Vb

2. CBL -5 (ENT)
A 65-year-old diabetic male visits the emergency department for
excruciating left earache. He has discharge from this ear since couple
of weeks. He has been treated by many doctors without cure.
Examination reveals granulation in the left external auditory canal, and
a naked bone at the junction of the cartilaginous and osseous portions
of the floor of the auditory meatus. His left Pinna is healthy and the TM
is intact, though congested.

3. QUESTIONS
Q- 1 What is your likely diagnosis?
Q- 2 Enumerate the differential diagnosis?
Q- 3 What are the treatment options of this case?
Q- 4 Name the complications?

4. KEY
Answers:
1. LIKELY DIAGNOSIS
Keeping in view the history and clinical examination, the
most likely diagnosis is Malignant (Necrotizing) Otitis externa.

5. KEY
3. DIFFERENTIAL DIAGNOSIS
a. Otitis Externa Haemorrhagica
b. Herpes Zoster Oticus (Ramsay Hunt syndrome)
c. Malignancy
d. Keratosis Obturans
e. Canal Cholesteatoma

6. KEY
3. TREATMENT OPTIONS
a. Avoid and treat predisposing factors, e.g., Diabetes mellitus
b. Aural Toilet
c. Pain Killers
d. Surgical debridement of Necrosed tissue / granulation tissue
e. Daily packs of Ribbon Gauze Wicks impregnated with
Gentamicin ointment
f. 6 to 8 weeks I / V antibiotic ( Ciprofloxacin )
g. Hyperbaric Oxygen

7. KEY
7. COMPLICATIONS
a. Disease may spread to the TMJ
b. Parotid Gland
c. Mastoid
d. Base of the Skull
e. Internal Carotid Artery
f. Jugular foramen (Involving all the cranial nerves)
g. Brain Abscess

8. Thank you