Clinical Approach and Investigations of Ear Discharge
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Clinical Approach and Investigations of Ear Discharge
- 2. ï ï ï ï ï Age ASOM, CSOM (TTD & congenital AAD) common in children CSF otorrhea can be congenital Neoplasm of ear in 30 â 50 years old Sex CSOM more common in boys Race ASOM more common in Native American Occupation Factory, Airport, Airbase Address Near Airport,Industrial Area
- 3. Chief Complain: Ear discharge: side and duration ï HOPC ï âș Duration âș Side: Unilateral Bilateral âș Onset ï Acute: Acute OM, TM perforation, OE, Furuncle ï Insidious: CSOM, Cholesteatoma, ï Recurrent: Furuncle
- 4. âș Progression ï Continuos: CSOM ï Intermittent: ASOM -frequency of episodes -duration of each episodes ï Symptom is increasing/decreasing
- 5. âș Amount Scanty : CSOM Profuse âș Nature watery: Otomycosis serous: CSF Otorrhea purulent: Furuncle, malignant OE (blood stained), CSOM âș Trauma History: Blood discharge âș Foul Smelling: CSOM, Osteomyelitis
- 6. ï Associated Symptoms âș Pain + Deafness: Furuncle âș Pain + Hearing Loss + CN palsy: Malignant âș âș âș âș âș OE Itching + Seborrheic Dermatitis of scalp: Seborrhoiec OE Irritation + Itching + blocked sensation + dull ache: Otomycosis Pruritis Tinnitus Vertigo
- 7. ï Activities that can affect the canal or TM âș Swimming: Otitis Externa âș Insertion of object: Cotton buds, FB âș Trauma: Ear pick âș Ear Drops ï Antibiotic: Otomycosis ï Chloromycetin, Neomycin: Eczematous Otitis Externa
- 8. ï Past History âș URTI, chronic sinusitis, chronic rhinitis ï dysfunctional ET ï ASOM ï CSOM âș Diabetes, Immunodeficiency âș Previous Surgery in Ear, Sinus, Pharynx âș Ear Diseases during Childhood: Congenital Disease
- 9. ï ï ï ï ï PINNA tenderness on moving pinna in furuncle PRE-AURICULAR spreading cellulitis in furuncle and malignant OE POST-AURICULAR lymphadenopathy in furuncle +/greasy yellow scale in the sulcus TRAGAL TENDERNESS furuncle,otomycosis, malignant OE MASTOID TENDERNESS CSOM
- 10. ï EXTERNAL AUDITORY CANAL -skin fissure and meatal stenosis in diffuse OE -otomycosis: white fluffy (candida), greenish (A.fumigatus) -lumen occluded by edema/abscess in furuncle -granulation tissue/polyp in malignant OE -vesicle formation, oozing and crusting in eczematous OE -greasy yellow scale in seborrhoeic OE
- 11. ï - TYMPANIC MEMBRANE: ASOM retracted and hyperemia bulging and fluid levels/bubbles (suppuration) Congested, edematous, bulging, pus pointing (before perforation) Pin-hole perforation, light house sign, pulsatile ear discharge (after perforation) Pin hole perforation without discharge (resolution)
- 12. ï The following findings are of particular concern âș Recent major head trauma âș Any cranial nerve dysfunction (including sensorineural hearing loss) âș Fever âș Erythema of ear or periauricular tissue âș Diabetes or immunodeficiency
- 13. ï ï Blood Glucose: DM Microscopy âș cholesteatoma, crust, granulation tissue in CSOM ï Pure Tone Audiometry âș Unilateral SN Hearing Lost in Neoplasm of Ear, Malignant OE ï ï To rule out CSF leak âș á”2transferrin in discharge fluid Culture & Sensitivity âș For refractory cases in which initial antibiotic therapy has failed
- 14. CT of temporal bone âș Fracture, Osteomyelitis ï Biopsy âș When auditory canal granulation tissue present ï