ent csom ppt (1). pptx for 3 year MBBS.

ENT case study on chronic suprattive otitis media.

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

16. 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

17. 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

18. 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

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

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

21. 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

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

23. 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

24. 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

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

26. 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