Right side chronic suppurative otitis media, uncomplicated, Tubotympanic type, active

stage, with conductive hearing loss

Name: XYZ
Age / Sex: 30 / male
Occupation: Agriculturist
Address: Ramnagar

CHIEF COMPLAINTS:
Right ear discharge - 3 years
Right ear hearing loss – 6 months

HISTORY

HOPI:
Ear discharge – Right side, 3 years, insidious in onset, intermittent (appears on water entry into ear after head
bath and on cold attack), now having discharge, yellowish, sticky, moderate in amount (frequent cleaning
necessary), NOT FOUL SMELLING & NOT BLOOD STAINED.
Right side hearing loss – 6 months, slow onset, slowly progressive, not able to hear speech in crowded places
but can hear in quite surroundings (mild grade)
No associated ringing in ears (TINNITUS), giddiness (VERTIGO), ear pain, headache, facial weakness on right
side
No associated nasal block or discharge, facial pain, sore throat, fever
No diabetes mellitus, hypertension
Not a regular swimmer

PAST HISTORY:
No past history of ear trauma, head injury, exanthematous fevers, TB

FAMILY HISTORY:
No similar complaints in the family.

PERSONAL HISTORY:
Not a smoker or alcoholic, No other systemic complaints.

GENERAL PHYSICAL EXAMINATION:

Moderately built and nourished, PICKLE – Negative.

ENT EXAMINATION
NOSE AND PNS
External nose, Vestibule and Anterior Rhinoscopy: Essentially Normal
No Paranasal sinuses tenderness

ORAL CAVITY & THROAT

Oral cavity, Oropharynx including palatine tonsils: Essentially normal

Dr.V.Srinivas,HOD – ENTHNS, BGSGIMS, Bengaluru

 EAR EXAMINATION

PART RIGHT EAR LEFT EAR

PINNA Normal Normal

PRE AURICULAR AREA Normal Normal

POST AURICULAR AREA Normal Normal

MASTOID TENDERNESS
Absent Absent
(Three finger test)
Mucopurulent discharge, not foul
EAC Normal
smelling, not blood stained
TYMPANIC MEMBRANE
Pars flaccida Normal Normal

Pars Tensa Central Perforation (medium sized Normal

in posterosuperior and
Posteroinferior quadrant)
(Diagram)
MIDDLE EAR
Mucosa Congested and oedematous

Contents exposed Incudo stapedial joint, long Not seen

process of incus and round
window niche seen
FACIAL NERVE Normal Normal

FISTULA TEST Negative Negative

TUNING FORK TESTS

Rinne Negative (BC more than AC) Positive (AC more than BC)

Weber Lateralised to Right ear

ABC Not reduced Not reduced

DIAGNOSIS:
Right side chronic suppurative otitis media, uncomplicated, Tubotympanic type, active
stage, with conductive hearing loss

Dr.V.Srinivas,HOD – ENTHNS, BGSGIMS, Bengaluru

 Bilateral chronic suppurative otitis media, uncomplicated, Tubotympanic type, active
stage, with bilateral conductive hearing loss which is more on right side

Name: XYZ
Age / Sex: 24 / male
Occupation: Student
Address: Kengeri

CHIEF COMPLAINTS:
Bilateral ear discharge – Since childhood
Bilateral hearing loss – 3 years

HISTORY

HOPI:
Ear discharge – Bilateral, since childhood, insidious in onset, intermittent (appears on water entry into ear after
head bath and on cold attack), now having discharge, yellowish, sticky, mild in amount (seen on tip of ear bud
when cleaned), NOT FOUL SMELLING & NOT BLOOD STAINED.
Bilateral hearing loss – 3 years, slow onset, slowly progressive, not able to hear speech even in quite
surroundings (moderate grade), more on right side
No associated ringing in ears (TINNITUS), giddiness (VERTIGO), ear pain, headache, facial weakness on right
side
No associated nasal block or discharge, facial pain, sore throat, fever
No diabetes mellitus, hypertension
Regular swimmer

PAST HISTORY:
No past history of ear trauma, head injury, exanthematous fevers, TB

FAMILY HISTORY:
No similar complaints in the family.

PERSONAL HISTORY:
Not a smoker or alcoholic, No other systemic complaints.

GENERAL PHYSICAL EXAMINATION:

Moderately built and nourished, PICKLE – Negative.

ENT EXAMINATION
NOSE AND PNS
External nose, Vestibule and Anterior Rhinoscopy: Essentially Normal
No Paranasal sinuses tenderness
ORAL CAVITY & THROAT
Oral cavity, Oropharynx including palatine tonsils: Essentially normal

Dr.V.Srinivas,HOD – ENTHNS, BGSGIMS, Bengaluru

 EAR EXAMINATION

PART RIGHT EAR LEFT EAR

PINNA Normal Normal

PRE AURICULAR AREA Normal Normal

POST AURICULAR AREA Normal Normal

MASTOID TENDERNESS
(Three finger test)
EAC
Pars flaccida
Absent
Mucopurulent discharge, not foul
smelling, not blood stained,
moderate in amount
TYMPANIC MEMBRANE
Normal
Absent
Mucopurulent discharge, not foul
smelling, not blood stained,
moderate in amount
Normal

Pars Tensa Subtotal perforation Medium sized, anteroinferior and

(Diagram) posteroinferior quadrant
(Diagram)
MIDDLE EAR
Mucosa Congested and oedematous Congested and oedematous

Contents exposed Incudo stapedial joint, long round window niche seen
process of incus, round window
niche and Eustachian tube
opening seen
FACIAL NERVE Normal Normal

FISTULA TEST Negative Negative

TUNING FORK TESTS

Rinne Negative (BC more than AC) Negative (BC more than AC)

Weber Lateralised to Right ear

ABC Not reduced Not reduced

DIAGNOSIS:
Bilateral chronic suppurative otitis media, uncomplicated Tubotympanic type, active stage,
with bilateral conductive hearing loss which is more on right side

Dr.V.Srinivas,HOD – ENTHNS, BGSGIMS, Bengaluru

 Left side chronic suppurative otitis media, uncomplicated Tubotympanic type, inactive
stage, with conductive hearing loss

Name: XYZ
Age / Sex: 17 / female
Occupation: Factory worker
Address: RR nagar

CHIEF COMPLAINTS:
Left ear discharge - 3 years
Left ear hearing loss – 9 months

HISTORY

HOPI:
Ear discharge – Left side, 3 years, insidious in onset, intermittent (appears on water entry into ear after head
bath and on cold attack), no discharge now since 3 months, yellowish, sticky, mild in amount (seen on tip of
ear bud when cleaned), NOT FOUL SMELLING & NOT BLOOD STAINED.
Left side hearing loss – 9 months, slow onset, slowly progressive, not able to hear speech even in quite
surroundings (moderate grade)
No associated ringing in ears (TINNITUS), giddiness (VERTIGO), ear pain, headache, facial weakness on right
side
No associated nasal block or discharge, facial pain, sore throat, fever
No diabetes mellitus, hypertension
Not a regular swimmer

PAST HISTORY:
No past history of ear trauma, head injury, exanthematous fevers, TB

FAMILY HISTORY:
No similar complaints in the family.

PERSONAL HISTORY:
Not a smoker or alcoholic, No other systemic complaints.

GENERAL PHYSICAL EXAMINATION:

Moderately built and nourished, PICKLE – Negative.

ENT EXAMINATION
NOSE AND PNS
External nose, Vestibule and Anterior Rhinoscopy: Essentially Normal
No Paranasal sinuses tenderness
ORAL CAVITY & THROAT
Oral cavity, Oropharynx including palatine tonsils: Essentially normal

Dr.V.Srinivas,HOD – ENTHNS, BGSGIMS, Bengaluru

 EAR EXAMINATION

PART RIGHT EAR LEFT EAR

PINNA Normal Normal

PRE AURICULAR AREA Normal Normal

POST AURICULAR AREA Normal Normal

MASTOID TENDERNESS
Absent Absent
(Three finger test)
EAC Normal Normal

TYMPANIC MEMBRANE
Pars flaccida Normal Normal

Pars Tensa Normal Central Perforation (Subtotal)

(Diagram)
MIDDLE EAR
Mucosa Normal pale pink in color

Contents exposed Incudo stapedial joint, long

Not seen
process of incus, round window
niche and Eustachian tube
opening seen
FACIAL NERVE Normal Normal

FISTULA TEST Negative Negative

TUNING FORK TESTS

Rinne Positive (AC more than BC) Negative (BC more than AC)

Weber Lateralised to Left ear

ABC Not reduced Not reduced

DIAGNOSIS:
Left side chronic suppurative otitis media, uncomplicated Tubotympanic type, inactive stage,
with conductive hearing loss

Dr.V.Srinivas,HOD – ENTHNS, BGSGIMS, Bengaluru

 Bilateral chronic suppurative otitis media, uncomplicated Tubotympanic type, inactive
stage, with conductive hearing loss which is more on left side

Name: XYZ
Age / Sex: 20 / male
Occupation: labourer
Address: kanakpura

CHIEF COMPLAINTS:
Bilateral ear discharge – Since childhood
Bilateral hearing loss – 3 years

HISTORY

HOPI:
Ear discharge – Bilateral, since childhood, insidious in onset, intermittent (appears on water entry into ear after
head bath and on cold attack), now no discharge since 3 years, yellowish, sticky, mild in amount (seen on tip
of ear bud when cleaned), NOT FOUL SMELLING & NOT BLOOD STAINED.
Bilateral hearing loss – 3 years, slow onset, slowly progressive, not able to hear speech even in quite
surroundings (moderate grade), more on left side
No associated ringing in ears (TINNITUS), giddiness (VERTIGO), ear pain, headache, facial weakness on right
side
No associated nasal block or discharge, facial pain, sore throat, fever
No diabetes mellitus, hypertension
Not a regular swimmer

PAST HISTORY:
No past history of ear trauma, head injury, exanthematous fevers, TB

FAMILY HISTORY:
No similar complaints in the family.

PERSONAL HISTORY:
Not a smoker or alcoholic, No other systemic complaints.

GENERAL PHYSICAL EXAMINATION:

Moderately built and nourished, PICKLE – Negative.

ENT EXAMINATION
NOSE AND PNS
External nose, Vestibule and Anterior Rhinoscopy: Essentially Normal
No Paranasal sinuses tenderness
ORAL CAVITY & THROAT
Oral cavity, Oropharynx including palatine tonsils: Essentially normal

Dr.V.Srinivas,HOD – ENTHNS, BGSGIMS, Bengaluru

 EAR EXAMINATION

PART RIGHT EAR LEFT EAR

PINNA Normal Normal

PRE AURICULAR AREA Normal Normal

POST AURICULAR AREA Normal Normal

MASTOID TENDERNESS
Absent Absent
(Three finger test)
EAC Normal Normal

TYMPANIC MEMBRANE
Pars flaccida Normal Normal

Pars Tensa Medium sized, anteroinferior and Subtotal perforation

posteroinferior quadrant (Diagram)
(Diagram)
MIDDLE EAR
Mucosa Normal Normal

Contents exposed round window niche seen Incudo stapedial joint, long
process of incus, round window
niche and Eustachian tube
opening seen
FACIAL NERVE Normal Normal

FISTULA TEST Negative Negative

TUNING FORK TESTS

Rinne Negative (BC more than AC) Negative (BC more than AC)

Weber Lateralised to Left ear

ABC Not reduced Not reduced

DIAGNOSIS:
Bilateral chronic suppurative otitis media, uncomplicated Tubotympanic type, inactive stage,
with conductive hearing loss which is more on left side

Dr.V.Srinivas,HOD – ENTHNS, BGSGIMS, Bengaluru