A 40-year-old female patient presents with a 6-month history of decreased hearing and discharge from the right ear, diagnosed with right-sided uncomplicated tubotympanic chronic suppurative otitis media in active stage. Examination reveals a central perforation in the tympanic membrane and moderate mucopurulent discharge. Management includes investigations, aural toileting, topical and systemic antibiotics, and surgical options if needed.

1. PATIENT PARTICULARS
• Name: Mrs. XYZ
• Age: 40 years
• Gender: Female
• Occupation: tailor
• Address: bangalore.
• Socio economic status: upper middle class
( modified Kuppuswamy’s socio economic status scale)
• Date of Admission: 12th February 2020.
• Date of Examination : 12th February 2020.

2. CHIEF COMPLAINTS
• Decreased hearing in Right ear since 6 months.
• Discharge in Right ear since 6 months.

3. HISTORY OF PRESENTING ILLNESS
• Patient was apparently normal 6 months back
• after which she noticed
• Decreased hearing in right ear which was
• insidious in onset, gradually progressive, better
• heard when spoken loudly.
• NO aggravating or relieving factors.

4. • The patient also complaints of
• Discharge from right ear since 6 months which was insidious in onset,
gradually progressive
• Moderate in amount
• mucopurulent in consistency,.
• Non foul smelling , non blood tinged
• aggravation on seasonal changes or cold weather and entry of water No
relieving factors.

5. • No history of Pain in ear
• No history of ringing sensation in ear
• No history of giddiness
• No history of Swelling around the ear

6. • No history of Fever
• No history of Giddiness
• No history of Headache
• No history of Facial Weakness
• No history of Visual defects or diplopia
• No history of retroorbital pain
• No history of Irritability or Neck Rigidity
No history of Nausea and Vomiting
• No history of trauma and surgery
• No history of Upper Respiratory Tract Infections, nasal obstruction
• No history of Throat pain

7. PAST HISTORY
• No history of diabetes, hypertension, asthma or any chronic
• illnesses.
• No h/0 of similar complains in the past.
• No history of trauma
• No h/0 of surgery.
• No h/o of any drug intake

8. FAMILY HISTORY
• No significant family history.
• No history of deafness in family

9. • Diet: Mixed diet
• Appetite: Normal
• Sleep: Adequate
• Bowel & Bladder habits: Regular
• No addictive habits

10. Summary
A 40 year old female presenting with complaints of decreased hearing in right
ear since 6 months and discharge in right ear since 6 months with no associated
co morbidities suggestive of uncomplicated tubotympanic chronic suppurative
otitis media- active stage

11. GENERAL PHYSICAL
EXAMINATION
• Patient aged about 40- years was conscious, cooperative, well oriented to time, place and person.
• Moderately built and well nourished.
• Height = 158cm Weight = 62kg
• BMI = 24.83 kg/m2
• No pallor.
• No icterus.
• No cyanosis.
• No clubbing.
• No generalized lymphadenopathy.
• No edema.

12. VITALS
• Pulse rate: 74beats/min
• Blood pressure: 124/80 mm of Hg of right arm measured in
sitting position
• Respiratory rate: 16 cycles/min,
• Temperature: Afebrile

13. • Cardiovascular system:
• Sounds S1 and S2 heard. No murmurs
• Respiratory system
• Normal vesicular breath sounds heard.
• Abdominal examination.
• No mass per abdomen
• No organomegaly
• CNS examination.
• No neurological deficit present.
• No Neck rigidity
• Cranial nerve examination -normal

14. LOCAL EAMINATION
• EAR
RIGHT EAR LEFT EAR
PRE AURICULAR REGION
tragal sign
NORMAL
absent
NORMAL
absent
PINNA NORMAL NORMAL
POST AURICULAR
REGION
mastoid
tenderness
NORMAL
Absent
NORMAL
Absent
EXTERNAL AUDITORY
CANAL
Shows presence of
discharge which was
moderate in quantity and
mucopurulent .
With no blood tinge
NORMAL

15. RIGHT EAR LEFT EAR
TYMPANIC MEMBRANE SHOWS SMALL SIZED
CENTRAL PERFORATION IN
THE ANTEROINFERIOR
QUADRANT WITH SMOOTH
AND ROUNDED MARGINS
PEARLY WHITE IN COLOUR
NORMAL
STRUCTURES VISIBLE
THROUGH PERFORATION
OPENING OF EUSTACHIAN
TUBE
-
STATUS OF MIDDLE EAR
MUCOSA
EDEMATOUS NOT VISIBLE
EXAMINATION OF FACIAL
NERVE
ABILITY TO CLOSE EYES
WRINKLING OF FOREHEAD
CLENCHING OF TEETH
PUFFING OF CHEEKS
ABILITY TO CLOSE EYES
WRINKLING OF FOREHEAD
CLENCHING OF TEETH
PUFFING OF CHEEKS
FISTULA TEST NEGATIVE NEGATIVE

17. TUNING FORK TESTS AND FUNCTIONAL
EXAMINATION
RIGHT EAR LEFT EAR
RINNE ‘S TEST NEGATIVE
( BONE CONDUCTION > AIR
CONDUCTION)
POSITIVE ( AC>BC)
WEBER‘ S TEST
LATERALIZED TO RIGHT SIDE
ABSOLUTE BONE
CONDUCTION TEST
NORMAL NORMAL
TESTS FOR BALANCE :
ROMBERG
S TEST
NORMAL NORMAL

18. • External Nasal Frame Work: Normal
• Vestibule : Tip Raising Test – NORMAL
• Ala: Normal
• Columella: Normal
• Vestibule : Normal
• Anterior Rhinoscopy
• Nasal mucosa : normal
• Septum: Present in midline
• Turbinates: Normal
• Meatus : normal

19. • Functional Examination:
• Cold Spatula Test: Fogging equal on both sides
• Cotton Wool Test : Movement is bilaterally equal
• Posterior rhinoscopy Examination: Not done
• Paranasal sinus tenderness : Absent
• Testing of olfaction : alcohol swab test – able to perceive smell

20. Oral cavity examination
• THROAT
• a) ORAL CAVITY
• Oral Hygiene : Good
• Mouth Opening: Adequate
• Lips: Normal
• Gums : normal
• Tongue: Normal
• Hardpalate: Normal

21. • Floor of Mouth: Normal
• Buccal Mucosa: Normal
• Gingivo Buccal Sulcus: Normal
• Dentition: Normal
• Retromolar Trigone: Normal

22. OROPHARYNX examination
• Uvula – midline and normal
• Soft palate – Normal
• Anterior pillar of fauces : normal
• Posterior pillar of fauces : normal
• Tonsils : normal
• Indirect Laryngoscopy: Not Done

23. • NECK:
• Laryngeal crepitus : Present
• Trachea: Appears to be in middle
• No palpable mass or swellings in neck.
• No Lymphadenopathy in neck.
• Thyroid : appears normal

24. Provisional diagnosis
• A 40 year old female named mrs .XYZ who came with complaints of ear
discharge and reduced hearing and my diagnosis is right sided uncomplicated
unilateral tubotympanic chronic suppurative otitis media in active stage with
unilateral ( right sided ) conductive hearing loss

25. MANAGEMENT:
☆INVESTIGATIONS:
• ROUTINE :
Blood - CBC and DLC ,TLC ,Hb level,ESR
Bleeding time & Clotting time,HbA1c
Urine- Sugar, Albumin , Microscopy
Skin prick test – Allergy
HIV Antibody testing –ELISA /EIA
Chest XRAY

26. • SPECIFIC:
-Microscopy
- Culture and Sensitivity
- Antibiotic sensitivity
- AUDIOMETRY – Pure tone audiometry + Patch test
- X –Ray of mastoid – SCHULLER’S VIEW

27. • TREATMENT :
- Aural toileting /Dry mopping
- Suction clearance or wet mopping
Note: Syringing is contraindicated =>Perforation
- Topical Antibiotics Ear drops (from sensitivity report)
~Gentamycin /Neomycin/Tobramycin
~ Ciprofloxacin/Ofloxacin/Moxifloxacin
~ Chloramphenicol
~ Polymyxin –B
- Systemic Antibiotics
- Steroids
- Rx of contributory factors +take precautionary measures.
-Surgical and reconstructive Rx