This case presentation describes a 25-year-old woman who presented with difficulty smiling and drooping of the left side of her face for three days. She had a history of chronic yellow drainage from her left ear for four months. On examination, she had facial asymmetry with difficulty moving the left side of her face. She was diagnosed with chronic suppurative otitis media of the left ear, which had led to left facial nerve palsy. She was started on topical and oral antibiotics as well as steroids to treat the infection and nerve palsy.
This case presentation describes a 25-year-old woman who presented with difficulty smiling and drooping of the left side of her face for three days. She had a history of chronic yellow drainage from her left ear for four months. On examination, she had facial asymmetry with difficulty moving the left side of her face. She was diagnosed with chronic suppurative otitis media of the left ear, which had led to left facial nerve palsy. She was started on topical and oral antibiotics as well as steroids to treat the infection and nerve palsy.
This case presentation describes a 25-year-old woman who presented with difficulty smiling and drooping of the left side of her face for three days. She had a history of chronic yellow drainage from her left ear for four months. On examination, she had facial asymmetry with difficulty moving the left side of her face. She was diagnosed with chronic suppurative otitis media of the left ear, which had led to left facial nerve palsy. She was started on topical and oral antibiotics as well as steroids to treat the infection and nerve palsy.
This case presentation describes a 25-year-old woman who presented with difficulty smiling and drooping of the left side of her face for three days. She had a history of chronic yellow drainage from her left ear for four months. On examination, she had facial asymmetry with difficulty moving the left side of her face. She was diagnosed with chronic suppurative otitis media of the left ear, which had led to left facial nerve palsy. She was started on topical and oral antibiotics as well as steroids to treat the infection and nerve palsy.
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CASE PRESENTATION:
CHRONIC SUPPURATIVE OTITIS
MEDIA WITH FACIAL NERVE PALSY
Supervisor: dr. H. Oscar Djauhari, Sp.THT-KL, M.Kes
Presented by: Cecile 2013-061-142 Florensia 2014-061-158 CASE Mrs. X, 25 years old came to hospital with chief complaint: difficulty of smiling and dropping of her left corner of mouth since three days ago. She had a history of chronic suppurative otitis media in her left ear. IDENTITY Name : Mrs. X Age : 25 years old Occupation : housewife Address : Jl. Cikole, Sukabumi COMPLAINT Chief complaint: difficulty in smilling and dropping of her left corner of mouth
Additional complaint: yellow fluid draining from
the left ear HISTORY OF PRESENT ILLNESS Patient had secretion coming out of her left ear. It comes out intermittently since 4 months ago. Secretion was yellowish in color, slightly thick in consistency and has foul smell. Patient went to general practitioner before but with no improvement. HISTORY OF PRESENT ILLNESS 3 days ago, patient noticed dropping of her left mouth corner and difficulty in smiling. Patient felt this symptom became worse along with time. Earache was absent. Fever and pain on other places were absent. Hearing loss (+), history of trauma (-). HISTORY OF PAST ILLNESS Since 4 months ago, patient had secretion coming out of her left ear intermittently. 2 months ago went to the community health centre and was given oral medication but the discharge still came out. Allergy (-)
ENT PHYSICAL EXAMINATION Nose Mucous membrane : within normal range Concha : eutrophy/eutrophy Cavum nasi : discharge -/-,mass -/-, crust -/-,bleeding -/- Septum : normal ENT PHYSICAL EXAMINATION Oropharynx o Mucous membrane: hyperemic -/-, oedem -/- o Arcus anterior : uvula in the middle, mass -/- o Pharynx : normal pharyngeal arch, hyperemic (-) o Tonsil : T1-T1, hyperemic (-)
Maxillofacial : asymmetrical Neck : lymphadenopathy (-) FACIAL NERVE PHYSICAL EXAMINATION Nervus VII Facial expression : asymmetrical, left side of the face slightly dropped Raising eyebrows : normal/ difficult Closing eyes : normal/left behind Smiling : normal/left behind WORKING DIAGNOSIS Chronic suppurative otitis media auris sinistra with complication of sinistra facial nerve paralysis.
Differential Diagnosis Primary tumor in the middle of left ear.
Workup Bacteria culture and sensitivity test from the ear discharge Audiometry test Head CT scan Lab : Complete blood count including differential count of white blood cells MEDICATION Topical antibiotic : ofloxacin ear drops 3mg/ml, 2 x 10 drops daily for 10 – 14 days in left ear Oral antibiotic : Amoxicillin-clavulanic acid, 2 x 500 mg p.o. for 10 – 14 days Steroid : Prednisone, 4 X 20 mg per day p.o. Nerve decompression CHRONIC SUPPURATIVE OTITIS MEDIA (CSOM) Definition a persistent or intermittent infected discharge through a non-intact tympanic membrane (ie, perforation or tympanostomy tube) Chronic perforation of the tympanic membrane can occur without suppuration “inactive” CSOM
Epidemiology prevalent in developing countries and is more common in lower socioeconomic groups in the developed world. CHRONIC SUPPURATIVE OTITIS MEDIA (CSOM) Pathogenesis most cases: CSOM occurs as a consequence of an episode of AOM with perforation, with subsequent failure of the perforation to heal. continued presence of a middle ear effusion degeneration of the fibrous layer of the tympanic membrane. P aeruginosa, S aureus, and the Proteus species. Two main mechanisms by which a chronic perforation can lead to continuous or repeated middle ear infections: Direct contamination from external ear because the protective physical barrier of the tympanic membrane is lost. The loss of “gas cushion” in preventing reflux of nasopharynx secretion results in the increased exposure of the middle ear to nasopharynx bacteria. CLINICAL FINDINGS SYMPTOMS AND SIGNS History of otorrhea, intermittent or continuous Hearing loss Discharge mucopurulent or bloodstained otorrhea Edematous mucous membrane in the middle ear Large perforation : identify the presence of ossicular discontinuity
SPECIAL TESTS A swab of the discharge : for culture and sensitivity test An audiologic evaluation Computed tomographic (CT) scans : demonstrating bony anatomy and are essential if an intracranial extension of the infection is suspected. DIFFERENTIAL DIAGNOSIS cholesteatoma chronic granulomatous conditions Wegener granulomatosis mycobacterial infection histiocytosis X sarcoidosis
necrotizing otitis externa or malignant neoplasm
