GOVERNMENT MEDICAL COLLEGE AND ESI HOSPITAL,COIMBATORE

Chronic Suppurative Otitis

Media
  Name-Mrs.ABC
 Age-32 years

Patient Details  Sex-Female

 Address-Singanallur
 Occupation-House wife
  Discharge from right ear for 2 years
Chief  Hard of hearing in right ear for 1 year
complaints
 Patient was apparently normal 2 years back when
she noticed discharge from right ear
 Insidious in onset
History of  Gradually progressive
presenting  Intermittent in nature
illness  Profuse in quantity
 Mucopurulent discharge
 Discharge is not blood stained and non foul
smelling
 Aggravated during episodes of URTI
 Ear is currently discharging for 3 days
 Patient also complains of decreased hearing in
right ear for past 1 year
 Insidious in onset
 Gradually progressive
History of  Aggravated during episodes of URTI
presenting
illness Patient denies any history of
 Ear pain
 Trauma to ear
 Vertigo
 Tinnitus
 She also denies any history of
 Headache
 Nausea and vomiting
 Fever with chills and rigor
History of  Neck rigidity
presenting  Giddiness
 Double vision
illness
 Facial asymmetry
 Nasal obstruction and discharge
 Throat pain
  No history of Diabetes Mellitus/ TB /
Hypertension / Asthma / Epilepsy / Thyroid
disorders
Past History
 No history of any previous surgeries
  Consumes mixed diet
 Normal bowel and bladder habits
 Normal sleep pattern
Personal  No alcohol intake, smoking or any substance
History abuse
  Attained menarche at 12 years

Menstrual  Has regular cycles of 4/28

History  No history of passage of clots or excessive
bleeding
Family History  Not contributary
  Patient is conscious, oriented to time place and
person.
 Moderately built and nourished
 No signs of
 Pallor
General  Icterus
Examination  Clubbing
 Cyanosis
 Pitting pedal edema
 Generalised lymphadenopathy
  Pulse rate - 82 beats /minute
 Blood pressure - 124/80 mmHg in Right upper
arm
Vitals  Respiratory rate - 16 breaths/ min
 Temperature - 98.4 F
  CVS - S1, S2 heard. No murmurs

 RS – Normal vesicular breath sounds heard , no

added sounds
Systemic
Examination
 Abdomen- Non tender , no organomegaly

 CNS – No focal neurological deficits

 Features Right ear Left ear

Pre Auricular Area Normal Normal

Pinna Normal Normal

Ear Post Auricular Area Normal Normal

Examination External Auditory Discharge seen Normal

Canal

Tragal sign Negative Negative

Tragal sign
 Right ear Left ear

Tympanic membrane • TM shows a central • TM is intact

perforation in • Appears pearly
Anteroinferior white in color
quadrant • Cone of light
• Cone of light present
absent • Pars tensa and pars
• Lateral process of flaccida appears
malleus appears normal

Ear more prominent

• Handle of malleus
appears
Examination foreshortened

Middle ear mucosa Visible and not Not seen

congested
Tympanic
membrane
Right ear
Tympanic
membrane
Left ear
 Tuning fork tests Right ear Left ear

Rinne’s test Negative Positive

BC>AC AC>BC

Weber’s test Lateralized to Right ear

Absolute Bone Same as examiner Same as examiner

Ear Conduction test

Examination
Special tests Right ear Left ear
Three point tenderness Negative Negative
test

Fistula test Negative Negative

Facial nerve Normal Normal
Tuning fork
Three point tenderness
Fistula test
  External appearance- Normal
 Vestibule- Normal
 Anterior Rhinoscopy- Normal
Nose
Examination  Airway Patency Tests- Normal
 Posterior Rhinoscopy- Not done
 Paranasal sinus- No tenderness present
  Oral cavity-Gingiva, gingivobuccal sulci,
teeth, buccal mucosa, Anterior 2/3 of tongue,
hard palate appears normal
 Oropharynx-Soft palate, Anterior and
Throat
posterior pillars, tonsils, Posterior pharyngeal
Examination wall appears normal
 Indirect laryngoscopy – Not done
  No lymph node enlargement
Neck  No swellings present
Examination  Laryngeal crepitus- Present
  32 year old female presented with complaints
of discharge from right ear with decreased
hearing for 2 years . On examination, tympanic
Summary membrane shows a central perforation. Tuning
fork tests indicate right sided conductive
hearing loss.
  Right sided Chronic suppurative otitis media
Provisional mucosal type currently in active stage with
conductive hearing loss without any
Diagnosis complications.
  Examination under microscope
 Culture and sensitivity of discharge

Investigations  Pure tone audiometry

 X Ray Mastoid- Schuller’s view
 HRCT temporal bone
Examination
under
microscope
Pure Tone
Audiogram
Xray Mastoid

Case courtesy of Henry Knipe, Radiopaedia.org, rID: 60135

  Medical treatment
 Aural toilet
Treatment  Antibiotic ear drops
 General measures to keep ear dry and to
avoid hard nose blowing.
  Tympanoplasty
Surgical
treatment  Cortical mastoidectomy
Tympanoplasty
 Cortical
mastoidectomy
THANK YOU