CLINICO PATHOLOGICAL CONFERENCE Department of ENT Head and Neck Surgery DHQ Hospital Rawalpindi

کہو وہ خدا ہی تو ہے جس نے تم کو پیدا کیا .00000000000000000 Say,it is He who has produced you and made for you hearing and vision and hearts; little are you grateful.(67:23) کہو وہ خدا ہی تو ہے جس نے تم کو پیدا کیا اور تمہارے کان اور آنکھیں اور دل بنائے،مگر تم کم شکر کرتے ہو

TASK FOR STUDENTS THREE CAUSES OF EAR DISCHARGE TASK FOR STUDENTS THREE CAUSES OF EAR DISCHARGE? THREE FEATURES OF IMPENDING INTRACRANIAL COMPLICATIONS IN CSOM? THREE COMPLICATIONS OF CSOM?

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CASE PRESENTATION SHAHRUKH FINAL YEAR STUDENT DR MUZAMMOL PGR, ENT

INTRODUCTION HIJAB 7 YEARS FEMALE Class 2 student Rawalpindi 12-02-2018

PRESENTING COMPLAINTS: Discharge left ear _____________ 4 year Decreased hearing left ear_____4 years

HISTORY OF PRESENT ILLNESS: Discharge left ear, Thick, scanty, foul smelling Yellowish in colour intermittent Took treatment Discharge continued

HISTORY OF PRESENT ILLNESS h/o mild to moderate hearing loss left ear. No h/o fever, headache, dizziness.

PAST MEDICAL HISTORY: H/o of pulmonary TB at age of 1 year Took ATT for 9 months vaccination completed

PAST SURGICAL HISTORY Not significant

FAMILY HISTORY: H/o TB in mother, took ATT 9 months. No h/o DM, HTN, IHD, asthma in family

PERSONAL HISTORY Appetite: good Sleep: adequate. Bowl and bladder: Regular No addiction

GENERAL PHYSICAL EXAMINATION: A young female sitting comfortably, well oriented in time, place and person BP: 110/70 mm Hg Pulse: 84/min Temperature: 37.8 C Respiration: 18/min No clubbing, cyanosis, pallor, jaundice, lymphadenopathy, pedal edema

EAR EXAMINATION RIGHT LEFT PREAURICULAR region NORMAL PINNA POSTAURICULAR region FISTULA TEST NEGATIVE MASTOID TENDERNESS ABSENT External auditory canal normal Thick,Scanty,yellow,foul smelling discharge RINNIES POSITIVE WEBER Lateralized to left

VESTIBULAR EXAMINATION Gait Normal Rombergs Negative Dysdiadochokinesia Absent Finger nose test Normal Nystagmus Absent

OTOSCOPY: Marginal perforation with attic involvement

NOSE EXAMINATION EXTERNAL APPEARANCE NORMAL VESTIBULE PARANASAL SINUSES NON TENDER ANTERIOR RHINOSCOPY NORMAL SEPTUM,MUCOSA, NORMAL LT WALL,FLOOR POSTERIOR RHINOSCOPY Patency test Patent bilaterally Olfaction Normal

THROAT EXAMINATION normal lips, gums, teeth, tongue, hard palace, soft palate, normal mucus membrane color and moisture; good orodental hygiene normal pharynx and tonsils. IDL: normal NECK: no palpable lymph nodes

SYSTEMIC EXAMINATION CVS: S1+S2+0 Abdomen: soft and non tender, no organomegaly RESPIRATORY: normal vesicular breathing bilateral. CNS examination was normal All cranial nerves were intact

PROVISIONAL DIAGNOSIS: LEFT CHRONIC SUPPURATIVE OTITIS MEDIA WITH CHOLESTEATOMA ACTIVE SQUAMOUS TYPE

EXAMINATION UNDER MICROSCOPE Purulent, scanty discharge in left ear canal, suction done to clear discharge. Large marginal perforation with attic involvement. Glistening white mass visible in attic region

BLOOD CP Hb ______12 g/dl Wbc count ___ 7700 / mm3 Platelets ____ _233000 / mm3 DLC: N: ________38.7 % L :________ 51.9 % Others: ___9.4 % RBC count: ____5.03 PCV _________ 36.8 % MCV__________73.3 fl MCH _________ 23.8 pg MCHC ________ 32.6 %

URINE R/E Physical/chemical analysis: Colour__________light yellow Turbidity_________nil Sediment________nil PH_______________6.0 Sp gravity________1.015 Glucose_________nil Albumin__________nil Ketones__________nil Nitrite_____________nil Bilirubin___________nil Urobilinogen______normal Microscopy pus cells________2-3 Red blood cells______nil Epithelial cells_________occasional Crystals_____________nil Casts_______________nil

LFT Total bilirubin _______________ 0.5 mg/dl ALT(SGPT) ________________ 23 U/L AST __________________________28 U/L ALKALINE PHOSPHATASE _______ 496 U/L

RFT Urea: _________________ 24 mg/dl Creatinine _____________ 0.5 mg/dl

INVESTIGATIONS: Pus culture and sensitivity: no growth seen after 48 hrs of incubation at 37C Pure tone audiometry (PTA)

PURE TONE AUDIOMETRY

CT SCAN TEMPORAL BONE

CT TEMPORAL BONE CORONAL VIEW

CT TEMPORAL BONE CORONAL VIEW

PLAN Left Mastoid exploration

PRE OPERATIVE PREPARATION COUNSELLING Facial nerve consent ANAESTHESIA FITNESS FOR GA

Wild’s postauricular incision

MCEVEN’S TRIANGLE

E:\PATIENTS DATA\Operations\VID-20180403-WA0001.mp4 file:///E:\PATIENTS%20DATA\Operations\VID-20180507-WA0004.mp4 file:///E:\PATIENTS%20DATA\Operations\VID-20180507-WA0005.mp4 E:\PATIENTS DATA\Operations\Mastoid Surgery (Basic to Radical Mastoidectomy).mp4

POST OPERATIVE

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