Case Presentation

• Name: Saravanan
• Age: 22yrs
• Sex:M
• Occupation: Buisiness
• Address: Vellore
Tamilnadu.
• Chief complaints:
• B/L ear discharge since 10 yrs
• B/L decreased hearing since 10yrs
• H/O Present illness:
• Patient was apparently normal 10 yrs back,then
he developed B/L ear pain followed by B/L ear
discharge.
• Pain is insidious onset, gradually
progressive,moderate,intermittent, throbbing in
nature,present deep inside the ear for few days
followed by ear discharge which is insidious
onset,gradually progressive, scanty in amount,
continuous, mucopurulent, whitish yellow in
colour,foul smelling,not blood stained.
• Decreased hearing in both ears, insidious onset,
gradually progressive,mild ,continuous, no
fluctuation of deafness.
• No h/o Ringing sensation in the ears
• No h/o headache
• No h/o giddiness
• No h/o Fever,nausea and vomitings
• No h/o facial weakness
• No h/o irritability and neck rigidity
• No h/o double vision
• No h/o unsteadiness
• No h/o trauma to head
• No h/o exposure to loud noise
• No h/o Nasal complaints
• No h/o Throat complaints
• Past history :
• No h/o similar complaints in the past.
• Not a known DM,HTN, TB, epilepsy, asthma.
• No h/o drug allergy.
• Treatment history:
• For the present complaint patient consulted to the
local doctor whenever increased discharge and foul
smell and used some medication and ear drops.
• He underwent Lt MRM 9 months back for Lt CSOM.
Personal history:
• Patient is on mixed diet.
• Bowel and bladder habits regular.
• Sleep adequate.
• No addictions.
Family history:
Nothing significant.
 General physical examination
• Patient conscious, well oriented, moderately built and
nourished.
• No Pallor
• No Cyanosis
• No Clubbing
• No Jaundice
• No lymphadenopathy
• No Pedal edema.
Vitals :
• Temp - Afebrile
• Pulse – 82beats/m, regular, good volume.
• BP – 120/70 mm of hg
• RR – 20 cycles/m
 Systemic examination

• CVS – S1,S2 heard , no murmurs.

• RS –B/L NVBS present, no added sounds.
• PA – Soft, NAD.
• CNS – NAD.
 ENT EXAMINATION
• Examination of ears:
• Rt ear:
• Pinna- normal
• Pre & post auricular region-Normal
• EAC-Mild mucopurulent discharge noted near TM.
• TM- Dull with loss of cone of light
Posterosuperior quadrant of pars tensa shows a
mild retraction pocket filled yellowish white cheesy
debris. Debris is foul smell,not blood tinged and mixed
with yellowish mucopurulent discharge.
Rest of the tympanic membrane is normal
 ENT EXAMINATION
• Lt Ear:
• Pinna- Normal
• Pre auricular region-Normal
• Postauricular region-Scar of previous surgery
noted
• EAC: posterior canal wall is removed and
mastoid cavity is seen and normal.
• TM- Intact.
Tuning fork tests:
• Rinne’s test: Negative in both ears
• Webers test: Lateralised to Rt ear
• ABC test: Equal to that of examiner.

Otoneurological examination
Fistula test :Negative
No facial asymmetry
 EXAMINATION OF NOSE

• External nose : Normal.

• Cold Spatula test : B/l equal mist formation
seen.
• Tip elevation test : No caudal dislocation of
septum
• Vestibule : Normal.
• Anterior rhinoscopy: Normal
• Posterior rhinoscopy : Normal
Examination of Paranasal sinuses :

• Inspection : Skin over the sinuses normal.

• Palpation : No sinus tenderness present.

 ENT Examination
EXAMINATION OF THROAT :
Examination of Oral cavity :
• Lips – Normal
• Angle of mouth: Normal
• Vestibule- Normal
• Teeth & Gums – Normal
• Tongue – Normal
• Floor of mouth – Normal
• Buccal mucosa – Normal
• Hard palate – Normal
• Examination of Oropharynx
• Soft Palate – Normal
• Anterior and Posterior pillars: Normal
• Tonsil – Atrophied and normal
• PPW – Normal
• Indirect Laryngoscopy- Normal
• Examination of Neck-Normal
• Provisional Diagnosis:
• Rt Chronic suppurative otitis media Attico
antral type, active with conductive hearing
loss without complications .
THANK YOU