A typical CSOM.... just for share... a 62 yr old granny, known case of chronic rhinosinusitis.... and frequent mucopurulent discharge from left ear with otalgia... which resolve on conservative treatment.... since last 2 yrs... no any history of any comorbidity... rx Tab.Cefuroxime 500mg bid tab.metro 200mg tds tab.Monteleucast plus levocetrizine 1od referred for ENT opinion...

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As seen in the pic. pt. seems to have Otitis externa also. So give local application of some antibiotic+ antifungal with steroid ointment in the ear canal along with this tmt.

Yes I agree with you sir, before that we have to examine the ear as there can be fungal debris sometimes which requires microsuction and if there is a perforation we have to tell the patient also how we have to manage it.
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Rule out diabetes.

Advised pus culture. X-ray skull to rule out mastoiditis or brain abscess. Treat be accordingly

Treatment as outlined Pus for culture and sensitivity. Once discharge subsides , ear examination under microscope or Endoscope Xray mastoids. CT PNS to know the extent of sinus disease.. Rule out diabetes

Have you ever considered complication like mastoiditis And infection spreading the brain.

Respected sir... She doesn't hv signs and symptoms of mastoiditis... But as you said it can be a complications, a possibility if not treated early... Thank you sir..
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Please rule out diabetes. Send pus for culture and sensitivity. Do an aural toilet and oto endoscopy to rule out secondary acquired cholesteatoma.

There's also otitis externa + infectious eczematoid dermatitis ( caused by pus coming from middle ear.

I agree with Dr.R.Gudipudi.

PT HAS C S OM WITH OTITIS EXTERNA NEEDS URGENT E N T CONSULTATION

Examination of ear, followed by pus for culture and if it is not responding to medication and treatment according to findings

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