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chronic ottis media presentation .case presentation
- 1. CASE PRESENTATION Dr. DikshyaShrestha Junior Resident Department of ENT and HNS, BPKIHS
- 2. Patient’s Particulars • Name:Mr. Shah • Age/Sex: 21 years/Male • Address: Itahari • Occupation:Student • Religion : Hindu • Informant: Self • Reliability: Good
- 3. Chief Complaint Discharge fromleft ear for 4 years Decrease hearing from left ear for 2 years
- 4. Discharge from leftear • Insidious onset • Gradually Progressive • purulent in nature • yellowish in color • Continuous • Scanty to moderate in amount • Foul smelling • Occasionally Blood Mixed • Partially relieved on topical medications • No aggravating factor
- 5. Decreased hearing fromleft ear • Insidious in onset • Gradually progressive • Non fluctuant • have difficulty in using mobile phone from left ear • Difficulty hearing and localizing sound when called from left side or behind
- 6. No history of •Ear ache • High grade fever • Headache, Nausea, vomiting • Loss of consciousness • Neck stiffness/photophobia • Abnormal body movements • Tinnitus ,vertigo
- 7. • Double vision,Retro-orbital pain • Facial deviation • Neck swelling • Gait/speech abnormalities • Foreign body insertion
- 8. Past history No H/osimilar illness in the past No h/o DM/Bronchial asthma,PTB No History of Head and Neck surgeries or Malignancy
- 9. Family History No h/osimilar illness in family member No h/o PTB/DM/HTN/Bronchial asthma No History of Head and Neck surgeries or Malignancy
- 10. Personal History Student lives infamily of 4 members Consumes mixed diet Bowel/bladder/sleep/appetite -Normal No Habit of putting oil in ear/ bathing in ponds
- 11. Drug History History oftaking topical ear drops on and off. Allergic History No h/o allergy to drugs or known substances.
- 12. GENERAL PHYSICAL EXAMINATION Generalexamination Patient is conscious, cooperative,average built and well oriented to time, place and person Pulse: 68 bpm, regular, normal rate, rhythm, volume and character, no RR delay, all peripheral pulses palpable. Blood Pressure: 110/70 mm Hg in right arm in sitting position Respiratory Rate: 20 breaths per minute Temp: 97.4°F, axillary
- 13. • Pallor • Icterus •Lymphadenopathy • Clubbing Absent • Cyanosis • Edema • Dehydration
- 14. Systemic Examination CNS :Grossly intact Respiratory: B/L Normal vesicular breath sounds No added sounds CVS: S1, S2 heard, No murmur Abdomen: Soft, non tender No organomegaly Bowel sound heard
- 15. Ear • Pinna: Bilateralpinna normal in shape, size, angle, position • Tragal tenderness: absent • Circumduction tenderness: absent • 3 finger test: absent
- 16. Pre auricular Region NoScar/sinus/ swelling/ discharges or tenderness Post auricular Region No Scar/sinus/ swelling/ discharges or tenderness Retroauricular groove: Not Obliterated
- 17. External Auditory Meatus B/LPatent No Discharge External Auditory Canal: without speculum and with Speculum Right Left Roof Anterior wall Posterior wall Floor wnl purulent discharge on EAC
- 18.
- 19. • Tuning ForkTest ( 256 Hz,512Hz, 1024 Hz) Right Left Rinne’s : +ve -ve Weber’s : ABC : Not Reduced Not Reduced
- 20. Seigalization Test: Right –within normal limit Left- no movement perceived Fistula test: B/L Negative Nystagmus: B/L Absent Facial Nerve Clinically Intact
- 21. Tests for Balance •Romberg’s Test : Negative • Gait: Normal • Unterberger Stepping Test : Negative
- 22. Examination of nose •NOSE • Skin overlying: • Root • Dorsum • Supratip • Tip • Columella • Osteocartilagenous Framework: No obvious deformity/ deviation WNL
- 23. •Vestibule: within normallimit •Patency test: bilaterally patent •Paranasal sinuses: No fullness, no tenderness
- 24. Anterior Rhinoscopy • Roof •Septum • Middle turbinate • Middle meatus • Inferior turbinate WNL • Inferior meatus • Floor
- 25. Posterior rhinoscopy • Bilateralposterior choanae • Posterior end of septum/turbinates • Bilateral eustachian tube Opening • Torus tubarius • Fossa of Rossenmuller • Uvula WNL
- 26. Examination of oralcavity Lips/ Gums/ Teeth Vestibule Tongue/Floor of the mouth Buccal mucosa Hard/soft palate Uvula Anterior pillar Tonsils Posterior pillar Tonsillolingual sulcus Posterior pharyngeal wall Retromolar trigone WNL
- 27. Indirect Laryngoscopy • Baseof Tongue • Vallecula • Median/lateral glossoepiglottic fold • Epiglottis • Aryepiglottic Fold • B/L Arytenoids • Interarytenoid region • B/L TVC • B/L FVC • Anterior commissure • Posterior commisure • B/L pyriform fossa WNL
- 28. Neck • No mass/swelling •No scar/sinus • No Tenderness • Laryngeal framework- wnl • Laryngeal crepitus- present • Lymphadenopathy- absent • B/L carotid pulsations palpable • Trachea- central
- 29. Provisional Diagnosis: Left ChronicOtitis Media Squamous Active With Moderate Conductive Hearing Loss Without Complication.
- 30.
- 31. PTA • Right: withinnormal limit • Left: 42db moderate conductive hearing loss
- 32.
- 33.
- 34. • Patient underwent LeftModified Radical Mastoidectomy with Type III tympanoplasty With Temporalis Fascia Grafting via postaural approach under General Anesthesia
- 36.
Editor's Notes
- #7 Gradenigo sign: ear discharge, retro orbital pain and diplopia, compression of abducen nerve in dorello canal under grubeno ligament
- #9 Head and neck malignancy leads to aural fullness mainly malignancy of nasopharynx
- #10 Ph of ear canal is 4.2 to 5.6 Ph of mustard oil: 3.6 to 5.5
- #21 Visual, vestibular and propioceptive
- #31 AIR BONE GAP
- #32 The Towne view is an angled anteroposterior radiograph of the skull and visualizes the petrous part of the pyramids, the dorsum sellae and the posterior clinoid processes, which are visible in the shadow of the foramen magnum Schuller's view is a lateral radiographic view of skull principally used for viewing mastoid cells