Lecture 7:

Ear Cases
Case 1
 Ear Q-7, P 20
Male Pt, 25 y old,
Offensive blood stained Rt ear discharge
5 weeks later: headache, vomitting, drowsy,
fever,
Exam: Attic perforation

Questions: Diagnosis, Why, How to

confirm, ear condition, management
 Case
Male Pt, 25 y old,
Offensive blood stained Rt ear discharge,

Increasing discharge, ear fills after

mopping, fever pain swelling

Questions: Diagnosis, Why, How to

confirm, management
 Case
Male Pt, 25 y old,
Offensive blood stained Rt ear discharge

Increasing discharge, Face Pain , Diplopia

Exam: Hyperthesia of face, squint

Questions: Diagnosis, Why, How to

confirm, management
 Case
Male Pt, 25 y old,
Offensive blood stained Rt ear discharge,

Diziness unsteadiness

Vertigo , Nystagmus

Headache, unsteady gait

 Case
Male Pt, 25 y old,
Offensive blood stained Rt ear discharge

Later: Persistant temporal Headache

No other neurological symptoms

Pulsating discharge
 Ear Q-11, P 20
Adult male, Rt MPD, for 10 y

Sudden dizziness, Total deafness,

severe vomiting
5 d later: Severe headache,
stiffness of neck back muscles
 Ear Q-3, P 20
Child 3 y old, Rt MPD, for 2y

Sudden fever , Decreased hearing,

decreased discharge

Diagnosis & DD
 Ear Q-12, P 21
Child 6y old, Rhinitis, Bilateral severe
ear pain, Fever 39c
Medical treatment, pain stopped,
Marked deafness 2w after
Q: 1ry condition,
Residual trouble: cause, how to avoid,
TM appearance, treatment
 Ear Q- 5&6 , P 20
A patient presented with ear ache:
source of pain How to diagnose

Discuss ear ache

 Ear Pain: Local Causes.
External otitis: Frunculosis causes
External ear throbbing pain, diffuse OE,
Otomycosis Tender Tragus
Perichondritis , Carcinoma

Acute OM (throbbing pain before TM

Middle ear rupture) Rinne test -ve
Chronic S OM is Not Painful unless
Complicated: e.g OE, / Lat.S. thrombosis,
Petrositis,/ Extrad absc., Temporal L absc.
ME Trauma / Tumours
 Ear Q-17, P 21
Male pt, 47y old, Left ear pain, duration 2d,
Pain: Throbbing, Increase with mastication
Previous similar attacks.
Examination: painful auricle movement,
reddish swelling in external part of post
meatal wall, Retro aur.sulcus ternder &
swollen, Rinne +ve, Weber central
Q: Diagnosis , reasons, DD, Cause
of recurrence, treatment
 Pain With Complicated Chronic
Suppurative Otitis Media
Swollen ext. canal + Tender tragus?? Otitis Externa

Severe headache , projectile vomitting, Blurred vision

Signs of Increased Intracranial tenion:

Meningitis & Brain Abscess

Temporal headache & Localizing signs Temp. Lobe Abscess

Vertigo, Ataxia, Abn gait, In-coordination Cerebellar Abscess

If there is neck rigidity, +ve Kernigs & Brudzneski signs

Meningitis
 Pain With Complicated Chronic
Suppurative Otitis Media

Mastoid pain, Swelling , increasing discharge? Mastoiditis

Face pain, Diplopia + Severe ear pain & discharge?

Trig. Gang., VI n palsy = Petrositis (Gradinigo Synd.)

Severe Temporal Headache, Without other neurological signs!!?

Extra Dural Abscess
Other possible signs include : Pulsating discharge, granulation end
erosion of tegmen (Operative and radiological finding
 Nerve supply

Auriculo-
X vagus temporal n.

IX
glossopharyngeal Facial n. Lesser
occipital

Great
auricular
n. C2-3
 Referred Ear Pain
Dental caries, abscess, gengivitis, Sinusitis,
V Trigiminal neuralgia
Herps zoster oticus, Bells palsy
VII
Tonsillectomy, Quinzy, Tongue ulces
IX (post.1/3), long styloid, glossoph. Neuralgia
Malignant tumours of hypopharynx, larynx,
X
& oesophagus, TB laryngitis
C2-3 Cervical spine problems: spondylosis, disc
prolapse, TB.
 Queckenstedts Test
in diagnosis of lateral sinus thrombosis:

Put lumbar puncture and measure CSF

pressure with the following maneuvers:
Press IJV on same side
Press IJV on opposite side
 Ear Q-15, P 21
Child, 3y old, unable to close right eye, dv of
mouth angle to left, crying, duration 2d,
previous ear pain improved with treatment

Diagnosis, original & complication,

findings, management
 Ear Q-20, P 22
Male, 25y old, Rt ear: severe pain & discharge
Discharge: scant, foul, duration: 5 y
6w ago: Headache, vomitting, blurred vision
Vertigo,
Exam: decreased allertness, temp. 36, pulse 62/m,
Rt attic perf. TF: Rt CHL
Q: Diagnosis, reasons, investig.
Explain:underlined