paediatric squamosal disease uncompicated , underwent canal wall down mastoidectomy. ct showing extensive disease with bone destruction , moderate conductive hearing loss in pre op period.

1. Case Presentation –
Cholesteatoma
Dr Safika Zaman
Dept of ENT and HNS
VIMS- RKMSP
kolkata

2. Patient details
• Name – S. P
• Age –7 year
• Sex –Female
• Student
• Residence – Kolkata

3. Chief complaints
• Discharge from left ear from 2 year
• Impaired hearing in the same ear from last 1 year

4. History of present complaints
• Discharge – from left side , insidious in onset , continuous from last 2 year
• Scanty in amount , mucopurulent , often mixed with blood , foul smelling.
• Decreased hearing – left ear, from last 1 ear , gradually progressive in nature ,
• Persistent , no problem in speech discrimination but difficulty in
understanding soft sound.

5. History
• No history of ear pain , tinnitus, spinning sensation of head,
• No history of facial muscle weakness, or deviation of face
• No relation of discharge with upper respiratory infection
• No history of severe headache with fever and vomiting
• No history of post auricular abscess or discharging sinus

6. History
• No previous medical or surgical significant history
• No known food or drug allergen
• Immunised according to NIS
• Fine motor , gross motor , speech and language development is appropriate
for age
• Single child

7. Treatment history
• In last 2 years patient received multiple course of oral antibiotic and
antibiotic steroid drop , discharge never responded to the therapy and was
persistent .

8. Personal history
• Sleep , bowel , bladder , appetite – no recent change

9. General examination
Conscious , oriented and co- operative
Weight – 20 kg
BP – 90 /70
P- 120/min
RR- 18 / min
Temp – Normal
Pallor , cyanosis, clubbing , jaundice – absent

10. Local examination
• Pinna –both ear - normal in size and shape, no skin changes or lesion
present.
• Local temp of pinna for both ear is normal
• Pre-auricular region – in both ear no swelling or discharge present
• Post auricular region –in both ear no swelling , scar , fistula present .

11. Local examination
• External auditoty canal - left ear canal was filled
with pearly epithelial debri and mucoid discharge –
• After cleaning – posterior canal wall is congested.
• Tympanic membrane - left TM is congested ,attic
fullness present, small central perforation, no
impression of handle of malleus is appreciable , no
cone of light present.
• Right ear – both EAC and TM examination is
within normal limit.

12. • Sigalization – no acute onset nystagmus or vertigo
• Examination of nose – within normal limit
• Examination of oral cavity and oropharynx – WNL
• Examination of facial nerve – WNL

13. Tuning fork test
Right ear Left ear
Rinnes test Positive Negetive
Webers test Towards left ear

14. Provisional diagnosis
• Active , squamosal chronic otitis media, uncomplicated

15. Investigations- PTA

16. Tympanogram

21. Management
• Canal wall down mastoidectomy with ossiculoplasty and grafting

22. Thank you