Case #3 A sixteen year old male with a history of chronic otitis media is brough
ID: 3513963 • Letter: C
Question
Case #3 A sixteen year old male with a history of chronic otitis media is brought to their family physician by his mother. He is diagnosed with partial conductive hearing loss in his right ear. He has no fever, generally feels well. His heart rate is seventy beats/min, respiration is eleven breaths per minute, and blood pressure is 115/70. He tells the doctor that his earfs) do not ring. There is no pain, and does not recall any recent trauma to the ear. Are there any other questions the doctor might ask? . Are there additional exams that can be performed? List at least 4 rule outs for this condition. Will this condition require the expertise of a specialist? What is the most likely cause? What is the treatment?Explanation / Answer
Chronic ottis media is the inflammation of middle ear with respect to etiologic agents, occurrence. This is of two types
A. Acute otitis media: It is caused by Streptococcus pyogenes, Moraxella catarrhalis, Mycoplasma and it is the Infection with the onset of pain with symptoms like fever, sometimes non infectious fluid.
B. Chronic otitis media: Chronic otitis media is caused by Peptostreptococcus spp, Bacteroides fragilis etc. It is the inflammation after 3 weeks of acute otitis media. Symptoms include loss of hearing. Chronic otitis media is a disease which results from long term damage to middle ear by infection. It results in hole in ear drum, persistence of fluid behind the ear drum, continuous flow of pus from ear and the disturbance in balance or equilibrium of the body.
It is caused due to several reasons like blockage of Eustachian tubes due to nose and throat infection. If blockage persist for long time then tissue of middle ear gets changes, first mucus gets thickened in blocked area. In this immune system of both Eustachian tubes and middle ear gets disturbed and allow bacteria to enter in the space of middle ear and infect there and creates painful ear. It can damage the ear drum permanently then there can be hearing loss.
If such type of patient comes to doctor then doctor should ask about
* Continuous flow of fluid from ear.
*confusion or sleepiness
*headache or earache
*Any swelling behind the ear.
To check above there should be some test like
Tympanometry to check movement of ear drum during this a air pressure created inside the canal to check movement of eardrum.
Tympanocentsis -in this a tiny tube pierce in the ear drum to drain fluid.
It can be cured by antibiotics, steroids or placement of ventilation tubes on basis of patient condition. Surgery can also be done in above case but healing takes lot of time and care of patient.
This type of condition cannot be cured by simple physician. If there is persistent of above symptoms then a proper ENT or otologist should be consult.
Cause: Peptostreptococcus spp, Bacteroides fragilis etc.
Treatment: Antibiotic ear drops and Sometimes antibiotics by mouth.
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