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Case A

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by

Sharif Hasan

on 23 January 2013

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Transcript of Case A

Noble's Hospital A&E Department Case of the Week “Ear Infection” FY2 Sharif Hasan History P/C Lt ear infection 8/52
Pain score, night 9/10, now 4-5/10
noise, impaired hearing, discharge, foul odour, dizziness
Lt face weakness > 1/52
anorexia & weight loss
No fever or rash History Seen by GP x 4
3 courses of ABx & 1 x ear drops
“Pain in my ear, I can’t take it anymore, I am not
going any where until I know what’s wrong”

PMH/Meds nil
Allergies NKDA
Occupation forklift driver Examination Undistressed, T 36 C, Lt facial weakness, foul odour

Rt ear clear, intact tympanic membrane

Lt ear
Discharge, yellow thin, dripping
No external tenderness
Localized tenderness in front of ear
hearing
Ear canal: full of debris & pus, tender
Couldn’t visualize tympanic membrane Examination Cranial Nerves

VI Abducens
Intact, good ocular movements

VII Facial
Lt unilateral facial weakness
Upper and lower muscles affected, eyebrow & mouth Diagnosis Definitely not otitis externa!!

VI CN Palsy secondary to otitis media

? Perforated Lt tympanic membrane Management Analgesics, Cocodamol 8/500

Referred to ENT
O/E: bone sequestra, suppuration
Sample for histology
? Neoplasm ? SCC
Urgent CT 08/09/2009
Full transcript