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Abstract: The patient, a 61-year-old male, presented to our otolaryngology outpatient clinic three days ago with a recurrence of left ear pain after a cold, accompanied by pus flow from the left ear without fever, dizziness, or headache. The patient was given routine blood tests, pure tone hearing threshold measurement, CT and other relevant tests, and a clear diagnosis of chronic otitis media was made. He was treated with oral + topical medication, and his condition was controlled and his symptoms improved significantly after treatment.
Basic information】Male, 61 years old
Disease Type】Chronic otitis media
Hospital】Yinchuan First People’s Hospital
Date of consultation】January 2022
Treatment plan】Oral (cefixime capsule) + topical (hydrogen peroxide solution, levofloxacin hydrochloride ear drops)
Treatment period】2 weeks of home treatment
Treatment effect】The condition was controlled and the symptoms were significantly improved
I. Initial consultation
When the patient entered the consultation room, he was in acute pain. Careful questioning of the patient’s medical history revealed that he had a 10-year history of left ear abscess, which was not taken seriously, and was treated with oral amoxicillin capsules and topical oxyfloxacin ear drops each time. The patient denied the history of hypertension and diabetes. 3 days ago, he came to our ENT outpatient clinic because of the recurrence of pus and running water in the left ear after a cold, not accompanied by fever, dizziness, headache and other symptoms.
After completing the relevant laboratory tests, the routine blood test indicated that the percentage of neutrophils was elevated, and bacterial culture and drug sensitivity test were performed on the secretion from the external ear canal. Pure-tone hearing threshold measurement suggested conduction deafness in the left ear; CT of the temporal bone suggested chronic otitis media; electronic endoscopy suggested perforation of the tympanic membrane tension, mucosal congestion in the middle ear cavity, and a small amount of purulent secretions. Combined with the patient’s clinical manifestations and relevant examinations, the diagnosis of chronic otitis media was made clearly.
II. Treatment history
We explained the patient’s condition: chronic purulent otitis media is most commonly caused by Staphylococcus aureus, followed by Pseudomonas aeruginosa. Based on our experience, we chose broad-spectrum cephalosporin III oral antibiotics (cefixime capsules), and also used hydrogen peroxide solution to flush the external ear canal and levofloxacin hydrochloride ear drops to spot the ear.
In addition to the necessary treatment, the same attention needs to be paid in life, with a diet that is easy to digest and nutritious; pay attention to rest during treatment. After the ear canal stops flowing and the pus is dry, tympanic membrane repair can be considered to improve the patient’s hearing and reduce the number of inflammatory episodes.
III. Treatment effect
After the above-mentioned communication, the patient had a certain understanding of the disease and realized that recurrent chronic suppurative otitis media could lead to intracranial and extracranial complications. After 2 weeks of oral medication + external ear canal irrigation + topical medication, the patient’s symptoms of ear canal discharge and ear pain were significantly relieved and his hearing slightly improved, while he strengthened his exercise and avoided catching cold to reduce the frequency of otitis media attacks. In summary, the patient was treated at home for a total of 2 weeks, and his condition is now under control and his symptoms have improved significantly.
IV. Notes
We are glad that the patient’s symptoms have improved after active treatment. Chronic otitis media is very common in clinical practice, and most patients consider themselves to have this disease as common and do not pay enough attention to it. In fact, recurrent episodes of chronic otitis media can lead to intracranial and extracranial complications, so after the patient’s symptoms are controlled, tympanic membrane repair is recommended to improve the patient’s hearing and reduce the number of inflammatory episodes. During treatment, patients need to maintain a positive attitude, rest properly, avoid strenuous activities, and eat a reasonable diet. If the symptoms of abscess worsens, or if fever, headache, dizziness and other related symptoms appear, it is important to follow up with a doctor in a timely manner.
V. Personal insight
If you encounter a patient with recurrent pus in the external ear canal in the clinic, you should first be alert to the presence of any related complications. Chronic otitis media may be complicated by adhesive otitis media, tympanosclerosis, middle ear cholesterol granuloma, occult otitis media, and so on.
For patients with chronic otitis media, the first thing to do in daily life is to build up confidence in overcoming the disease, actively exercise, avoid catching a cold, pay attention to hygiene, prevent sewage from entering the ear when bathing, and swim carefully. In addition, it should be noted that this disease is prone to recurrence, so you should seek medical attention promptly after the appearance of the above-mentioned symptoms to achieve early diagnosis and early treatment.