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Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
Clinical Approach and Investigations of Ear Discharge
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Clinical Approach and Investigations of Ear Discharge

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  • 1.      Age ASOM, CSOM (TTD & congenital AAD) common in children CSF otorrhea can be congenital Neoplasm of ear in 30 – 50 years old Sex CSOM more common in boys Race ASOM more common in Native American Occupation Factory, Airport, Airbase Address Near Airport,Industrial Area
  • 2. Chief Complain: Ear discharge: side and duration  HOPC  › Duration › Side: Unilateral Bilateral › Onset  Acute: Acute OM, TM perforation, OE, Furuncle  Insidious: CSOM, Cholesteatoma,  Recurrent: Furuncle
  • 3. › Progression  Continuos: CSOM  Intermittent: ASOM -frequency of episodes -duration of each episodes  Symptom is increasing/decreasing
  • 4. › Amount Scanty : CSOM Profuse › Nature watery: Otomycosis serous: CSF Otorrhea purulent: Furuncle, malignant OE (blood stained), CSOM › Trauma History: Blood discharge › Foul Smelling: CSOM, Osteomyelitis
  • 5.  Associated Symptoms › Pain + Deafness: Furuncle › Pain + Hearing Loss + CN palsy: Malignant › › › › › OE Itching + Seborrheic Dermatitis of scalp: Seborrhoiec OE Irritation + Itching + blocked sensation + dull ache: Otomycosis Pruritis Tinnitus Vertigo
  • 6.  Activities that can affect the canal or TM › Swimming: Otitis Externa › Insertion of object: Cotton buds, FB › Trauma: Ear pick › Ear Drops  Antibiotic: Otomycosis  Chloromycetin, Neomycin: Eczematous Otitis Externa
  • 7.  Past History › URTI, chronic sinusitis, chronic rhinitis  dysfunctional ET  ASOM  CSOM › Diabetes, Immunodeficiency › Previous Surgery in Ear, Sinus, Pharynx › Ear Diseases during Childhood: Congenital Disease
  • 8.      PINNA tenderness on moving pinna in furuncle PRE-AURICULAR spreading cellulitis in furuncle and malignant OE POST-AURICULAR lymphadenopathy in furuncle +/greasy yellow scale in the sulcus TRAGAL TENDERNESS furuncle,otomycosis, malignant OE MASTOID TENDERNESS CSOM
  • 9.  EXTERNAL AUDITORY CANAL -skin fissure and meatal stenosis in diffuse OE -otomycosis: white fluffy (candida), greenish (A.fumigatus) -lumen occluded by edema/abscess in furuncle -granulation tissue/polyp in malignant OE -vesicle formation, oozing and crusting in eczematous OE -greasy yellow scale in seborrhoeic OE
  • 10.  - TYMPANIC MEMBRANE: ASOM retracted and hyperemia bulging and fluid levels/bubbles (suppuration) Congested, edematous, bulging, pus pointing (before perforation) Pin-hole perforation, light house sign, pulsatile ear discharge (after perforation) Pin hole perforation without discharge (resolution)
  • 11.  The following findings are of particular concern › Recent major head trauma › Any cranial nerve dysfunction (including sensorineural hearing loss) › Fever › Erythema of ear or periauricular tissue › Diabetes or immunodeficiency
  • 12.   Blood Glucose: DM Microscopy › cholesteatoma, crust, granulation tissue in CSOM  Pure Tone Audiometry › Unilateral SN Hearing Lost in Neoplasm of Ear, Malignant OE   To rule out CSF leak › ᵝ2transferrin in discharge fluid Culture & Sensitivity › For refractory cases in which initial antibiotic therapy has failed
  • 13. CT of temporal bone › Fracture, Osteomyelitis  Biopsy › When auditory canal granulation tissue present 

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