A female patient with history of ear discharge since 4 years.h/o of hearing loss since 1 year and giddiness since one week . On examination and CT scan shows following picture. What is the diagnosis and how patient should be managed.



patient has bilateral unsafe CSOM...cholrsteatoma has eroded lateral semicircular canal leading to type III labrynthine fistula...this is a reason for recent onset giddiness.....cholesteatoma has already created automastoid with erosion of long process of incus....patient requires MRM but no ossiculoplasty as there is exposed labyrinth ....ensure to create wide meatoplasty with well.polished mastoid cavity with low facial ridge

Looks like chronic suppurative otitis media (left side) , with mastoiditis , ?vestibulitis , take a ear pus swab for culture sensitivity & then treat with proper antibiotics, get audiometry after a wk ,look for any signs of spread of infection ? to brain?

mostly it's a case of B/l CSOM ( assuming discharge is from both ear) with conductive hearing loss. also include mastoiditis. she can be first managed with ear toileting Oral and local antibiotics preferably ciplox 750 BD and ciplox ear drops for 1 week. can also take an ear swab for diagnosis. also r/o nasal etiology as in most cases of b/l CSOM there may be a nasal pathology.

ct pic shows soft tissue in mastoid with LSCC erosion case of csom with cholesteatoma with complications

Bilateral Con with AAD Lat SCC fistula MRM with or without obliteration depending upon extent of disease Left side surgery takes priority as disease more extensive

she can be initially given medical management ..if not subsiding then go for tympanoplasty +mastoidectomy

Please mention which side she has ear discharge right /left ?

Please elaborate your otoscope findings ? tm perforation?

aggre with dr.savidha . giddiness due LSCC fistula

Looks like COM complicated to suppurative labyrinths, antibiotics then mastoid exploration

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