A 36-year-old male presented with decreased hearing in both ears for 3 months. Physical examination and lab tests revealed chronic suppurative otitis media caused by bacteria like Pseudomonas aeruginosa. The patient was prescribed antibiotics like Augmentin to be taken before meals, antihistamine Levocitrizine to be taken in the evening, pantoprazole for gastric acid suppression, and diclofenac for pain relief. He was counseled on lifestyle modifications like avoiding inserting objects in ears and swimming until fully recovered.

1. CASE PRESENTATION ON
CHRONIC SUPPURATIVE OTITIS MEDIA

2. A 36 years male patient was admitted in the
hospital with chief complaints of decrease in
hearing of both ears since 3 months .He is not
having any ear discharge and ear heaviness and
not having fever, headache.10 years back he
undergone surgery for Hydrocele.
The above case was presented in the SOAP
format
BRIEF SUMMARY OF CASE

3. 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.

4. OBJECTIVE EVIDENCE
• Physical examinations :
Temp : 98.6
Pulse rate : 72/min
Resp rate : 16/min
B.P : 120/80 mm of Hg
• Systemic examinations :
CVS : S1S2+
CNS : normal
Abdomen : Bowel sounds - yes

5. BIOCHEMICAL LABARATORY
INVESTIGATIONS
S.NO PARAMETER OBSERVED VALUE NORMAL VALUE
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 15.5g/dl 14 – 18 %

6. ASSESMENT
• Based on the subjective and objective evidences
the final diagnosis is the patient is suffering from
the CSOM (chronic suppurative otitis media )
• 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

7. 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

8. CLINICAL PRESENTATIONS
 Draining ear
 Fever
 Vertigo
 Loss of hearing
 External auditory canal – Oedematous
 Middle ear mucosa –
oedematous/polypoid/erythematous
 Granular tissue is often seen

9. 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 )

10. 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

11. DRUG INFORMATION
S.NO Name of drug Category M.O.A Side effect M.O.P
1. Pantoprazole Proton pump
inhibitor
Suppress
gastric acid
secretion
Headache,ed
ema,vertigo,
utricaria
Serum
gastrin
levels etc.
2. Augmentin cephalosporin Clavulanic
binds & inhibits
beta lactase;
inactivate
amoxicillin
Diarrhoea,sk
in rash,
abdominal
distress,
loose stools
nausea
RFT,hepatic,
hematologic
al function,
LFT
3. Levocitrizine Antihistamine Active isomer
of cetirizine,
selectively
inhibits
histamine h1
receptor
Sleepiness,
headache,
diarrhoea,
dry mouth
vomiting
Creatinine
clearance
4. Diclofenac Analgesic Inhibits cox1,
cox-2.
Heart
failure,hepat
o & renal
toxicity
Bp ,heart
rate,
RFT,LFT

12. PATIENT COUNCELLING
ABOUT DISEASE :
• CSOM is a chronic inflammation of the middle
ear and the mastoid cavity.
• It is caused due to bacteria like Pseudomonas
aeruginosa, Staphylococcus aureus etc.
• And due to multiple episodes of AOM, living
in crowded conditions, being a member of
large family and passive smoking.

13. 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

14. 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
 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

15. REFERENCES
• www.uptodate.com
• www.medscape.com
• www.mayoclinic.com