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CSOM by Nomi
CSOM
CHRONIC SUPPURATIVE OTITIS MEDIA


                      NAUMAN AHMAD
PARTICULARS

• PATIENT NAME – XYZ
• AGE – 27 YEARS
• GENDER – MALE
• ADDRESS – ATTOCK

                       WITH PATIENT’S
                        PERMISSION
PRESENTING COMPLAINTS


-- DISCHARGE RIGHT EAR

                         One year
-- DECREASED HEARING
   RIGHT EAR
HISTORY OF PRESENT ILLNESS
• One year ago had an episode of upper respiratory tract
  infection with pain right ear

• Subsequently patient developed intermittent ear discharge

• Discharge:
          • Profuse
          • Mucopurulent
          • Odourless
          • Not blood stained

• Decreased hearing right ear
PAST HISTORY
OPERATED FOR ACUTE APPENDICITIS 03 YEARS AGO

At C.M.H Lahore
Personal History

Family History     Not Contributory


Drug History
GENERAL PHYSICAL EXAMINATION

                                   -- PULSE 74/ min,
 -- Pallor   - absent              regular

 -- Jaundice - negative            -- TEMPERATURE
                                   98*F
 - Neck veins - not engorged
                                   -- BLOOD
 - Lymph nodes - not palpable      PRESSURE
                                    120/80 mm Hg
 - Clubbing
 - Koilonychia            normal   -- Respiratory Rate
 - Odema feet                      16/ min
SYSTEMIC EXAMINATION

CNS
• NAD

RESPIRATORY SYSTEM
• NAD

GIT
• NAD

CVS
• NAD
ENT EXAMINATION
      EAR


      NOSE


      THROAT
• EAR
• RIGHT EAR : Medium sized central perforation in
  the pars tensa
• No discharge
• No cholesteatoma
• LEFT EAR : normal
• Whispered voice not appreciated in right ear
Tuning fork test
RINNE TEST
     • NEGATIVE ON RIGHT SIDE
     • POSITIVE ON LEFT SIDE



WEBER TEST
     .   LATERALIZED TO RIGHT SIDE
NOSE
•NAD

THROAT
•NAD
PROVISIONAL DIAGNOSIS

CHRONIC SUPPURATIVE OTITIS MEDIA
    ( TUBOTYMPANIC TYPE , INACTIVE )
INVESTIGATIONS

• PURE TONE AUDIOGRAM

• X-RAY MASTOID
CSOM by Nomi
X-RAY MASTOID
FINAL DIAGNOSIS


CHRONIC SUPPURATIVE OTITIS MEDIA
            (TUBOTYMPNIC)
TREATMENT
               ( during active episode )

• REGULAR AURAL TOILET

• EAR DROPS ( 0.6% ofloxacin 3 drops two times a day for 7
  days , steroids -- betamethasone )

• SYSTEMIC ANTIBIOTICS ( Capsule ampicillin 625mg three times
  a day for 7 days )

• NASAL DECONGESTANTS ( XYLOMETAZOLINE nasal spray three
  times a day for 7 days )

• Systemic anti-histamines ( tab. loratidine 10mg once daily )
COUNSELING

• KEEP EAR DRY

• MYRINGOPLASTY
CSOM by Nomi

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CSOM by Nomi

Notas del editor

  1. My patient a 27 year old male resident of attock
  2. Presented with complains of ear discharge and decreased hearing in right ear for 1 year
  3. My patient was asymptomatic 1 year ago when he had an episode of urti followed by severe pain in rt ear, which resulted in pus discharge from rt ear, The episode settled with medication prescribed at local Garrison medical center. Since then he IS HAVING intermittent discharge from his right ear. It usually follows an upper resp tract inf. It is copious and mucprlnt. He described it as odourless and has never been blood stained. Most of the time it stops with the resolution of urti. It is never accompanied by pain. He also complains of decreased hearing in his rt ear for last 1 year. It is constant and he feels difficulty in hearing normal conv. Voice. There is no history of pain in the ear, accompanied head ache, dizziness or facial weakness.
  4. He was operated for ac appendicitis 3 years ago
  5. On gpe he is young male of average built concious , coopertive well orirnted in time place and person, sitting comfortably in bed with stable vital signs
  6. His systemic examination was unremarkable
  7. A detailed ear nose and throat examination was carried out
  8. On aural examination the pinna and eac appeared normal on both sides and there was no tendernes on either side. Speculem examination of Rt ear revealed medium sized central perforation in the pars tensa. There was no discharge orcholesteatomaHisLeft ear did not reveal any abnormality, more over he could hear conversational voice in both ears where as whispered voice could only be heard in lft ear
  9. His tunning fork tests revealed a conductive type of decreased hearing in rt ear
  10. Rest of the nose throat and neck examination was normal
  11. ON THE BASIS OF HISTORY AND EXAMINATION….
  12. Pure tone audiogram shows a conductive HEARING loss inrt ear with 20-30 decibel air bone gap
  13. X ray mastoids did not reveal any abnormality
  14. Based on history, clinical examination and investigations a final diagnosis of was made ……. Inactive withCONDUCTIVE HEARING LOSS
  15. Patient was managed with aural toilet , local antibiotic drops and oral antibiotic drops
  16. Patient was counseled to keep his ear dry by avoiding water entry in the ear, and prompt treatment of urti to be carried out if such an episode occur. He was ADVISED TO keep his ear dry for about 3 months, so that the surgical procedure can be carried out, for repair of the tympanic membrane that is myringoplasty.