It is a case of chronic suppurative otitis media.
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.
AIM: 1. Control infection.
1) AURAL TOILET: Remove all discharge & debris from ear by-
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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