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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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