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It is a case of chronic suppurative otitis media.

INVESTIGATION:

1)      EXAMINATION UNDER MICROSCOPE:  It provides information regarding presence of granulation, in growth of squamous epithelium from the edges of perforation, status of ossicular chain, tympanosclerosis & adhesion.

An ear which appears dry may show hidden discharge. Rarely cholesteatoma may coexist with central perforation.

2)      AUDIOGRAM: Assessment of degree of hearing loss & its type. Usually conductive loss, but a sensorial element may be present.

3)      CULTURE & SENSITIVITY FOR EAR DISCHARGE: To select proper antibiotic ear drops.

4)      MASTOID X-RAY/ CT-SCAN OF TEMPORAL BONE: Mastoid is usually sclerotic but may be pneumatized with clouding of air cells. No evidence of bone destruction. Bone destruction is present in attico-antral disease.

TREATMENT:

AIM: 1. Control infection.

  1. Eliminate ear discharge.
  2. At a later stage correct hearing loss by surgical means.

1) AURAL TOILET: Remove all discharge & debris from ear by-

  1. a) Dry mopping with absorbent cotton buds.
  2. b) Suction clearance under microscope.
  3. c) Irrigation with sterile normal saline & dried after irrigation.

2) EAR DROP: Antibiotics ear drops- Neomycin, Polymycin, Chloromycin, Gentamycin.

Combined with steroids- Local anti-inflammatory effect.

3) SYSTEMIC ANTIBIOTICS: Useful in acute exacerbation of chronically infected ear.

4) PRECAUTIONS: Patient are instructed to keep water out of the ear during- bathing, swimming, hair wash.

    * Rubber insert can be use.

    * Hard nose blowing avoided- as it can push infection from nasopharynx to middle ear.

5) TREATMENT OF CONTRIBUTORY CAUSES: To treat concurrently infected tonsils, adenoids, maxillary antral nasal allergy.

6) SURGICAL TREATMENT: Aural polyp or granulation, if present, should be removed before the local treatment with antibiotics.

7) RECONSTRUCTIVE SURGERY: One ear is dry myringotomy with or without ossicular reconstruction can be done to restore hearing.

 

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