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CASE PRESENTATION ON CHRONIC SUPPURATIVE OTITIS MEDIA
- 1. CASE PRESENTATION ON CHRONIC SUPPURATIVE OTITIS MEDIA Presented by Makbul Hussain Chowdhury Pharm.D 5th year H.T. No.: 15Z11Tooo6
- 2. Definition : It is a chronic inflammation of the middle ear and the mastoid cavity. Etiology & risk factors : Pseudomonas aeurignosa. Living in crowded conditions. multiple episodes of AOM. passive smoking, genetic disorders. being a member of large family.
- 3. PATHOPYSIOLOGY: Breakdown of skin cerumen Inflammation and edema of the skin leads to pruritus and obstruction. The sequence of events alters the quality and amount cerumen produced ,impairs epithelial migration , increases the Ph of ear canal The resulting dark, warm, alkaline, moist ear canal becomes an ideal breeding ground for numerous organisms
- 4. Signs and symptoms Draining ear Fever Vertigo Loss of hearing External auditory canal – Oedematous Middle ear mucosa –oedematous/ polypoid/ erythematous Granular tissue is often seen
- 5. CASE STUDY PATIENT’S Demographics Name: XXX Age: 36years SEX: Male IP No.: 190648957
- 6. SOAP FORMAT SUBJECTIVE EVIDENCE: A 36 years male patient was admitted in the hospital with chief complaints of decrease in hearing of both ears. He is not having any ear discharge , heaviness , headache and fever. He undergone surgery for Hydrocele 10 years back. He is not having any family history and social history. He doesn’t have any drug allergies.
- 7. SOAP FORMAT OBJECTIVE EVIDENCE: Physical examinations : Temp : 98.6º F Pulse rate : 72/min Respiratory rate : 16/min B.P : 120/80 mm of Hg Systemic examinations : CVS : S1S2+ CNS : normal Abdomen : Bowel sounds - yes
- 8. SOAP FORMAT BIOCHEMICAL LABARATORYINVESTIGATIONS: S. No PARAMETER OBSERVED VALUE NORMALVALUE 1 Monocytes 1.0 2.0 – 10.0% 2 Neutrophils 53 % 40.0 – 75.0 % 3 Lymphocytes 40% 20 – 45 % 4 Eosinophils 2.0% 0.0 – 7. 0% 5 Haemoglobin 15.5mg/dl 14 – 17.5 mg/dl 6 T. WBC 15000cumm 4000-11000cumm 7 S. Cretinine 1.1mg/dl 0.6-1.2mg/dl
- 9. SOAP FORMAT ASSESMENT: Based on the subjective and objective evidences it is assess that the patient is suffering from the CSOM (chronic suppurative otitis media )
- 10. SOAP FORMAT PLAN: GOALS: To prevent signs & symptoms by sympthamatic therapy. To avoid the further complications. To decrease the disease progression. STANDARD TREATMENT: Myringotomy (Surgical incision of the ear drum). By taking antibiotics (Topical quinolones).
- 11. CURRENT DRUG CHART S.NO BRAND NAME GENERIC NAME DOSE R.O.A FREQ 1 Pantocid Pantoprazole 40 mg P/O OD 2 Augmentin Amoxicillin & Clavulante 625 mg P/O TID 3 Levorid Levocetrizine & pseudoephedrine 5 mg P/O OD 4 Voltaren Diclofenac 50 mg P/O TID
- 12. DRUG INFORMATION S.NO Name of drug Category M.O.A Side effect 1 Pantoprazole Proton pump inhibitor Suppress gastric acid secretion Headache, edema, vertigo, Utricaria 2 Augmentin cephalosporin Clavulanic binds & inhibits beta lactase;inactivate amoxicillin Diarrhoea, skin rash, loose stools, Nausea 3 Levocitrizine Antihistamine Active isomer of cetirizine, selectively Inhibits histamine h1 receptor Sleepiness, headache, diarrhoea, dry mouth, Vomiting 4 Diclofenac Analgesic Inhibits cox1, cox-2. Heart failure, hepato & renal toxicity
- 13. PATIENT COUNCELLING ABOUT DISEASE : Chronic Suppurative Otitis Media is a chronic inflammation of the middle ear and the mastoid cavity. It is caused due to bacteria like Pseudomonas aeruginosa, Staphylococcus aureus etc. Due to multiple episodes of Acute Otitis Media, living in crowded conditions Chronic Suppurative Otitis Media occurs.
- 14. PATIENT COUNCELLING ABOUT THE DRUGS: Augmentin : Do not crush or chew , take before meals Levocitrizine : Consumed usually in evening Avoid drinking alcohol Pantoprazole : Due to EDTA in preparation, zinc supplementation may be needed in patients prone to zinc deficiency Diclofenac : Avoid with milk
- 15. PATIENT COUNCELLING LIFE STYLE MODIFICATIONS Shake your ears dry after swimming. Blow dry your ears on a low setting , holding the dryer 12 inches away. Use ear drops to prevent the infections. Don’t put anything smaller than your elbow in your ear. The ear should be protected from water during recovery from the external otitis.
- 16. PATIENT COUNCELLING LIFE STYLE MODIFICATIONS Hearing aids & ear phones should not be worn until the pain & discharge have subsided. Patient should be told that ear canal is self cleaning & that fingers, towels & cotton swab should not be inserted into the ears. The patient should not swim.