The document presents a case of a 7-year-old female patient with chronic otitis media, characterized by persistent discharge from the left ear and progressive hearing loss over two years. Despite multiple courses of antibiotics, the discharge remained unchanged, with notable findings during local examination including a central perforation and congested tympanic membrane. The proposed management plan includes canal wall down mastoidectomy with ossiculoplasty and grafting.

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