case dr. oscar

8/9/2019 Case Dr. Oscar

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Case Presentation

Supervisor:

dr. H. Oscar Djauhari, Sp. THT-KL


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THE CASETHE CASE


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The CaseThe Case

a 55-years old man came tohospital with difcultyin s!i"in#

and droppin# o$ the ri#htcorner o$ his !outh since 5 daysago. He had a history o chronic

suppurative otitis !edia o hisright ear.


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IdentityIdentity

Name : Mr. !ge : 55 years old

"ccupation : #a$or

!ddress : %u&a$umi


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History o 'resent IllnessHistory o 'resent Illness

'atient had secretion co!in# out o$ his ri#htear. It comes out intermittently since % !onthsa#oand the "atest &as ' !onth a#o.%ecretion was (e""o&ish in color( s"i#ht"(thic) in consistency and has $ou" s!e"".

'atient went to general practitioner $eore $utwith no impro)ement.

* da(s a#o( patient noticed a drop o$ hisri#ht !outh corner and di+cu"t( in s!i"in#.

'atient elt this symptom eca!e &orse alongwith time. Earache &as asent. *e)er andpain on other places were a$sent. Hearing loss+,. Tinnitus +,. History o trau!a -.


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History o 'ast IllnessHistory o 'ast Illness

%ince months ago( patient hadsecretion coming out o his right earintermittently.

/ months ago went to the communityhealth centre and was gi)en oralmedication $ut the discharge stillcame out.

!llergic +-Hypertension +-

0ia$etes Mellitus +-


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'hysical 12amination'hysical 12amination

+3enerali4ed %tatus+3enerali4ed %tatus3eneral appearance: moderately ill!wa&eness : compos mentis

lood 'ressure : 667897 mmHg

'ulse rate : 7 $eat per minute;espiration rate: /7 $et per minute

Temperature : oC


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+1ars+1ars

/i#ht ear :

!uricle : normal

Canalis !cousticus 12terna : hyperemic +-( edema +-(dischar#e 0 !ini!a", (e""o&ish and puru"ent(cholesteatoma +-( odorous s!e"" 0 laceration +-( cerumen +-

Tymphanic mem$rane : !ar#ina" per$oration, cone o$ "i#ht - ;etroauricular : deormities +-( edema +-( hyperemic +-

;inne test +-( ?e$er "atera"i1ation to the ri#ht( pro"on#edSch&aach.

Le$t ear :

!uricle : normal Canalis !cousticus 12terna : hyperemic +-( edema +-(

discharge +-( cholesteatoma +-( odorous smell +-( laceration

+-( cerumen +-

Tymphanic mem$rane : intact( $ulging +-( cone o light +,

;inne test +,( ?e$we no laterali4ation( %chwa$ach test same with thee2aminer.


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+Nose+Nose/i#ht 2ose :

Mucous mem$rane : within normalrange

Concha: eutrophy

Ca)um : discharge+-(mass+-(crust+-

%eptum : normal

Le$t nose :

Mucous mem$rane : within normal range Concha : eutrophy

Ca)um : discharge+-(mass+-(crust+-

%eptum : normal


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++Nasopharyn2( "ropharyn2(Nasopharyn2( "ropharyn2(

Ma2iloascial( and Nec&Ma2iloascial( and Nec&2POP

Mucous mem$rane : hyperemic +-( edema+-

!rcus anterior : u)ula in themiddle( mass +-

'haryn2 : hyperemic +-

Tonsil : T6-T6( hyperemic +-

3a4i""o$acia" : !symmetrical

2ec) : lymphadenopathy +-( +-


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+*acial Ner)e+*acial Ner)e

5acia" 2erve E4a!ination +right 8let

*acial e2pression : asymmetrical( right

side o aceslightly dropped

;aising eye$row : difcult 8 normal

Closing eyes : let $ehind 8 normal

%miling : let $ehind 8 normal


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?or&ing 0iagnosis?or&ing 0iagnosis

Chronic suppurati)e otitis mediao the right ear with a

complication o right acial ner)e

paralysis.

6or)up

acteria culture and sensiti)ity testrom the ear discharge


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MedicationMedication

Topical !nti$iotic : o@o2acin


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L7TE/AT8/E /E97E6L7TE/AT8/E /E97E6

'art II


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Chronic %uppurati)e "titisChronic %uppurati)e "titis

Media +C%"MMedia +C%"M0eAnition

a persistent or intermittent inected dischargethrough a nonintact tympanic mem$rane +ie(peroration or tympanostomy tu$e

Chronic peroration o the tympanicmem$rane can occur without suppuration inactive; CSO3

1pidemiology pre)alent in de)eloping countries and is more

common in lower socioeconomic groups in thede)eloped world.


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Chronic %uppurati)e "titisChronic %uppurati)e "titis

Media +C%"MMedia +C%"M'athogenesis

most cases: C%"M occurs as a conseBuence o anepisode o !"M with peroration( with su$seBuentailure o the peroration to heal.

continued presence o a middle ear eusion degeneration o the A$rous layer o the tympanicmem$rane.

Pseudomonas aeruginosa, Staphylococcus aureus(and the Proteus species.

two main mechanisms $y which a chronic

peroration can lead to continuous or repeatedmiddle ear inections: 0irect contamination rom e2ternal ear $ecause the

protecti)e physical $arrier o the tympanic mem$rane is lost. The loss o Dgas cushionE in pre)enting re@u2 o

nasopharyn2 secretion results in the increased e2posure o

the middle ear to nasopharyn2 $acteria.


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Clincal *indingsClincal *indings

S


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0ierential 0iagnosis0ierential 0iagnosis

cholesteatomachronic granulomatous conditions

?egener granulomatosis

myco$acterial inection

histiocytosis

sarcoidosis

necroti4ing otitis e2terna ormalignant neoplasm


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TreatmentTreatment

2O2S8/=7CAL 3EAS8/ES !ural toilet

Topical anti$iotics

%ystemic anti$iotics

S8/=7CAL 3EAS8/ES

TympanoplastyTympanomastoid surgery


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ComplicationsComplications

Se>ue"ae Tympanosclerosis

!telectasis o tympanic mem$rane

7ntrate!pora" Co!p"ications

Mastoiditis

'etroisitis *acial Ner)e 'aralysis

%uppurati)e #a$yrinthitis

7ntracrania" Co!p"ications

Meningitis

Intracranial a$scess #ateral sinus throm$osis

"tic Hydrocephalus


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*acial Ner)e*acial Ner)e


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0ierential 0iagnosis o0ierential 0iagnosis o

*acial 'aralysis*acial 'aralysis


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THA2K

case dr. oscar

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