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 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 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 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

- vegetarian
B&B
- regular
Sleep
- adequate
Habits
- 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 , 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

LEFT
Preauricular
normal
Pinna
normal
Postauricular
a swelling 2*2

RIGHT
normal
normal
normal

no signs of inflammation, edges well

defined, surface smooth

TYMPANIC MEMBRANE

RIGHT

LEFT

SEIGALISATION
FACIAL NERVE

normal
FISTULA SIGN
negative
MASTOID TENDERNESS

absent
TFT
RINNES
negative
WEBERS
lateralized to left
ABC
decreased
decreased

normal
negative
absent
negative

nose
Cold spatula test:
External appearance: normal
ARE

vestibule: normal

S shaped DNS

b/l HIT

turbinates pale

mucosa normal
Paranasal sinuses:
non tender
PRE:

NORMAL

ORAL CAVITY: lips, gums, teeth, anterior 2/3 rd tongue.

Hard palate, GLS, GBS normal

OROPHARYNX:
ANTERIOR PILLAR
TONSILS
POSTERIOR PILLAR
PPW
IDL:

RIGHT
normal
GRAGE1
normal
normal

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