25 Important Cases in EAR, NOSE & THROAT 25 Important Cases in EAR, NOSE & THROAT Case 1: 10 year old child was having a right mucopurulent otorrhea for the last 4 years. A ‘week ago he became dizzy with a whirling sensation, nausea, vomiting and nystagmus to the opposite side; his deafness became complete and his temperature was normal. Three days later he became feverish, irritable and continuously erying apparently from severe headache. Also he had some neck retraction. The child was nat managed properly and died by the end of theweek i CASEL Diagnosis & | Right chronic suppurative otitis media (mucopurulent otorhea of 4 years duration) Reasons complicated by suppurative labyrinthitis (dizziness, nausea and vomiting with | nystagmus to the opposite side and complete loss of hearing) and then complicated by | meningitis (fever, severe headache and neck retraction). | Explain the | Whirling sensation: vertigo due to inner ear inflammation | following | manifestations ‘destruction the direction of nystagmus is toward the diseased ear. ‘Severe headache: increased intracranial pressure due to meningitis, Neck retraction: due to meningeal inflammation Nystagmus to the opposite side: suppurative labyrinthitis leading to fast phase of eye mavementto the opposite ear and slow phase to the diseased ear nystagmus direction is called according to the fast phase. In serous labyrinthitis with no inner ear cell Further Otologic examination possible finding of a marginal perforation of atticoantral CSOM | examination &/or (cholesteatoma) investigations Audiogram to reveal SNHL in the affected ear Kernig's and Brudzinski's signs Fundus examination to show papilledema Lumbar puncture: turbid high pressure CSF with pusrichin proteins Complete blood picture Treatment Antibiotics that cross the blood brain barrier Analgesics SurgicoMed.com 2 intPoRTaNT CASES Iv Nose & THROAT