Case presentation

Deepika kamathCase presentationSiddharchaya52 yearsMaleWelderHonnalliChief complaintsH/o bilateral ear discharge more left sided on and off since 15 yearsH/o decreased hearing left sided more than right sided since 10 yearsHistory of presenting illnessEAR DISCHARGEIt initially started in the left ear and after a gap of 2 years it started in the right earInsidious in onsetGradually progressivePatient 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 smellingIt is intermittent

Each episode lasts for 7 daysRelieved with topical medicationsOne episode every 6 monthsIncreased amount of discharge during episodes of upper respiratory tract infections and entry of water into the earsPresent ear discharge is 20 days back Which relieved temporily on medicationDecreased hearing 10 yearsLeft> rightInsidious in onsetGradually progressiveWorsens during episodes of active ear dischargePatient says he cannot hear soft soundsCan percieve only loud noise

Ringing sound in the left ear 7 yearsMore on the left sideIntermittentSound of a ringing bellLasting 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 obstructionNo h/o giddinessNo h/o weakness of face, deviation of the angle of the mouthNo h/o fever, headache, vomiting, neck stiffnessNo h/o earacheNo h/o visual disturbances, speech problemsNo h/o traumaNo h/o postaural swelling associated with feverNo h/o nasal obstructionNo h/o recurrent attcks of throat pain, dysphagia,odynophagia

Past historyPatient was diagnosed to have kidney stones 6 years back for which he underwent treatmentNo h/oTbDiabetes HypertensionBronchial asthmaEpilepsyProlonged hospitalisationBlood transfusionDrug allergiesTreatment historyUsed topical medication for 1 week everytime he used to hav ear dischargeDetails not available1 week back the patient received the following medicationsTab. Ciplox 500 mg BDTab diclo 50 mg BDOtolux o ear drops 3 -3-3Family historyNo similar complaints in the familyPersonal historyAppetite goodDiet - vegetarianB&B - regularSleep - adequateHabits - used to smoke beedi abstained since 15 years

General examination52 year old male patient, moderately built and nourishedConscious, co operative, well oriented to time, place , personVITALS:BP: 120/80 mm hgPR: 76/ MINRR: 18/ MINNo pallor, icterus, cyanosis, clubbing , lymphadenopathySystemic examinationCVS: S1 & S2 heard , no murmurs

RS: B/L NVBS heard, no added sounds

P/A: soft, non tender, no organomegaly

CNS: normal

Local examinationEAR RIGHT LEFTPreauricular normal normalPinna normal normalPostauricular normal a swelling 2*2 no signs of inflammation, edges well defined, surface smoothPalpation : soft in consistencyEAC normal normalTYMPANIC MEMBRANE

RIGHT LEFTSEIGALISATIONFACIAL NERVE normal normalFISTULA SIGN negative negativeMASTOID TENDERNESS absent absentTFTRINNES negative negativeWEBERS lateralized to leftABC decreased decreasednoseCold spatula test:

External appearance: normal

ARE vestibule: normal S shaped DNS b/l HIT turbinates pale mucosa normalParanasal sinuses: non tender

PRE: NORMAL

ORAL CAVITY: lips, gums, teeth, anterior 2/3 rd tongue. Hard palate, GLS, GBS normal

OROPHARYNX: RIGHT LEFTANTERIOR PILLAR normal normalTONSILS GRAGE1 GRADE1POSTERIOR PILLAR normal normalPPW normal normal

IDL: NORMAL

NECK: no palpable lymph nodesPROVISIONAL DIAGNOSISB/L chronic otitis media active squamous with conductive hearing loss with allergic rhinitis without any complicationsinvestigationsOtoscopyOtomicroscopyCulture in case of dischargePTAX RAY B/L mastoids schullers viewChest x ray PA viewX RAY pns wayers viewRoutine investigationsBloodUrine routineECGMANAGEMENTEither intact canal wall or canal wall down mastoidectomy with ossiculoplasty