csom - case presentation
TRANSCRIPT
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Deepika kamath
Case presentation
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Siddharchaya
52 years
Male
Welder
Honnalli
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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
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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
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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
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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
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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
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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
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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
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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
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Family history No similar complaints in the family
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Personal history Appetite – good
Diet - vegetarian
B&B - regular
Sleep - adequate
Habits - used to smoke beedi abstained since
15 years
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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
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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
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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
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TYMPANIC MEMBRANE
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RIGHT LEFT
SEIGALISATION
FACIAL NERVE normal normal
FISTULA SIGN negative negative
MASTOID TENDERNESS
absent absent
TFT
RINNES negative negative
WEBERS lateralized to left
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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
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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
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PROVISIONAL DIAGNOSIS B/L chronic otitis media active squamous with
conductive hearing loss with allergic rhinitis
without any complications
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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
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MANAGEMENT Either intact canal wall or canal wall down
mastoidectomy with ossiculoplasty