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Case presentation
Deepika kamath
 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
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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
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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
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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 3 -3-3
Family history
 No similar complaints in the family
Personal history
 Appetite – good
 Diet
 B&B
 Sleep
 Habits
- vegetarian
- regular
- adequate
- 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 ,
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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
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RIGHT
normal
normal
normal
LEFT
Preauricular
normal
Pinna
normal
Postauricular
a swelling 2*2
no signs of
inflammation, edges well defined, surface smooth
Palpation : soft in consistency
EAC
normal
normal
TYMPANIC MEMBRANE
RIGHT
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LEFT
 SEIGALISATION
 FACIAL NERVE
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normal
FISTULA SIGN
negative
MASTOID TENDERNESS
absent
TFT
RINNES
negative
WEBERS
lateralized to left
ABC
decreased
normal
negative
absent
negative
decreased
nose
 Cold spatula test:
 External appearance: normal
 ARE
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 Paranasal sinuses:
 PRE:
vestibule: normal
S shaped DNS
b/l HIT
turbinates pale
mucosa normal
non tender
NORMAL
 ORAL CAVITY: lips, gums, teeth, anterior 2/3 rd tongue. Hard
palate, GLS, GBS – normal
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OROPHARYNX:
ANTERIOR PILLAR
TONSILS
POSTERIOR PILLAR
PPW
RIGHT
normal
GRAGE1
normal
normal
 IDL: NORMAL
 NECK: no palpable lymph nodes
LEFT
normal
GRADE1
normal
normal
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