F/12, yrs, pus discharge from left ear for 3 years, took t/t from ENT, (4mnths back, prescription attached) but still no response, I started with ceftiaxone+sulb 1.5gm i/v for 4 days with orally clavum 625, bevon syp.,pantop 40, tab. Cetrizin for 5 days od, but still pus discharge is present, plse help me how to manage.

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This looks to be a c/o of CSOM Showing greenish dis coloration of discharge likely gramnegative infection with otomycosis. Yes pus for C&S and also for fungal C&S mri mastoid should be done for surgical intervention

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Take pus for culture and sensitivity . Other conditions like enlarged adenoids and rhinosinusitis have to be ruled out. There is a possibility of Tuberculosis of middle ear also.

1.culture- sensitivity of ear discharge 2. X-ray mastoid / CT Temporal bones 3. Nasal drops thrice daily 4. Add capsule ambroxol/ n acetyl cysteine once daily. 5.Aural toileting 6.Strict abstinence from head bath/ water entry to ear 7.Examination under microscope/ endoscope after ear dries up. 8.examination of nose / nasopharynx and throat.

Otitis media pus for culture and sensitivity must then treat spar200 bd with recofast tds 5 days otrivin nasal drops 3 bd ciplox ear drops 5 drops five times a day

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Culture & Sensitivity for pus Maybe Anaerobic or fungal infection,so before taste, below Medicine can be tried--Tab-fluconozole150, odx10+Tab-Metrogyl400 bdx10+Tab-Azithro500bdx5+ Candibiotic ear drops+Tab-Livocet 10 mg odx1o

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It looks like otomicosis with secondary infection of cartilage also.First treat with antifungal both systemic and local.clean the ear carefully before putting antifungal drops.Add vit c and appropriate antibiotic after pus culture.He may need mastoid surgery too.

Fungal otomycosis Commanly Aspergillosis,Treat with IV Amphotericin B

Pus for culture and sensitivity maybe fungle case of chronic otitis media

Pus,culture-senstivity test, X-ray Mastoid process. Anti allergic,Anti inflamatory-analgesics with supportive B-Complex and Nasal Drop apply with proper position that locally affect to eustachian tube. Antibiotics according to C/S. Try to keep ear dry and maintain oral hygiene and nasal clean.

See whether the patient has adenoid hypertrophy or not, dental carries ore/of any infections. If not present only steroid antibiotics combination and antihistamines will suffice, if any ppting factor is present it should be addressed. Also precautions to keep ear dry. Continued

Review after 2 weeks. If discharging culture and sensitivity of pus may be done a and change antibiotics, also, systemic.
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