Differential Diagnosis for an 18-year-old with Earache and Clear Liquid Draining from the Ear
- Single most likely diagnosis:
- Otitis media with perforation: This is the most likely diagnosis given the symptoms of earache and clear liquid (likely cerebrospinal fluid or purulent discharge) draining from the ear. The absence of pain on touching the external ear and the presence of clear discharge suggest a middle ear infection that has perforated the eardrum.
- Other Likely diagnoses:
- Eustachian tube dysfunction: This condition can lead to a middle ear effusion, which may cause earache and, if the eardrum is perforated, drainage. However, the clear liquid drainage is more suggestive of otitis media with perforation.
- Serous otitis media: This condition involves fluid accumulation in the middle ear without signs of acute infection. While it could cause earache, the clear liquid drainage is less typical for this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Cerebrospinal fluid (CSF) leak: Although less likely, a CSF leak due to a traumatic or congenital defect in the temporal bone could present with clear liquid drainage from the ear. This condition requires prompt diagnosis and treatment to prevent meningitis.
- Mastoiditis: This is an infection of the mastoid bone, which can occur as a complication of otitis media. While less common, it is a serious condition that requires prompt treatment to prevent complications like abscess formation or intracranial spread of infection.
- Rare diagnoses:
- Labyrinthine fistula: A rare condition where there is an abnormal connection between the inner and middle ear, which could cause clear liquid drainage. This is often associated with trauma, surgery, or congenital anomalies.
- Cholesteatoma: A type of skin cyst in the middle ear that can cause chronic infection and drainage. While it could present with earache and drainage, the clear liquid nature of the discharge is less typical for this condition.