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

3. کہو وہ خدا ہی تو ہے جس نے تم کو پیدا کیا
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

4. 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?

5. `

6. CASE PRESENTATION
SHAHRUKH FINAL YEAR STUDENT DR MUZAMMOL PGR, ENT

7. INTRODUCTION HIJAB 7 YEARS FEMALE Class 2 student Rawalpindi

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

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

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

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

12. PAST SURGICAL HISTORY
Not significant

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

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

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

16. 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

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

18. OTOSCOPY:
Marginal perforation with attic involvement

19. 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

20. 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

21. 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

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

23. 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

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

25. 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

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

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

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

29. PURE TONE AUDIOMETRY

30. CT SCAN TEMPORAL BONE

31. CT TEMPORAL BONE CORONAL VIEW

32. CT TEMPORAL BONE CORONAL VIEW

33. PLAN
Left Mastoid exploration

34. PRE OPERATIVE PREPARATION
COUNSELLING
Facial nerve consent
ANAESTHESIA FITNESS FOR GA

35. Wild’s postauricular incision

37. MCEVEN’S TRIANGLE

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

44. POST OPERATIVE

45. Thank you