Differential Diagnosis for 49-year-old Female with Ear Pain
- Single most likely diagnosis
- Otitis Externa: This condition, also known as swimmer's ear, is an inflammation of the outer ear and ear canal. The patient's report of ear pain worsened by movement of the ear and the belief that she got water in her ear strongly supports this diagnosis. Otitis externa is common in individuals who have recently been swimming or exposed to water, which can introduce bacteria into the ear canal.
- Other Likely diagnoses
- Middle Ear Infection (Otitis Media): Although less likely given the absence of nasal congestion or recent illness, otitis media could still be a consideration, especially if the patient has a history of such infections. The pain radiating to the lateral neck could be consistent with referred pain from the middle ear.
- Eustachian Tube Dysfunction: This condition can cause ear pain and is often associated with nasal congestion or recent upper respiratory infections, which the patient denies. However, it could still be considered, especially if the patient has a history of similar issues.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Mastoiditis: A serious infection of the mastoid bone in the skull, located behind the ear. It's a complication of otitis media and can present with ear pain, fever, and neck stiffness. Although unlikely given the short duration of symptoms and lack of systemic signs, it's crucial not to miss this diagnosis due to its potential severity.
- Temporal Arteritis (Giant Cell Arteritis): This condition involves inflammation of the blood vessels and can cause severe headaches, jaw pain, and vision problems. While it's more common in older adults, it could present with ear pain and should be considered, especially if there are other systemic symptoms.
- Rare diagnoses
- Ramsay Hunt Syndrome (Herpes Zoster Oticus): A rare neurological disorder caused by the varicella-zoster virus, which can lead to ear pain, facial paralysis, and vesicles in the ear. It's less likely given the patient's presentation but should be considered if the patient develops additional neurological symptoms.
- Ear Canal Foreign Body: Although the patient denies using eardrops or other medications, the possibility of a foreign body in the ear canal, either from an attempt to clean the ear or an accidental insertion, should be considered, especially if the pain is severe and localized.