Deepika kamath Case presentation

Siddharchaya 52 years Male Welder Honnalli

Chief complaints H/o bilateral ear discharge more left sided on and off since 15 years H/o decreased hearing left sided more than right sided since 10 years

History of presenting illness EAR DISCHARGE It initially started in the left ear and after a gap of 2 years it started in the right ear Insidious in onset Gradually progressive Patient says that he is not aware of the discharge only when he cleans his ear his cotton bud comes to know Discharge is scanty, purulent, yellow, occasionally blood stained and foul smelling It is intermittent

Each episode lasts for 7 days Relieved with topical medications One episode every 6 months Increased amount of discharge during episodes of upper respiratory tract infections and entry of water into the ears Present ear discharge is 20 days back Which relieved temporily on medication

Decreased hearing 10 years Left> right Insidious in onset Gradually progressive Worsens during episodes of active ear discharge Patient says he cannot hear soft sounds Can percieve only loud noise

Ringing sound in the left ear 7 years More on the left side Intermittent Sound of a ringing bell Lasting throughout the episode of discharge Relieved with its resolution He also gives history of excessive sneezing Each episode lasts for 5 minutes

Associated with watery nasal discharge No H/o nasal obstruction No h/o giddiness No h/o weakness of face, deviation of the angle of the mouth No h/o fever, headache, vomiting, neck stiffness No h/o earache No h/o visual disturbances, speech problems No h/o trauma No h/o postaural swelling associated with fever No h/o nasal obstruction No h/o recurrent attcks of throat pain, dysphagia,odynophagia

Past history Patient was diagnosed to have kidney stones 6 years back for which he underwent treatment No h/o Tb Diabetes Hypertension Bronchial asthma Epilepsy Prolonged hospitalisation Blood transfusion Drug allergies

Treatment history Used topical medication for 1 week everytime he used to hav ear discharge Details not available 1 week back the patient received the following medications Tab. Ciplox 500 mg BD Tab diclo 50 mg BD Otolux o ear drops

Family history No similar complaints in the family

Personal history Appetite – good Diet - vegetarian B&B - regular Sleep - adequate Habits - used to smoke beedi abstained since 15 years

General examination 52 year old male patient, moderately built and nourished Conscious, co operative, well oriented to time, place, person VITALS: BP: 120/80 mm hg PR: 76/ MIN RR: 18/ MIN No pallor, icterus, cyanosis, clubbing, lymphadenopathy

Systemic examination CVS: S1 & S2 heard, no murmurs RS: B/L NVBS heard, no added sounds P/A: soft, non tender, no organomegaly CNS: normal

Local examination EAR RIGHT LEFT Preauricular normal normal Pinna normal normal Postauricular normal a swelling 2*2 no signs of inflammation, edges well defined, surface smooth Palpation : soft in consistency EAC normal normal

TYMPANIC MEMBRANE

RIGHT LEFT SEIGALISATION FACIAL NERVE normal normal FISTULA SIGN negative negative MASTOID TENDERNESS absent absent TFT RINNES negative negative WEBERS lateralized to left ABC decreased decreased

nose Cold spatula test: External appearance: normal ARE vestibule: normal S shaped DNS b/l HIT turbinates pale mucosa normal Paranasal sinuses: non tender PRE: NORMAL

ORAL CAVITY: lips, gums, teeth, anterior 2/3 rd tongue. Hard palate, GLS, GBS – normal OROPHARYNX: RIGHT LEFT ANTERIOR PILLAR normal normal TONSILS GRAGE1 GRADE1 POSTERIOR PILLAR normal normal PPW normal normal IDL: NORMAL NECK: no palpable lymph nodes

PROVISIONAL DIAGNOSIS B/L chronic otitis media active squamous with conductive hearing loss with allergic rhinitis without any complications

investigations Otoscopy Otomicroscopy Culture in case of discharge PTA X RAY B/L mastoids schullers view Chest x ray PA view X RAY pns wayers view Routine investigations Blood Urine routine ECG

MANAGEMENT Either intact canal wall or canal wall down mastoidectomy with ossiculoplasty