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CSOM by Nomi
- 2. CSOM CHRONIC SUPPURATIVE OTITIS MEDIA NAUMAN AHMAD
- 3. PARTICULARS • PATIENT NAME – XYZ • AGE – 27 YEARS • GENDER – MALE • ADDRESS – ATTOCK WITH PATIENT’S PERMISSION
- 4. PRESENTING COMPLAINTS -- DISCHARGE RIGHT EAR One year -- DECREASED HEARING RIGHT EAR
- 5. HISTORY OF PRESENT ILLNESS • One year ago had an episode of upper respiratory tract infection with pain right ear • Subsequently patient developed intermittent ear discharge • Discharge: • Profuse • Mucopurulent • Odourless • Not blood stained • Decreased hearing right ear
- 6. PAST HISTORY OPERATED FOR ACUTE APPENDICITIS 03 YEARS AGO At C.M.H Lahore
- 7. Personal History Family History Not Contributory Drug History
- 8. GENERAL PHYSICAL EXAMINATION -- PULSE 74/ min, -- Pallor - absent regular -- Jaundice - negative -- TEMPERATURE 98*F - Neck veins - not engorged -- BLOOD - Lymph nodes - not palpable PRESSURE 120/80 mm Hg - Clubbing - Koilonychia normal -- Respiratory Rate - Odema feet 16/ min
- 9. SYSTEMIC EXAMINATION CNS • NAD RESPIRATORY SYSTEM • NAD GIT • NAD CVS • NAD
- 10. ENT EXAMINATION EAR NOSE THROAT
- 11. • EAR • RIGHT EAR : Medium sized central perforation in the pars tensa • No discharge • No cholesteatoma • LEFT EAR : normal • Whispered voice not appreciated in right ear
- 12. Tuning fork test RINNE TEST • NEGATIVE ON RIGHT SIDE • POSITIVE ON LEFT SIDE WEBER TEST . LATERALIZED TO RIGHT SIDE
- 14. PROVISIONAL DIAGNOSIS CHRONIC SUPPURATIVE OTITIS MEDIA ( TUBOTYMPANIC TYPE , INACTIVE )
- 15. INVESTIGATIONS • PURE TONE AUDIOGRAM • X-RAY MASTOID
- 17. X-RAY MASTOID
- 18. FINAL DIAGNOSIS CHRONIC SUPPURATIVE OTITIS MEDIA (TUBOTYMPNIC)
- 19. TREATMENT ( during active episode ) • REGULAR AURAL TOILET • EAR DROPS ( 0.6% ofloxacin 3 drops two times a day for 7 days , steroids -- betamethasone ) • SYSTEMIC ANTIBIOTICS ( Capsule ampicillin 625mg three times a day for 7 days ) • NASAL DECONGESTANTS ( XYLOMETAZOLINE nasal spray three times a day for 7 days ) • Systemic anti-histamines ( tab. loratidine 10mg once daily )
- 20. COUNSELING • KEEP EAR DRY • MYRINGOPLASTY
Notas do Editor
- My patient a 27 year old male resident of attock
- Presented with complains of ear discharge and decreased hearing in right ear for 1 year
- My patient was asymptomatic 1 year ago when he had an episode of urti followed by severe pain in rt ear, which resulted in pus discharge from rt ear, The episode settled with medication prescribed at local Garrison medical center. Since then he IS HAVING intermittent discharge from his right ear. It usually follows an upper resp tract inf. It is copious and mucprlnt. He described it as odourless and has never been blood stained. Most of the time it stops with the resolution of urti. It is never accompanied by pain. He also complains of decreased hearing in his rt ear for last 1 year. It is constant and he feels difficulty in hearing normal conv. Voice. There is no history of pain in the ear, accompanied head ache, dizziness or facial weakness.
- He was operated for ac appendicitis 3 years ago
- On gpe he is young male of average built concious , coopertive well orirnted in time place and person, sitting comfortably in bed with stable vital signs
- His systemic examination was unremarkable
- A detailed ear nose and throat examination was carried out
- On aural examination the pinna and eac appeared normal on both sides and there was no tendernes on either side. Speculem examination of Rt ear revealed medium sized central perforation in the pars tensa. There was no discharge orcholesteatomaHisLeft ear did not reveal any abnormality, more over he could hear conversational voice in both ears where as whispered voice could only be heard in lft ear
- His tunning fork tests revealed a conductive type of decreased hearing in rt ear
- Rest of the nose throat and neck examination was normal
- ON THE BASIS OF HISTORY AND EXAMINATION….
- Pure tone audiogram shows a conductive HEARING loss inrt ear with 20-30 decibel air bone gap
- X ray mastoids did not reveal any abnormality
- Based on history, clinical examination and investigations a final diagnosis of was made ……. Inactive withCONDUCTIVE HEARING LOSS
- Patient was managed with aural toilet , local antibiotic drops and oral antibiotic drops
- Patient was counseled to keep his ear dry by avoiding water entry in the ear, and prompt treatment of urti to be carried out if such an episode occur. He was ADVISED TO keep his ear dry for about 3 months, so that the surgical procedure can be carried out, for repair of the tympanic membrane that is myringoplasty.