Differential Diagnosis for 64-year-old Female with Sinus Pressure and Vertigo
- Single most likely diagnosis:
- Sinusitis (likely left-sided) - The patient's complaint of increasing sinus pressure focused to the left side of her face, along with left ear pain, suggests a diagnosis of sinusitis. The absence of fever and significant nasal drainage does not rule out this diagnosis, as these symptoms can be variable.
- Other Likely diagnoses:
- Eustachian tube dysfunction - The patient's complaint of left ear pain and vertigo could be related to Eustachian tube dysfunction, which can cause middle ear pressure changes leading to ear pain and balance issues.
- Allergic rhinitis - Although the patient reports that Claritin makes her tired and she hasn't taken it recently, her history of chronic vertigo and current sinus pressure could still be related to allergic rhinitis, especially if her symptoms are exacerbated by allergies.
- Benign Paroxysmal Positional Vertigo (BPPV) - Given the patient's chronic history of vertigo, BPPV is a possible cause of her current symptoms, especially if the vertigo is triggered by specific head movements.
- Do Not Miss diagnoses:
- Acute otitis media - Although the patient denies fever, acute otitis media (middle ear infection) can present with ear pain and vertigo, and it's crucial to diagnose and treat promptly to avoid complications.
- Meniere's disease - This inner ear disorder can cause vertigo, ear pain, and pressure, and while less common, it's a critical diagnosis not to miss due to its impact on the patient's quality of life and the need for specific management.
- Temporal bone fracture or other traumatic injuries - Although the patient doesn't report any recent trauma, it's essential to consider the possibility, especially if there's any concern about the mechanism of injury or if the patient's symptoms worsen.
- Rare diagnoses:
- Vestibular migraine - This condition can cause vertigo and is often accompanied by headache and sensitivity to light and sound, but it's less likely given the patient's primary complaint of sinus pressure.
- Autoimmune inner ear disease - This rare condition can cause vertigo, ear pain, and hearing loss, and while unlikely, it should be considered if other diagnoses are ruled out and the patient's symptoms persist or worsen.
- Nasopharyngeal carcinoma - Although extremely rare and unlikely without other symptoms like significant nasal drainage or a visible mass, any persistent or unexplained sinus symptoms in an older adult warrant thorough investigation to rule out malignancy.