and treatment.
- Rare diagnoses:
- Sinusitis - Although possible, sinusitis is less common in children under the age of 2, and the diagnosis would require further evaluation, such as imaging studies.
- Mastoiditis - This complication of AOM is rare but can occur, especially if AOM is not promptly treated. The patient's symptoms and physical examination findings do not strongly suggest mastoiditis, but it should be considered if the patient's condition worsens or does not improve with treatment.