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        It is a case of tubo-tympanic type of CSOM.

INVESTIGATION:

  • EXAMINATION UNDER MICROSCOPE: To see-

          A) Margin of perforation.

          B) Any ingrowing epithelium.

          C) Granulation tissue & polyp.

          D) Evidence of cholesteatoma.

          E) Collection of swab from middle ear.

          F) Hidden pin hole perforation.

          G) Status of middle ear mucosa.

          H) Status of ossicular chain.

  • AUDIOGRAM:

          A) PTA- Mild conductive loss between 20 to 30dB.

          B) Patch test- out patient procedure.

Audiogram after patching (closed perforation).

Improve hearing- intact ossicular chain.

↓ hearing- ossicular fixity or discontinuity.

No improvement- Technical fault or improper patching.

  • CULTURE & SENSITIVITY OF DISCHARGE: To select proper antibiotic ear drops.
  • IMAGING:

          A) X-RAY Mastoid- To rule out mastoiditis.

          B) X-RAY Paranasal sinuses- Sinusitis.

          C) X-RAY Soft tissue neck lateral view- adenoid enlargement.

          D) CT Scan- Temporal bone- evidence of bone destruction (not present).

          E) Diagnostic nasal endoscopy.

MANAGEMENT:

AIM: 1. Control infection.

  1. Eliminate ear discharge.
  2. Correct hearing loss surgically.

MEDICAL:

  1. AURAL TOILET- Remove all discharge & debris by- dry mopping, wet mopping- not done, suction cleaning.
  2. EAR DROPS- Neomycin, polymyxin, chloromycin, gentamycin- combined with steroids.
  3. SYSTEMIC ANTIBIOTICS- Acute exacerbation of chronically infected ear.

SURGICAL:

  1. REMOVAL OF SEPTIC FOCI- Tonsillectomy, adenoidectomy, sinus wash.
  2. MYRINGOPLASTY- Hearing loss <40dB
  3. TYMPANOPLASTY- hearing loss >40dB
  4. MASTOIDECTOMY (CORTICAL)- If mastoiditis present.

PREOPERATIVE:

  1. Avoid entry of water into ear by ploughing with cotton balloon by using a ear plague or by avoiding swimming.
  2. Common cold should be treated immediately.
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