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CSOM - Case Presentation

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Page 1: CSOM - Case Presentation

Deepika kamath

Case presentation

Page 2: CSOM - Case Presentation

Siddharchaya

52 years

Male

Welder

Honnalli

Page 3: CSOM - Case Presentation

Chief complaints H/o bilateral ear discharge more left sided on and

off since 15 years

H/o decreased hearing left sided more than right

sided since 10 years

Page 4: CSOM - Case Presentation

History of presenting illness

EAR DISCHARGE

It initially started in the left ear and after a gap of

2 years it started in the right ear

Insidious in onset

Gradually progressive

Patient says that he is not aware of the discharge

only when he cleans his ear his cotton bud comes

to know

Discharge is scanty, purulent, yellow, occasionally

blood stained and foul smelling

It is intermittent

Page 5: CSOM - Case Presentation

Each episode lasts for 7 days

Relieved with topical medications

One episode every 6 months

Increased amount of discharge during episodes

of upper respiratory tract infections and entry of

water into the ears

Present ear discharge is 20 days back

Which relieved temporily on medication

Page 6: CSOM - Case Presentation

Decreased hearing 10 years

Left> right

Insidious in onset

Gradually progressive

Worsens during episodes of active ear discharge

Patient says he cannot hear soft sounds

Can percieve only loud noise

Page 7: CSOM - Case Presentation

Ringing sound in the left ear

7 years

More on the left side

Intermittent

Sound of a ringing bell

Lasting throughout the episode of discharge

Relieved with its resolution

He also gives history of excessive sneezing

Each episode lasts for 5 minutes

Page 8: CSOM - Case Presentation

Associated with watery nasal discharge

No H/o nasal obstruction

No h/o giddiness

No h/o weakness of face, deviation of the angle of the mouth

No h/o fever, headache, vomiting, neck stiffness

No h/o earache

No h/o visual disturbances, speech problems

No h/o trauma

No h/o postaural swelling associated with fever

No h/o nasal obstruction

No h/o recurrent attcks of throat pain, dysphagia,odynophagia

Page 9: CSOM - Case Presentation

Past history Patient was diagnosed to have kidney stones 6 years

back for which he underwent treatment

No h/o

Tb

Diabetes

Hypertension

Bronchial asthma

Epilepsy

Prolonged hospitalisation

Blood transfusion

Drug allergies

Page 10: CSOM - Case Presentation

Treatment history Used topical medication for 1 week everytime he

used to hav ear discharge

Details not available

1 week back the patient received the following

medications

Tab. Ciplox 500 mg BD

Tab diclo 50 mg BD

Otolux o ear drops 3 -3-3

Page 11: CSOM - Case Presentation

Family history No similar complaints in the family

Page 12: CSOM - Case Presentation

Personal history Appetite – good

Diet - vegetarian

B&B - regular

Sleep - adequate

Habits - used to smoke beedi abstained since

15 years

Page 13: CSOM - Case Presentation

General examination 52 year old male patient, moderately built and

nourished

Conscious, co operative, well oriented to time,

place , person

VITALS:

BP: 120/80 mm hg

PR: 76/ MIN

RR: 18/ MIN

No pallor, icterus, cyanosis, clubbing ,

lymphadenopathy

Page 14: CSOM - Case Presentation

Systemic examination CVS: S1 & S2 heard , no murmurs

RS: B/L NVBS heard, no added sounds

P/A: soft, non tender, no organomegaly

CNS: normal

Page 15: CSOM - Case Presentation

Local examination EAR

RIGHT LEFT

Preauricular normal

normal

Pinna normal

normal

Postauricular normal a

swelling 2*2

no

signs of inflammation, edges well defined, surface

smooth

Palpation : soft in consistency

EAC normal

Page 16: CSOM - Case Presentation

TYMPANIC MEMBRANE

Page 17: CSOM - Case Presentation

RIGHT LEFT

SEIGALISATION

FACIAL NERVE normal normal

FISTULA SIGN negative negative

MASTOID TENDERNESS

absent absent

TFT

RINNES negative negative

WEBERS lateralized to left

Page 18: CSOM - Case Presentation

nose Cold spatula test:

External appearance: normal

ARE vestibule: normal

S shaped DNS

b/l HIT

turbinates pale

mucosa normal

Paranasal sinuses: non tender

PRE: NORMAL

Page 19: CSOM - Case Presentation

ORAL CAVITY: lips, gums, teeth, anterior 2/3 rd tongue. Hard palate, GLS, GBS – normal

OROPHARYNX: RIGHT LEFT

ANTERIOR PILLAR normal normal

TONSILS GRAGE1 GRADE1

POSTERIOR PILLAR normal normal

PPW normal normal

IDL: NORMAL

NECK: no palpable lymph nodes

Page 20: CSOM - Case Presentation

PROVISIONAL DIAGNOSIS B/L chronic otitis media active squamous with

conductive hearing loss with allergic rhinitis

without any complications

Page 21: CSOM - Case Presentation

investigations Otoscopy

Otomicroscopy

Culture in case of discharge

PTA

X RAY B/L mastoids schullers view

Chest x ray PA view

X RAY pns wayers view

Routine investigations

Blood

Urine routine

ECG

Page 22: CSOM - Case Presentation

MANAGEMENT Either intact canal wall or canal wall down

mastoidectomy with ossiculoplasty