2. • NAME : Miss.Thejaswini
• AGE : 24 years
• SEX : Female
• RELIGION : Hindu
• Address : Bengaluru, india
3. • c/o Bilateral Ear discharge since 1.5 years
• c/o Decreased hearing in bilateral ear since 1 year
Chief complaints:
4. HISTORY OF PRESENTING ILLNESS :
• Patient was apparently normal 1.5years back, then she developed bilateral ear
discharge,
• Right ear discharge - insidious in onset, intermittent in nature, moderate in amount, yellowish in
colour, sticky consistency, non foul smelling, non blood tinged, aggravating after head bath,
relieved on medication. (Last discharge 3weeks back);
• left ear discharge – insidious in onset, continuous in nature, scanty in amount, yellowish white in
colour, foul smelling, non blood tinged, no aggravating factors, sometimes relieved on
medication.
• Patient also complaints of reduced hearing in bilateral ear since 1 year, it was
insidious in onset, continuous in nature, moderate degree hearing loss(patient finds
difficult to talk over phone), no aggravating / relieving factors.
5. HOPI (cont.) :
• No H/O Giddiness,
• No H/O Ringing sensation,
• No H/O Facial weakness, difficulty in closing eyes, dribbling of saliva
• No H/O post aural pain
• No H/O Fever, Headache,
• No H/O Double vision,
• No H/O Nasal / Throat complaints
6. PAST HISTORY :
• H/O Bilateral ear discharge and right ear pain present 3 weeks back,
diagnosed as right ear otitis externa – patient hospitalized (treated with
inj.FORTUM) and patient was discharged after 10days of antibiotics.
7. PERSONAL HISTORY :
• Diet : mixed
• Sleep : adequate
• Appetite : good
• Bowel and bladder : normal and regular
FAMILY HISTORY :
• Nothing significant
• No history of similar complaints in the family
8. GENERAL PHYSICAL EXAMINATION :
• male child , moderately built and nourished
• conscious, co operative
• Patient is afebrile
• Pulse : 82bpm
• Pallor
• Icterus
• Clubbing
• Cyanosis absent
• Lymphadenopathy
• edema
9. LOCAL EXAMINATION : EAR
RIGHT EAR LEFT EAR
Pinna Normal Normal
Pre auricular area Normal Normal
Post auricular area Normal Normal
Tragal tenderness absent absent
Mastoid tenderness absent absent
External auditory canal normal normal
Tympanic membrane Pars flaccida : NORMAL
Pars tensa :
• Small central perforation in AS
Quadrant
• Medium sized central perforation
involving PS and PI Quadrant.
• Outer attic wall erosion
• Grade 4 Retraction
(Adherent pars tensa)
• ? small central perforation in AI
quadrant.
• Foreshortened handle of malleus
• Long process of incus visualized.
12. TFT RIGHT EAR LEFT EAR
Rinne test 256 Hz
512 Hz
1024 Hz
NEGATIVE
NEGATIVE
positive
NEGATIVE
NEGATIVE
positive
Webers test Lateralized towards LEFT ear
Absolute bone conduction test Not reduced not reduced
RIGHT LEFT
Middle ear Not visible. • Foreshortened handle of malleus
• Long process of incus visualized.
• Hypertrophied middle ear mucosa.
Fistula test negative negative
Facial nerve intact intact
13. LOCAL EXAMINATION :
• NOSE EXAMINATION :
• External frame work of nose :
root : normal
Nasal bridge : normal
Tip: normal
• Skin over the nose : normal
• Elevation of tip: nasal vestibule normal
14. Right Left
Septum Appears central
Mucosa Normal Normal
Inferior turbinate Normal Normal
Inferior meatus Normal Normal
Middle turbinate normal normal
Middle meatus Normal normal
floor Normal normal
Anterior rhinoscopy :
15. POSTERIOR RHINOSCOPY Right left
Choana normal
Posterior end of septum Normal normal
Posterior end of turbinates normal normal
Eustachian tube opening normal normal
Fossa of rosenmuller Normal normal
uvula Central In position
16. • Functional tests
Right Left
Smell sensation Normal normal
Cold spatula normal normal
Cotton wool normal normal
18. LOCAL EXAMINATION :
NORMAL
ORAL CAVITY EXAMINATION : FINDINGS :
lips normal
Vestibule normal
UGBS/UGLS normal
LGLS/LGBS normal
Buccal mucosa normal
Anterior 2/3rd tongue normal
Floor of mouth normal
Teeth normal
Hard palate normal
19. OROPHARYNX EXAMINATION : FINDINGS :
soft palate Normal
uvula Normal
anterior pillars Normal
tonsillar area Normal
posterior pillars Normal
posterior pharyngeal wall Normal
posterior 1/3 of tongue Normal
20. INDIRECT LARYNGOSCOPIC EXAMINATION : FINDINGS
Base of tongue Normal
Glossoepiglottic fold normal
Vallecula normal
Epiglottis Normal
Aryepiglottic folds Normal
Arytenoids Normal
Inter arytenoid area Normal
Vocal cords b/l vocal cords mobile on phonation
Pyriform fossa normal
Post cricoid area normal
21. NECK EXAMINATION FINDINGS :
Trachea Midline
External laryngeal contour Normal
Laryngeal crepitus Present
Lymph nodes No evident palpable lymph nodes
No visible pulsations / engorgement
No thyroid enlargement
22. • 24years old Female, came with c/o bilateral ear discharge and
reduced hearing since 1.5years, history suggestive of ear pathology;
Examination shows left ear : outer attic wall erosion, grade 4
adherent pars tensa; right ear : small CP in AS quadrant, medium CP
in PS & PI quadrant.
• Hence the probable diagnosis would be Bilateral chronic suppurative
otitis media – Left ear : Atticoantral type, inactive stage with
moderate conductive hearing loss; Right ear : Tubotympanic type,
active stage with moderate conductive hearing loss with no signs of
complications.
PROBABLE DIAGNOSIS :
