Signs and Examination of Chronic Suppurative Otitis Media

A detailed description of signs and symptoms of CSOM

1. EXAMINATION OF EAR IN CSOM AKASH T NARESH 04 7 th Term

2. The examination of ear is carried out with Bull’s eye lamp and forehead mirror. Method of examination: The patient should sit erect with his head 10-12 inches forward from the back of the chair. While examining the patient, surgeon’s both legs should be together on the right side. For the examination of ear, the light should be focussed at the tragus through the forehead mirror.

3. Examination of External Auditory Canal Pinna is pulled upward, outward and backward to make external auditory canal straight in adults. In children, bony canal isn’t developed yet hence pinna is pulled downward and backward to make external auditory canal straight.

4. Examination of Tympanic Membrane

5. Following parameters are to be observed: Colour: Red and congested- ASOM Pale and amber colour- Secretory otitis media Flamingo pink blush(Schwartze sign)- Otosclerosis

6. Perforation

7. Number Size Margin Shape Site Middle Ear mucosa

8. Handle of malleus : it can be normal, shortened or foreshortened. Cone of light : normal cone of light indicates normal tympanic membrane Quadrants of Tympanic Membrane Retraction Pockets : normally seen in posterosuperior quadrant Mobility of Tympanic membrane

9. Eustachian Tube Examination The various methods to know the patency of Eustachian tube are: Valsalva’s method Toynbee’s test Politzer’s test Eustachian tube catheterisation

10. Valsalva’s Manoeuvre/Method Forced expiration on a closed glottis. Procedure: Ask the patient to close the mouth and pinch the nose by hand and blow. In a patent Eustachian tube, the air reaches the middle ear.

11. Toynbee’s Method Procedure: Ask the patient to swallow while his nose is held closed, middle ear pressure increases momentarily and then decreases. Positive Toynbee’s test indicates patent Eustachian tube.

12. Politzer’s Method Procedure : The nozzle of the Politzer’s bag is inserted into one nostril of the patient and then both the nostrils are tightly closed by the doctor. The patient is given a sip of water and asked to swallow, and the bag is squeezed simultaneously. Patient may feel air reaching in his/her ears.

13. Eustachian Tube Catheterisation Eustachian tube is catheterized by the Eustachian tube catheter and air is pumped through the air bulb. Not performed routinely May lead to scarring and further blockage of Eustachian tube.

14. Fistula Test To find out whether an abnormal communication exists between middle and inner ear. Procedure: On alternating pressure and release of tragus on external canal, the pressure of the middle ear is changed. If the patient complains of giddiness or nystagmus, the fistula test is positive. Instrument used : Siegle’s pneumatic speculum

15. Examination of Facial Nerve Facial nerve is examined by asking the patient to: Raise the eyebrows Close the eyes tightly Blow the cheek Whistle Stretch the neck

16. Main muscles affected in facial nerve paralysis Occipitofrontalis Raises eyebrows Orbicularis Oculi Closes eyes Corrugators and Procerus Wrinkle skin between eyebrows- Frown Buccinator Blowing of cheek Orbicularis oris Closes the mouth Risorius Grinning Mentalis Wrinkles the chin, important in drinking

17. Tuning Fork Tests It is done to know the type of deafness and degree of deafness. Frequencies of tuning forks used: 256 Hz, 512 Hz, 1024 Hz Tests are: Rinne’s test Weber’s test ABC test Schwabach’s test

18. Rinne’s Test To determine type and degree of deafness Procedure:

19. Findings In Rinne’s Test Rinne’s positive AC>BC Normal, sensorineural deafness Rinne’s negative BC>AC Conductive deafness False Rinne’s negative Rinne’s test is negative in affected ear but Weber’s test is not lateralised to affected ear Severe unilateral sensorineural deafness Rinne’s Equal AC=BC Mild conductive deafness Rinne’s infinitive Only AC, no BC is heard

20. Weber’s Test Done with any tuning fork. It is used to: Determine side having greater hearing loss. To unearth false negative Rinne’s test. To detect malingering.

21. Findings in Weber’s test In conductive deafness: It is lateralized to diseased ear. In sensorineural deafness: It is lateralized towards better ear. In normal individuals: It is equally distributed between two ears and the test is negative.

22. Absolute Bone Conduction Test It is the comparison of the duration of bone conducted sound of the patient to that of the examiner. ABC reduced: in sensorineural deafness ABC not reduced: normal ear and in conductive deafness

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