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    Case Report Omsk

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    Fazax Faza
    This document reports on a case of chronic suppurative otitis media (CSOM) in a 62-year-old male patient who presented with a 2-week history of left ear discharge. On examination, the patient had a central perforation of the left tympanic membrane with discharge but the right ear was normal. Based on the history and examination, the patient was diagnosed with CSOM of the left ear. He was treated with aural toilet, ciprofloxacin antibiotic, ambroxol tablet, and an antihistamine-decongestant tablet. The patient was advised to keep his ear dry and avoid colds and flu to prevent recurrence. He will return in a week

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    Case Report Omsk

    Uploaded by

    Fazax Faza
    173 views34 pages
    This document reports on a case of chronic suppurative otitis media (CSOM) in a 62-year-old male patient who presented with a 2-week history of left ear discharge. On examination, the patient had a central perforation of the left tympanic membrane with discharge but the right ear was normal. Based on the history and examination, the patient was diagnosed with CSOM of the left ear. He was treated with aural toilet, ciprofloxacin antibiotic, ambroxol tablet, and an antihistamine-decongestant tablet. The patient was advised to keep his ear dry and avoid colds and flu to prevent recurrence. He will return in a week

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    This document reports on a case of chronic suppurative otitis media (CSOM) in a 62-year-old male patient who presented with a 2-week history of left ear discharge. On examination, the patient had a central perforation of the left tympanic membrane with discharge but the right ear was normal. Based on the history and examination, the patient was diagnosed with CSOM of the left ear. He was treated with aural toilet, ciprofloxacin antibiotic, ambroxol tablet, and an antihistamine-decongestant tablet. The patient was advised to keep his ear dry and avoid colds and flu to prevent recurrence. He will return in a week

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    173 views34 pages

    Case Report Omsk

    Uploaded by

    Fazax Faza
    This document reports on a case of chronic suppurative otitis media (CSOM) in a 62-year-old male patient who presented with a 2-week history of left ear discharge. On examination, the patient had a central perforation of the left tympanic membrane with discharge but the right ear was normal. Based on the history and examination, the patient was diagnosed with CSOM of the left ear. He was treated with aural toilet, ciprofloxacin antibiotic, ambroxol tablet, and an antihistamine-decongestant tablet. The patient was advised to keep his ear dry and avoid colds and flu to prevent recurrence. He will return in a week

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 34

    CASE REPORT

    CHRONIC SUPPURATIVE OTITIS MEDIA


    Moderator : dr.H. KRT Bambang Purwoatmodjo .Sp THT-KL,MM

    Adre Dwi Wiratama


    (10/296883/KU/13696)
    Khavidz Faza G
    (10/296941/KU/13709)

    Introduction
    Chronic suppurative otitis media (CSOM) defined as a
    chronic inflammation of the middle ear and mastoid
    cavity which presents with recurrent ear discharge or
    otorrhea through a tympanic perforation. (WHO,2004)
    A study in Jakarta shows that the prevalence of CSOM in
    2012 is 3,4%. It is considered as high CSOM prevalence
    by WHO (2-4%). (Pasra, 2012)
    CSOM typically occur in children. (Lasisi, 2007)

    Anatomy of Middle Ear

    Tortora, 2009

    Tympanic Membrane

    Divided into 4
    quadrants:
    1. Anterosuperior
    2. Anteroinferior
    3. Posterosuperior
    4. Posteroinferior

    Dhingra, 2006

    Histology of Middle Ear

    Antero-inferior compartment of the middle ear were


    composed by cilliated pseudostratified epithel with
    goblet cell and have a thick connective tissue.
    Postero-superior compartment were layered with
    monocellular epithel which do not have cillia and
    produce mucous.
    Helmi, 2005

    Vascularization of Middle Ear


    Vascularization of middle ear provided by the branches
    external carotid arteries.
    Superficial petrose arteries + Superior tympanic arteries
    superior part of middle ear
    Tympanic posterior arteries posterior part of middle
    ear
    Tympanic inferior arteries inferior part of middle ear
    Helmi, 2005

    Definition
    A chronic inflammation of the middle ear and mastoid
    cavity which presents with:
    recurrent ear discharge or otorrhea through a
    tympanic perforation.
    Patients with tympanic perforations which continu to
    discharge mucoid material for periods of from 6 weeks
    to 3 months, despite medical treatment, are
    recognized as CSOM.
    WHO, 2004

    Classification

    Benign

    Mucosal/safe/non
    cholesteatum/tubotympanic

    Malign

    Bone/dangerous/cholesteatum/atticoant
    ral
    Helmi, 2005

    Pathogenesis
    Most of benign CSOM was started from the dysfunction
    of eustachian tube
    Pathophysiology of CSOM occurred in 2 ways:
    1. Some patient develop CSOM as the result of acute
    otitis media that are unresolved completely. It
    could happened because the inadequate and
    incomplete treatment. The presence of CSOM was
    mostly caused by recurrent acute otitis media
    2. Some patient develop CSOM as the result from preexisting tympanic membrane perforation which
    eliminates the middle ear cushion and allowing
    the air to escape from middle part of the ear and
    the nasopharyngeal secretes could flow retrograde
    into the middle cavity.
    Roland, 2002 & Helmi, 2005

    Pathogenesis
    Unresolved acute otitis media could happened because:
    Does not diagnosed promptly
    Delayed treatment
    Does not treated with adequate treatment
    High virulence
    Patient with immuno-depressed
    Malnutrition condition.

    Recurrences of perforation can lead into CSOM and a larger


    perforation size.
    Wiertsema & Leach, 2009

    CSOM PATHWAY
    Extrinsic
    Intrinsic

    Tubal
    dysfunction

    Obstruction

    Air
    absorption
    Negative
    pressure

    Inadequate therapy,
    immunodepressed, high
    virulence, and delayed
    treatment

    Retracted
    eardrum
    Transudation
    Infection
    Exudation

    AOM

    CSOM
    6-12
    weeks

    Perforation

    Soepardi, 2012

    Bacteria

    Number of Findings

    Percentage

    Aerobic

    11

    22,46

    aeruginosa
    Staphylococcus aureus

    16,33

    A. anitratus

    14,29

    Proteus nirabilis

    8,16

    Difteroid

    6,12

    Streptococcus

    4,08

    epidermidis
    Klebsiella pneumonia

    2,04

    2,04

    hemolyticus
    P. alkalifacies

    2,04

    Streptococcus

    2,04

    anhemolyticus
    Anaerobic

    Bacreiodes fragilis

    8,16

    Clostridium sporogens

    6,12

    Clostridium perforogens

    4,08

    Clostridium novyi

    2,04

    Pseudomonas

    Streptococcus

    ETI
    OLO
    GY

    Helmi,

    Risk Factor
    Intrinsic Factor:
    1.Race
    2.Young age
    3.Upper respiratory
    tract infection
    4.Educational level of
    parent

    Extrinsic Factor:
    1.Parental smoking
    2.Daycare attendance
    3.Breastfeeding vs
    bottlefeeding

    Morris 2013 & Van der veen 2006

    Signs and Symptoms


    Otorrhea with purulent and mucoid consistency which
    can be occured continuously or intermitten,
    decreasing the hearing ability (conductive hearing
    loss), and tympanic membrane perforation

    Helmi, 2005

    Diagnosis

    Perforated eardrum with a history of persistent or


    recurrent otorrhea for more than 2 months
    Helmi, 2005

    History-taking - Physical Examination - Supportive


    Examination
    WHO, 2004

    Management
    1st management: ( Primary care )
    1. Rule out complication
    2. Aural toilet to start antiseptic and antibiotic
    treatment
    3. Topical antibiotic treatment as a first line or
    monotherapy
    WHO, 2004

    Helmi, 2005

    CASE REPORT

    CASE REPORT
    History taking
    Name

    :S

    Age
    Sex

    : 62 years old

    No.RM

    : 362733

    : Male

    MAIN COMPLAINT
    Discharge in left ear

    Present Illness History


    Patient complained about discharge in his left ear in 2 weeks
    continuously.
    The discharge, according to the patient, was
    mucopurulen consistency without foul smelling.

    yellowish

    Patient also mentioned slight loss of hearing and pain in the left
    ear.
    Patient experience itching in the left ear and didnt experience
    any dizziness. Those symptoms didnt appear in the right ear.
    Patient at that time was not experiencing cough, flu or fever,
    but did so in the previous week.

    Patient Illness History


    Patient has been experiencing the same
    symptoms with discharge since two years ago
    intermittent.
    The symptoms were relieved after using eardrops.
    History of allergy: denied
    History of Diabetes Mellitus + Hypertension:
    denied

    Family Illness History


    History of the same disease: (-)
    History of Diabetes Mellitus and Hypertension:
    (-)

    PHYSICAL EXAMINATION
    General appearance :
    Compos Mentis, good nutritional status
    Vital sign
    Heart rate
    : 72 bpm
    Respiratory rate
    : 16 x/menit
    Temperature
    : -C
    Blood pressure
    : 110/70 mmHg

    PHYSICAL EXAMINATION
    Right ear

    : within normal limit

    Left ear

    : discharge (+) occluding CAE

    Left ear post-suction


    mass (-)

    : hyperemic (-), edema (-),

    Right ear otoscopy : within normal limit


    Left ear otoscopy
    : cone of light (-), discharge
    in tympanic membrane, central perforation.

    PHYSICAL EXAMINATION
    Rhinoscopy anterior

    : within normal limit

    Rhinoscopy posterior

    : within normal limit

    Oropharyng

    : within normal limit

    Laryngoscopy indirect

    : within normal limit

    Ear
    Test
    Rinne
    Webber
    Schwabach

    Right Auricle

    Left Auricle

    Left lateralization
    Same as
    prolonged
    examiner

    Suspect : AS CHL
    Tuning Fork Test : Conductive Hearing Loss Auris
    Sinistra

    Diagnosis
    Chronic Suppurative Otitis Media, Benign
    Type Active phase Auris Sinistra

    Management

    Aural Toilet: Hydrogen Peroxide 3% AS, 2x1


    Ciprofloxacin 2x 500 mg
    Ambroxol 30mg Tab 3x1
    Tremenza Tab 2x1

    Education for Patient


    Keep ear dry: close ear holes while showering,
    avoid swimming, avoid water entering the ear
    canal
    Avoid cough and flu.

    Problem
    Recurrence

    Planning
    Come back in a week to assess the effectivity of
    therapy.
    Microbiological culture if no improvement

    Conclusion

    Patient diagnosed with chronic suppurative otitis


    media benign type active phase of left ear. The
    patient was treated with aural toilet with 3% of
    Hydrogen Peroxide twice a day, Ciprofloxacin
    antibiotic , ambroxol tablet thrice a day, and
    Triprolidine hcl + Pseudoephedrine hcl tablet twice a
    day.

    Thankyou

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