case presentation suppurative otitis media csom

suppurative otitis media

1. A Case Presentation on Chronic Suppurative Otitis Media (CSOM) DEPARTMENT OF PHARMACY PRACTICE NIRMALA COLLEGE OF PHARMACY Presented by: T. JOHN WESLY IV/VI Phar m D Y21PHD0830

2. BRIEF SUMMARY ABOUT THE CASE A 26 yrs old female patient was admitted in the hospital with the chief complaints of ear pain and discharge from the right ear since 2years associated with mild hearing loss since few months ago . Hence admitted for further management. She had no other comorbidities and her immunization history was up to date, Her appetite, bowel & bladder movements are normal. The above case was presented in the format of SOAP analysis

3. SUBJECTIVE EVIDENCE A 26 yrs old female patient was admitted in the hospital. C/o Ear pain and discharge from the right ear since 2yrs associated with mild hearing loss since few months ago No History of Fever / Cough / Cold Immunization history – Up to mark Personal history : Appetite – Normal Diet – Mixed Bowel – Regular

4. OBJECTIVE EVIDENCE Physical examination BP: 120/80mm/hg PR: 80bpm RR: 18/min Spo2: 98%@RA Systemic examination Temperature: Normal CVS: S 1 S 2 + CNS: NFND

5. LABORATORY INVESTIGATIONS Complete blood count Haematology Abnormal value Normal value Haemoglobin 11.5 g/dl 12.0 – 15.0 g/dl MCH 26.6 pg/cell 27.0 – 31.0 pg/cell RDW 15.5% 11.6 – 14.0% Pure tone test Audiological diagnosis Right ear : Mild conductive hearing loss Left ear : Normal hearing sensitivity

6. DIAGNOSTIC TESTS Audiological Diagnosis

7. ASSESSMENT : Based upon subjective and objective evidences the diagnosis was found to be Chronic suppurative otitis media tubo- tympanic disease Definition : Chronic Suppurative Otitis Media (CSOM ) is a persistent inflammation of the middle ear or mastoid cavity, and is associated with recurrent ear discharge (otorrhea) through a perforated tympanic membrane (eardrum). It is a chronic form of otitis media, a middle ear infection. Tubo-tympanic disease is a specific type of CSOM that primarily affects the anterior and inferior parts of the middle ear, particularly the Eustachian tube (tubo) and the tympanic cavity (tympanic).

8. ETIOLOGY Causes of chronic suppurative otitis media include acute otitis media and blockage of a eustachian tube. A flare-up may occur after a cold, an ear infection or after water enters the middle ear. People usually have hearing loss and persistent drainage from the ear. Doctors clean the ear canal and give ear drops. Antibiotics and surgery may be used for severe cases

9. RISK FACTORS Poor socioeconomic conditions (e.g., overcrowded housing, poor hygiene and nutrition) Multiple episodes of acute otitis media (AOM) Living in crowded conditions Previous traumatic perforation of the TM Insertion of grommets

10. PATHOPHYSIOLOGY

11. SIGNS AND SYMPTOMS Painless otorrhea (fluid draining from ear) Conductive hearing loss Fever, headache, and confusion Swelling, tenderness, and redness behind the ear Ear pain

12. STANDARD TREATMENT Pharmacological Treatment Topical Antibiotics : Ciprofloxacin, ofloxacin , gentamicin drops Systemic Antibiotics : Amoxicillin - clavulanate , cefuroxime, ciprofloxacin Steroid Drops : Dexamethasone, Betamethasone Surgical Treatment Myringoplasty/Tympanoplasty Mastoidectomy Hearing Rehabilitation Hearing Aids Audiological Assessment

13. PLAN Prevent further complications Reduce disease progression Relieve from symptoms

14. SURGICAL PROCEDURE Surgery : Right Tympanoplasty + Mastoidectomy

15. DRUG CHART S.no Brand name Generic name Category Dose R.O.A Frequency Use/indication 1. Tab. AUGMENTIN Amoxicillin/ Pottasium clavulanate Antibiotics 625mg P/O 1 - 0 - 1 To kill bacterial infections 2. Tab. PANTOP Pantoprazole Proton pump inhibitors 40mg P/O 1 – 0 - 1 To decrease the amount of acid produced in stomach 3. Tab. ULTRACET Tramadol Opioid Analgesics 1 tab P/O 1- 0 - 1 To decrease severe chronic pain 4. Tab. BLEXTEN Bilastine Antihistamines 20mg P/O 0 – 0 - 1 To treat allergic conditions

16. DRUG INFORMATION Name of the drug Category MOA ADR’S Amoxicillin/ Pottasium clavulanate Antibiotics This action activates autolytic enzymes in the bacterial cell wall, resulting in cell wall lysis and bacterial cell destruction.  Rashes, vomitings, nausea Pantoprazole Proton pump inhibitors S uppresses the final step in gastric acid production by forming a covalent bond to two sites of the (H+,K+)-ATPase enzyme  Headache, Diarrhea Stomach pain, Nausea or vomiting. Tramadol Opioid Analgesics Inhibition of ascending pain pathways from the brain Kidney manifestation, Dizzy or drowsy, constipation, and nausea Bilastine Antihistamines B inding to and preventing activation of the H1 receptor, bilastine reduces the development of allergic symptoms due to the release of histamine from mast cells Nausea, vomiting, dryness in the mouth, diarrhoea.

17. PATIENT COUNSELLING Avoid swimming Do not do any activity that could get water into the ear Avoid usage of headsets & electronic device Avoid Living in crowded areas & Avoid loud activities and places whenever possible. PHARMACIST INTERVENTION No interactions were fo und No medication errors were found