Differential Diagnosis for Facial Weakness and Ear Pain
- Single most likely diagnosis
- Ramsay Hunt Syndrome (Herpes Zoster Oticus): This condition is characterized by facial weakness, ear pain, and a vesicular rash (cold sore) in the ear, which matches the patient's symptoms. The presence of a cold sore and the specific pattern of facial weakness support this diagnosis.
- Other Likely diagnoses
- Bell's Palsy: This is a common cause of facial weakness, especially in older adults. However, the presence of ear pain and a cold sore makes Ramsay Hunt Syndrome more likely. Bell's Palsy typically presents with sudden onset of unilateral facial weakness without other symptoms.
- Lyme Disease: Lyme disease can cause facial weakness, but it is usually accompanied by other symptoms such as a distinctive rash (erythema migrans), fever, and arthritis. The patient's symptoms do not strongly suggest Lyme disease, but it remains a consideration.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Stroke: Although the patient's symptoms are more suggestive of a peripheral cause of facial weakness, a stroke (particularly a brainstem stroke) can cause facial weakness and should be ruled out with imaging studies if there are any doubts.
- Cerebellopontine Angle Tumor: Tumors in this location, such as acoustic neuromas, can cause facial weakness and ear symptoms. While less likely, missing this diagnosis could have significant consequences, making it a "do not miss" diagnosis.
- Rare diagnoses
- Melkersson-Rosenthal Syndrome: This rare neurological disorder causes recurrent, often unilateral, facial paralysis or weakness, along with swelling of the face and lips (usually the upper lip) and the development of folds and furrows in the tongue (fissured tongue). It does not typically present with ear pain or a cold sore.
- Sarcoidosis: This systemic disease can cause facial weakness among many other symptoms, due to granulomatous inflammation affecting various parts of the body, including the nervous system. However, it would be an unusual presentation without other systemic symptoms.