2. 
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


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

3. 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

4. › Progression
 Continuos: CSOM
 Intermittent: ASOM
-frequency of episodes
-duration of each episodes
 Symptom is increasing/decreasing

5. › 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

6. 
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

7.  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

8. 
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

9. 




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

10. 
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

11. 
-
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)

12.  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

13. 

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

14. CT of temporal bone
› Fracture, Osteomyelitis
 Biopsy
› When auditory canal granulation tissue
present
