CASE PRESENTATION

1. Case presentation on Right
Labyrinthine Erosion
R.Anusha
Pharm D VI Year
Roll No:170514882007.

2. Patient name:Mrs.BS
Gender:Female
Age:26 years
IP No:285535
DOA:22/10/19
DOD:24/10/19

3. SUBJECTIVE
• Chief Complaints: Hard of hearing both ears, right > left ear.
• Present Illness History: Hard of hearing both ears, right > left
ear since 3 months. Dizziness since 2 days.
• Past medical/medication history: Nil
• Allergies: NKDA

4. OBJECTIVE
PHYSICAL APPEARANCE:
Height: 162cms
Weight: 50 kgs
B.M.I: 18.8 kg/m2.
VITALS:
Patient alert, conscious
B.P: 110/70 mmHg.
R.R: 18 breaths/min.
P.R: 72 beats/min.
Temperature: Afebrile

5. Diagnostic test:
Hb:12.2gm
TLC:4,900 cells/mm3
Platelets:3,32,000/micro.litre
FINAL DIAGNOSIS: Bilateral chronic otitis with right
labyrinthine erosion
ENT:
• Ear:Ear ache, Tinnitus, Vertigo
Left ear: Wax present
Right ear:Central perforation +
• Nose: No abnormality detected
• OC/OP: No abnormality detected
(oral cavity/oropharynx)

6. DRUG CHART
Brand Generic Dose ROA Freq. Category Indication
Inj.Monocef
On 22/10/19
Ceftriaxone 1 gm IV BD Antibiotic Infection
Prophylaxis
Inj.Stemtil
On 22/10/19
Prochlorperazine (1ml)
12.5mg/ml
IV BD Dopamine
antagonist
Dizziness
IVF RL
On 23/10/19
(7:15 am)
Ringer lactate 100 ml/hr IV Over
4hours
Electrolyte Hydration
Inj.Dynapar
On 23/10/19
Diclofenac 75 mg IV OD Analgesic Ear Pain
IV Fluid DNS
On 23/10/19
(8:00 pm)
Dextrose normal
saline
100 ml/hr IV Over
4hours
Electrolyte Hydration
Inj.Pantop
On 23/10/19
Pantoprazole 40 mg IV OD PPI Ulcer
prophylaxis
T.Stugil
On 23/10/19
Cinnarizine
Domperidone
15mg +
20mg
(1tab)
PO BD Dopamine
antagonist,
Anti
emetic
Dizziness

7. • Treatment is aimed at relieving symptoms.
• To opt for surgical therapy if necessary.
• To improve quality of life.
Goals of the Treatment

8. ASSESSMENT
DAY-1(22/10/19)
• A 26 YOF patient came with complaint of hard of hearing in
both ears and dizziness since 2 days.
• Patient was given Inj.Monocef (Ceftriaxone) an antibiotic as
a infection prophylaxis.
• To decrease her dizziness associated with nausea and
vomiting, Inj.Stemtil (Prochlorperazine) was given which
controls nausea and vomiting by blocking dopamine
receptors found in the trigger zone and prevents it from
sending messages to the vomiting center.

9. DAY-2(23/10/19)
• IVF Ringer lactate solution was given for hydration.
Patient was evaluated, investigated and the findings were:
• Cholesteatoma sac (abnormal,non cancerous skin growth) in
the middle ear cavity and mastoid.
• Malleus:Absent, Incus:Eroded, Stapes:Intact and mobile.
• And treated surgically with right mastoid exploration + type
III tympanoplasty under general anaesthesia.
Mastoid Exploration:Removal of diseased mastoid cells.
Type III Tympanoplasty:Reconstruction of Ear drum.

11. • IV Dextrose normal saline was given for hydration.
• Inj.Pantoprazole was given for ulcer prophylaxis.
• Inj.Dynapar was given as an analgesic for ear pain.
• T.Stugil(Cinnarizine and Domperidone) was given for
dizziness associated with nausea and vomiting. Cinnarizine
acts mainly on the blood vessels and prevents constriction on
the vessels. In theory it therefore improves the
microcirculation of the ear. Domperidone acts as antiemetic
agent.
DAY-3(24/10/19)
• Post operative hospital stay was uneventful.
• Patient vitals were stable and was discharged in
haemodynamically stable condition.

12. PLAN
Monitoring parameters:
• Monitor vitals
• Monitor for resolution of symptoms i.e ear pain and
dizziness.

13. Patient counselling
Disease related
Drink plenty of liquid, particularly water, to avoid
becoming dehydrated.
You should rest in bed to avoid falling and injuring yourself.
Your symptoms can improve after a few days.
To minimise any dizziness and vertigo:
lie still in a comfortable position during an attack
avoid alcohol
avoid bright lights
try to cut out noise and anything that causes stress from your
surroundings.
You should also avoid driving, using tools and machinery, or
working at heights if you're feeling dizzy and unbalanced.

14. Drug related:
Take T.STUGIL(Cinnarizine,Domperidone) orally twice
daily for 5 days given to control giddiness.
1 tab PO after breakfast
1 tab PO after dinner
Take T.CEFPODEM(Cefpodoxime) 200 mg orally 1 tab
twice daily after breakfast and after dinner for 5 days given
for infection prophylaxis.
Take T.PAN 40 mg 1 tab orally twice daily before breakfast
for 5 days given for ulcer prophylaxis for 5 days.
Take T.HIFENAC-P (Aceclofenac 100 mg+ Paracetamol
325 mg) 1 tab orally twice daily after breakfast and after
dinner for 3 days given for pain relief.
Normal activities can be resumed after 1 week.
To attend ENT OP on 30/10/19.