It is a chronic inflammation of the middle ear and the mastoid cavity.

1. CASE PRESENTATION
ON
CHRONIC SUPPURATIVE OTITIS MEDIA
Presented by
Makbul Hussain Chowdhury
Pharm.D 5th year
H.T. No.: 15Z11Tooo6

2. Definition :
 It is a chronic inflammation of the middle ear and the
mastoid cavity.
Etiology & risk factors :
 Pseudomonas aeurignosa.
 Living in crowded conditions.
 multiple episodes of AOM.
 passive smoking, genetic disorders.
 being a member of large family.

3. PATHOPYSIOLOGY:
Breakdown of skin cerumen
Inflammation and edema of the skin leads to pruritus and
obstruction.
The sequence of events alters the quality and amount cerumen
produced ,impairs epithelial migration , increases the Ph of ear
canal
The resulting dark, warm, alkaline, moist ear canal becomes an
ideal breeding ground for numerous organisms

4. Signs and symptoms
 Draining ear
 Fever
 Vertigo
 Loss of hearing
 External auditory canal – Oedematous
 Middle ear mucosa –oedematous/ polypoid/ erythematous
 Granular tissue is often seen

5. CASE STUDY
PATIENT’S Demographics
Name: XXX
Age: 36years
SEX: Male
IP No.: 190648957

6. SOAP FORMAT
SUBJECTIVE EVIDENCE:
 A 36 years male patient was admitted in the hospital with
chief complaints of decrease in hearing of both ears.
 He is not having any ear discharge , heaviness , headache
and fever.
 He undergone surgery for Hydrocele 10 years back.
 He is not having any family history and social history.
 He doesn’t have any drug allergies.

7. SOAP FORMAT
OBJECTIVE EVIDENCE:
 Physical examinations :
Temp : 98.6º F
Pulse rate : 72/min
Respiratory rate : 16/min
B.P : 120/80 mm of Hg
 Systemic examinations :
CVS : S1S2+
CNS : normal
Abdomen : Bowel sounds - yes

8. SOAP FORMAT
BIOCHEMICAL LABARATORYINVESTIGATIONS:
S. No PARAMETER OBSERVED VALUE NORMALVALUE
1 Monocytes 1.0 2.0 – 10.0%
2 Neutrophils 53 % 40.0 – 75.0 %
3 Lymphocytes 40% 20 – 45 %
4 Eosinophils 2.0% 0.0 – 7. 0%
5 Haemoglobin 15.5mg/dl 14 – 17.5 mg/dl
6 T. WBC 15000cumm 4000-11000cumm
7 S. Cretinine 1.1mg/dl 0.6-1.2mg/dl

9. SOAP FORMAT
ASSESMENT:
 Based on the subjective and objective evidences it is assess
that the patient is suffering from the CSOM (chronic
suppurative otitis media )

10. SOAP FORMAT
PLAN:
GOALS:
 To prevent signs & symptoms by sympthamatic therapy.
 To avoid the further complications.
 To decrease the disease progression.
STANDARD TREATMENT:
 Myringotomy (Surgical incision of the ear drum).
 By taking antibiotics (Topical quinolones).

11. CURRENT DRUG CHART
S.NO BRAND
NAME
GENERIC NAME DOSE R.O.A FREQ
1 Pantocid Pantoprazole 40 mg P/O OD
2 Augmentin Amoxicillin &
Clavulante
625 mg P/O TID
3 Levorid Levocetrizine &
pseudoephedrine
5 mg P/O OD
4 Voltaren Diclofenac 50 mg P/O TID

12. DRUG INFORMATION
S.NO Name of drug Category M.O.A Side effect
1 Pantoprazole Proton pump
inhibitor
Suppress gastric acid
secretion
Headache, edema,
vertigo, Utricaria
2 Augmentin cephalosporin Clavulanic binds &
inhibits beta
lactase;inactivate
amoxicillin
Diarrhoea, skin rash,
loose stools, Nausea
3 Levocitrizine Antihistamine Active isomer of
cetirizine, selectively
Inhibits histamine h1
receptor
Sleepiness, headache,
diarrhoea, dry mouth,
Vomiting
4 Diclofenac Analgesic Inhibits cox1, cox-2. Heart failure, hepato &
renal toxicity

13. PATIENT COUNCELLING
ABOUT DISEASE :
 Chronic Suppurative Otitis Media is a chronic inflammation of
the middle ear and the mastoid cavity.
 It is caused due to bacteria like Pseudomonas aeruginosa,
Staphylococcus aureus etc.
 Due to multiple episodes of Acute Otitis Media, living in
crowded conditions Chronic Suppurative Otitis Media occurs.

14. PATIENT COUNCELLING
ABOUT THE DRUGS:
 Augmentin : Do not crush or chew , take before meals
 Levocitrizine : Consumed usually in evening Avoid drinking
alcohol
 Pantoprazole : Due to EDTA in preparation, zinc
supplementation may be needed in patients prone to zinc
deficiency
 Diclofenac : Avoid with milk

15. PATIENT COUNCELLING
LIFE STYLE MODIFICATIONS
 Shake your ears dry after swimming.
 Blow dry your ears on a low setting , holding the dryer 12
inches away.
 Use ear drops to prevent the infections.
 Don’t put anything smaller than your elbow in your ear.
 The ear should be protected from water during recovery from
the external otitis.

16. PATIENT COUNCELLING
LIFE STYLE MODIFICATIONS
 Hearing aids & ear phones should not be worn until the pain &
discharge have subsided.
 Patient should be told that ear canal is self cleaning & that
fingers, towels & cotton swab should not be inserted into the
ears.
 The patient should not swim.