OTOLOGY
Case Scenario # 1 (Presbyacusis, Drug and noise induced SNHL)
65yrs old retired army officer complaining of bilateral progressive decrease hearing for few years. He is an insulin dependent diabetic, Ischemic heart disease, Hypertensive and takes tab Ascard, Lasix, and Tenormin. His complete ENT examination was normal with tympanic membranes intact and Rene’s +ve and weber’s not being lateralized.
a) Enumerate differential diagnosis in the given scenario
b) What is the most likely diagnosis
c) Describe the relevant pathophysiology of the given disease
d) How will you investigate such a patient
e) What are the treatment options available
Case Scenario # 2 (Eustachian tube dysfunction, Aero Otitis media)
33yrs old executive who just returned from a business trip from South Africa complains of Left sided ear blockage and Otalgia for 2 days. On examination the left tympanic membrane is retracted and inflamed while Right side seems to be normal. Weber test is lateralize to the Left side.
a) Discuss differential diagnosis
b) What is the likely diagnosis
c) How will you investigate such a patient
d) What treatment options are available
Case Scenario # 3 (Serous otitis media, glue ear)
5 years old boy with Mother complaining that child has difficulty hearing for 2 weeks. He has just recovered from an upper respiratory tract infection and is allergic to pollen. On examination both tympanic membrane are pale with loss of cone of light, on the right side bubbles could be visualized behind the tympanic membrane. While there is bilateral turbinate hypertrophy.
a) Discuss Differential diagnosis
b) What is the likely diagnosis
c) How will you investigate such a patient
d) What treatment options are available
Case Scenario # 4 (CSOM +/- Complications)
19yrs old female in OPD with Rt. Ear purulent discharge for more than 5 years, which is foul smelling, with progressive hearing loss. For past 1 week Pt. has developed headaches and vertigo as well. Examiantion reveals yellow color discharge and polyp arising from post wall in External auditory canal. While Weber’s lateralize towards Rt. Ear.
a) Discuss differential diagnosis
b) What is the most likely diagnosis
c) Describe the relevant pathophysiology of the disease
d) How will you investigate such a patient
e) What are the treatment options available
Case Scenario # 5 (Facial nerve palsy, Bell’s Palsy, Iatrogenic Facial nerve paralysis)
48yrs old diabetic, HTN Female who underwent mastoid surgery for right CSOM (Cholesteatoma) develops decrease movement in facial expression with drooping of angle of mouth on the Right side. The Surgeon explains that the disease was very extensive and difficult to remove completely. Pt. past history is positive for a similar episode on the Rt. Side 2 years back , which got better all by itself.
a) Enumerate differential diagnosis in the given scenario
b) What is the most probable diagnosis
c) Describe the relevant pathophysiology of the given disease
d) How will you investigate such a patient
e) What treatment options are available
Case Scenario # 6 ( Vertigo, Minere’s, BPPV, Labrynthitis)
45yrs female in OPD with complaints of Dizziness for few minutes followed by nausea for 1 week. The condition aggravates on looking towards the left side. Pt. denies complaints of hearing loss or tinnitus. ENT examination reveals no pathology otherwise.
a) Discuss differential diagnosis
b) What is the likely diagnosis
c) How will you investigate
d) What treatment options are available