SAFE Chronic Serous Otitis Media (CSOM) MBBS ENT .pptx

Safe CSOM MBBS ENT

1. CHRONIC SUPPURATIVE OTITS MEDIA (SAFE CSOM) Dr Saima Khan Resident , Rajiv Gandhi Medical College, Thane

2. CHIEF COMPLAINTS Mr XYZ , 35 year old male , Auto rikshaw driver , resident of Bhiwandi presented with : Right ear discharge since 2 years Right ear reduced hearing since 2 years

3. HOPI Apparently alright 2 yr back Noticed Right ear discharge , profuse , mucoid to mucopurulent , intermittent , non blood stained , non foul smelling Associated with history of ear drops reaching throat Aggrevated by upper respiratory tract infection Reduced temperorily by ear drops and oral medications Last episode of ear discharge was 3 months ago

4. Also complains of reduced hearing in Right ear since 2 years Gradually progressive Initially patient could hear whispers but now unable to do so He can hear normal routine conversations Can also understand the speech He tilts his head to left side in response to low voices or whispering voices Hears better whenever the ear is discharging

5. Not Associated with : swelling behind ear , earache , facial weakness ringing sensation in ear , giddiness bleeding from ear Deep pain behind eyes , double vision headache , fever , vomit , loss of consciousness Recent air travel , swimming or diving Any ototoxic drug intake Chemical or physical trauma Nose block , nasal discharge

6. SUMMARY 35 yr old male , presents with Right ear discharge and reduced hearing since 2 years , associated with upper respiratory tract infection , probably suffering from Chronic Suppurative Otitis Media , mucosal or safe variety with perforation and no complications with normal nose , throat and neck at present

7. Past History No similar episodes in childhood No previous medical or surgically significant events

8. Personal History Habit of cleaning ears by buds socio economic status - Class IV as per modified BG Prasad classification No overcrowding or common water source in family Denies addiction to smoking , or any other substance abuse No known allergies Prefers mixed diet with good appetite Sleep Adequate bowel , bladder habits are regular

9. Family History No similar complaints in family No history of hard of hearing in family No significant medical or surgical history

10. GENERAL EXAMINATION Examined in sitting posture in adequate light Average built and good nourishment BMI – 22 kg/m² , Afebrile Conscious , cooperative , oriented to time place and person No pallor , icterus , edema , clubbing , cyanosis , lymohadenopathy Pulse - 98 / m , regular rhythm , good volume BP – 120/80 mmHg , in supine position in right arm

11. SYSTEMIC EXAMINATION CVS - S1 S2 heart sounds heard , no murmur RS – Air entry bilaterally equal PA – Soft , non tender CNS – conscious cooperative oriented to time place and person , Cranial nerve examination normal , No facial palsy

12. ENT EXAMINATION RIGHT EAR LEFT EAR PINNA Normal Normal PRE AURICULAR AREA Normal Normal POST AURICULAR AREA Normal Normal TRAGAL TENDERNESS Absent Absent EXTERNAL AUDITORY CANAL Normal Normal

13. OTOSCOPIC FINDING

14. TYMPANIC MEMBRANE ( PARS TENSA) A single , small , Central perforation occupying postero inferior quadrant , having smooth edges , cone of light absent Handle of malleus with anterior and posterior malleal folds normal in position Middle ear mucosa normal Round window niche seen Intact , Cone of light in antero inferior aspect , handle of malleus and anterior posterior malleal folds Normal in position

15. PARS FLACCIDA Normal Normal FACIAL NERVE Intact Intact FISTULA TEST Negative Negative NYSTAGMUS Absent Absent

16. FUNCTIONAL TESTS TEST RIGHT EAR LEFT EAR RINNE 256 BC > AC AC > BC 512 AC > BC AC > BC 1024 AC > BC AC > BC WEBER Lateralised to right ear ABSOLUTE BONE CONDUCTION Equal in both ears

17. TESTS OF BALANCE No Ataxia Rombergs test Neg Untenburgers test neg Tandem gait Test normal No dysdiadokokinesia No past pointing

18. NOSE EXAMINATION Normal in external appearance and normal vestibule , columella , philtrum , tip , nasolabial folds, nasofacial angle Anterior rhinoscopy reveals normal mucosa , midline septum , normal floor and cavity Cold spatula test – Bilateral equal misting Paransal sinus examination normal

19. ORAL CAVITY EXAMINATION Mouth opening adequate , Hygiene maintained Normal lips , buccal mucosa , gingivobuccal and gingivolabial sulci , anterior two thirds of tongue , retromolar trigone , hard palate

20. OROPHARYNX Normal posterior one third of tongue , soft palate , anterior posterior pillars , tonsillar fossae , posterior pharyngeal wall

21. NECK EXAMINATION No apparent swelling , normal lymph nodes , laryngeal crepitus present , movements Normal

22. PROVISIONAL DIAGNOSIS Mr XYZ , 35yr old , auto rickshaw driver , is suffering from Chronic Suppurative Otitis Media, in quiescent stage , mucosal or safe variety , with central perforation and moderate conductive hearing loss in right ear with Weber lateralised to Right ear , having no complications and normal nose , throat and neck at present