Differential Diagnosis for a 4-year-old Boy with Worsening Ear Pain and Headaches
- Single most likely diagnosis:
- Acute mastoiditis: This condition is a complication of otitis media, especially in children who have had recurrent ear infections. The symptoms of ear pain, headaches, vomiting, and the physical examination findings of a bulging, erythematous, and opaque left tympanic membrane along with a tender, erythematous, and swollen left mastoid are highly suggestive of mastoiditis. The elevated leukocyte count with a predominance of neutrophils also supports an infectious process.
- Other Likely diagnoses:
- Recurrent or persistent otitis media: Given the patient's history of recurrent ear infections and the recent completion of a course of antibiotics, it's possible that the otitis media has not been fully eradicated or has recurred.
- Intracranial complications of otitis media (e.g., meningitis, brain abscess): Although less likely than mastoiditis given the lack of specific neurological findings, these conditions can occur as complications of otitis media and need to be considered.
- Do Not Miss diagnoses:
- Brain tumor: Although rare and less likely given the acute presentation, a brain tumor could cause increased intracranial pressure leading to headaches and vomiting, especially in the morning. The absence of specific neurological findings and the presence of ear symptoms make this less likely, but it's a diagnosis that could have severe consequences if missed.
- Meningitis: This is an infection of the meninges that could present with headaches, fever, and irritability. The normal funduscopic examination and lack of specific meningeal signs make this less likely, but it's crucial to consider due to its potential severity.
- Rare diagnoses:
- Lateral sinus thrombosis: A rare complication of otitis media or mastoiditis where a blood clot forms in the lateral sinus. This would be considered if there were signs of increased intracranial pressure or specific neurological deficits, which are not prominently featured in this case.
- Petrositis: Inflammation of the petrous part of the temporal bone, which is a rare complication of otitis media. It could present with severe ear pain and neurological symptoms, but it is less common than mastoiditis.