CSOM 18.pptx mbbs third years ent textbook

Csom ppt resentatives of each batch days before the study 3dfghc nvvijvvjjv

1. MSS JOMYIR ETE 22MBBS018 TOPIC : Case of CHRONIC SUPPURATIVE OTITIS MEDIA- TUBOTYMPANIC TYPE Miss Jomyir Ete 22MBBS018

2. Patient particulars: My patient is Nangram Mala,a 20y/o female student from Papu Nallah -Naharlagun and Christian by religion was examined by me on 30/05/24.

3. Chief complaints: She presented with chief complaints of: Discharge from right year x 3years Difficulty hearing on right ear x 3years

4. History of presenting illness : 1. My patient was apparently alright 3years back when she started having discharge from right ear which was insidious in onset, intermittent in nature, mucopurulent in consistency,non -foul smelling & yellowish-white in color. Non-blood stained and profuse in quantity (stains pillow) Aggravated with cough,cold & fever. Relieved by taking medicines.

5. 2. She also developed gradual onset difficulty hearing 2 years back which is progressive in nature. No aggravating and relieving factors.

6. Associated with; 1. Ear ache which is present at the time ear discharge-Insidious in onset,progressive in nature.No radiation or referring of pain. Aggravated with cold and cough and relieved upon taking medicines. 2. Dizziness where she experiences moving of surrounding structures, 3. Tinitus in right ear. No H/O Vertigo,any ear trauma.

7. No history of Nausea, Vomiting,any Nasal Obstruction or Throat Complaints.

8. PAST HISTORY: No h/o TB,DM,HTN or Ba . No H/o any surgery PERSONAL HISTORY: Non-vegetarian diet,non - smoker,non -alcoholic. Normal appetite & sleep pattern. Normal bladder and bowel habits. No known food or drug allergy or any seasonal allergy.

9. Family History: 7 members in family 5 siblings -3 sisters & 2 brothers (she is the first child) No similar incidence in family No h/0 TB,HTN,DM or BA in family No h/o consanguineous marriage

10. Socioeconomic status: Well ventilated Kaccha house with cement flooring LPG as source for cooking Income 30,000/month Well sanitized separate toilet No pets

11. GENERAL PHYSICAL EXAMINATION: Patient is conscious, cooperative, well oriented to time, place and person Average built and well nourished. No pallor. No icterus. No cyanosis. No clubbing. No generalized lymphadenopathy . No edema.

12. RIGHT EAR LEFT EAR PREAURICULAR REGION NORMAL NORMAL PINNA NORMAL ( shape,size and position) TRAGAL SIGN NEGATIVE NORMAL TRAGAL SIGN NEGATIVE POSTAURICULAR REGION NORMAL NORMAL EXTERNAL AUDITORY CANAL PRESENCE OF MUCOID SECRETION NORMAL TYMPANIC MEMBRANE CENTRAL PERFORATION Single,medium sized 1x1mm Oval shape with smooth margins Involving both of anterior quadrants PEARLY WHITE COLOR CONE OF LIGHT PRESENT MIDDLE EAR MUCOSA HIGHLY CONGESTED (red velvety) NORMAL OSSICULAR CHAIN APEARS TO BE PATENT PATENT LOCAL EXAMINATION OF EAR

13. EUSTACHIAN TUBE ( Valsalva Manouvre ) PATENT CRACKING SOUND OFTEN HEARD PATENT MASTOD REGION NORMAL/ NO TENDERNESS FELT NORMAL FACIAL NV NORMAL NORMAL

14. FUNCTIONAL EXAMINATION OF EAR: RINNE’S TEST BC>AC AC>BC WEBER’S TEST HEARD BETTER LATERALIZED TO RIGHT SIDE ABSOLUTE BONE CONDUCTION DECREASED AS COMPARED TO EXAMINER SAME AS EXAMINAR FISTULA TEST NEGATIVE NEGATIBE

15. PROVISIONAL DIAGNOSIS: Case of CHRONIC SUPPURATUVE OTITIS MEDIA (TUBOTYMPANIC TYPE) with no complications.

16. INVESTIGATIONS: Culture sensitivity of ear discharge Assessment under microscope: to see margins of perforation,any in growth epithelium,granulatiion tissue and polyp. Audiogram X-ray and CT scan Temporal bone

17. MANAGEMENT : MEDICAL MANAGEMENT- Aural toilet by :(a) dry mopping, (b) wet mopping or (c) suction cleaning 2. Antibiotic ear drops after culture and sensitivity report. Ear drops with ciprofloxacin,ofloxacin etc. 3. Combined with steroids for local inflammatory effect.

18. SURGICAL MANAGEMENT: Removal of septic foci, e.g. tonsillectomy, adenoid- ectomy , sinus wash. Small perforation confined to one quadrant can be cauterized microscopically by using 20% silver nitrate solution or 3% trichloroacetic acid to facilitate healing. Tympanoplasty for persistent perforation Reconstuctive myringoplasty If X-ray mastoid shows mastoiditis , cortical mastoidectomy .

19. THANK YOU