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35.

Lazaro, Fernando 62/M Lazaro, Fernando 62/M

 This is the case of F.L. a

 This is the case of F.L. a 62 year old male wh62 year old male who sought consult for dizzino sought consult for dizziness. Afteress. After examination and tests were done, patient was

examination and tests were done, patient was diagnosed withdiagnosed with Mixed Hearing LossMixed Hearing Loss. Patient. Patient was prescribed with Polynerv

was prescribed with Polynerve 1 tablet OD e 1 tablet OD x 2 weeks and was advised to x 2 weeks and was advised to follow-up. In mixedfollow-up. In mixed hearing loss, there is a

hearing loss, there is a combination of Conductive Hearing Loss and combination of Conductive Hearing Loss and SensorineurSensorineural Hearingal Hearing Loss. There is greater air

Loss. There is greater air conduction loss compared with bone conduction loss compared with bone conduction indicatingconduction indicating impaired sound conduction. There is

impaired sound conduction. There is an increased threshold of bone conduction.an increased threshold of bone conduction.

In Sensory Hearing Loss, the pathology may involve the inner and outer

In Sensory Hearing Loss, the pathology may involve the inner and outer hair cells of hair cells of  the Cochlea, hence the transmitted sound waves does not stimulate those structures. HL is the Cochlea, hence the transmitted sound waves does not stimulate those structures. HL is usually seve

usually severe to profound and more so in high frre to profound and more so in high frequency sounds (4,00equency sounds (4,000-8,000 kHz). 0-8,000 kHz). TheThe clarity of speech sound is usually distorted. The hearing is worse in the presence of 

clarity of speech sound is usually distorted. The hearing is worse in the presence of  background noise hence understanding speech is impaired. Etiology may

background noise hence understanding speech is impaired. Etiology may include congenitalinclude congenital aplasias of the

aplasias of the cochlea, presbyacusicochlea, presbyacusis, perilymph fistula, noise-induced, infection s, perilymph fistula, noise-induced, infection or ototoxicor ototoxic drugs such

drugs such as quinine, aminoglycosides or aspirin or as quinine, aminoglycosides or aspirin or Meniere’s disease. In NMeniere’s disease. In Neural Hearingeural Hearing loss, the pathology is in the

loss, the pathology is in the spiral ganglion and CN VIII. There is impaired nerve impulsespiral ganglion and CN VIII. There is impaired nerve impulse transmiss

transmission even if ion even if the cochlea is stimulated. There is the cochlea is stimulated. There is poorer speech discrimination aspoorer speech discrimination as compared with sensory hearing loss. It

compared with sensory hearing loss. It is associated with very severe hearing loss andis associated with very severe hearing loss and tinnitus. The etiology may be

tinnitus. The etiology may be an acoustic neuroma or an acoustic neuroma or vestibular schwannvestibular schwannoma.oma.

In CHL, the

In CHL, the pathology lies in the pathology lies in the external ear canal, ear drum (tympanic membrane),external ear canal, ear drum (tympanic membrane), ossicles or middle ear. Because of the pathology, impaired conduction of sound occur;

ossicles or middle ear. Because of the pathology, impaired conduction of sound occur;

hence, there is decreased intensity of sound

hence, there is decreased intensity of sound reaching the cochlea. Unlike SNHL, there is reaching the cochlea. Unlike SNHL, there is nono distortion of sound

distortion of sound hence understanding speech is no problem hence understanding speech is no problem with adequate intensity.with adequate intensity.

Persons with CHL tends to speak softly because they hear the speech louder (bone>air Persons with CHL tends to speak softly because they hear the speech louder (bone>air conduction), hence they lower their voices

conduction), hence they lower their voices since they perceive that they since they perceive that they are speaking loudly.are speaking loudly.

Hearing loss is mild to moderate around 30-40 dB. The

Hearing loss is mild to moderate around 30-40 dB. The most common etiology is Impactedmost common etiology is Impacted cerumen and other foreign bodies.

cerumen and other foreign bodies. Other possible etiology include: ear canal atresia, otitisOther possible etiology include: ear canal atresia, otitis externa/medi

externa/media, otosclerosis, ear canal a, otosclerosis, ear canal tumors, and myringitis. Diagnosis of tumors, and myringitis. Diagnosis of CHL includesCHL includes otoscopic findings of the ear canal and ear drum; Weber’s test that lateralizes to the otoscopic findings of the ear canal and ear drum; Weber’s test that lateralizes to the affected ear; a negative Rinne test

affected ear; a negative Rinne test (bone>air conduction); a higher air conduction (bone>air conduction); a higher air conduction thresholdthreshold on PTA. Treatment is directed at the specific etiology. For instance, in cases of impacted on PTA. Treatment is directed at the specific etiology. For instance, in cases of impacted cerumen, the cerumen is flushed out; or in AOM, the

cerumen, the cerumen is flushed out; or in AOM, the infection is relieved by antimicrobialinfection is relieved by antimicrobial agents.

agents.

36. Abulon, Leonard 36. Abulon, Leonard

 This is the case of

 This is the case of L.A., a 2 year old male L.A., a 2 year old male who sought for ear pain and who sought for ear pain and itchiness. Afteritchiness. After examination and tests were done, patient was

examination and tests were done, patient was diagnosed withdiagnosed with retained cerumen on leftretained cerumen on left ear

ear. . Aural flushing was done and patiAural flushing was done and patient was advised to follow-up anytime if with problement was advised to follow-up anytime if with problems.s.

Cerumen is produ

Cerumen is produced in the ear canal bced in the ear canal by sebaceous and cey sebaceous and cerumen glands. rumen glands. AA

protective film is formed consisting of lysozymes, fatty acids, acid milleu which protects the protective film is formed consisting of lysozymes, fatty acids, acid milleu which protects the skin from various infections. The

skin from various infections. The ear canal is also cleansed via epithelial migration from ear canal is also cleansed via epithelial migration from thethe tympanic membrane towards the external meatus which effectively removes the cerumen.

tympanic membrane towards the external meatus which effectively removes the cerumen.

Disturbance of this normal self-cleansing mechanism or excessive cerumen secretion may Disturbance of this normal self-cleansing mechanism or excessive cerumen secretion may cause impacted cerumen. It is usually

cause impacted cerumen. It is usually precipitateprecipitated by d by excessive cleaninexcessive cleaning of g of the ears withthe ears with cotton-tipped swabs. A cerumen plug may

cotton-tipped swabs. A cerumen plug may be formed which be formed which further hinders normal expulsionfurther hinders normal expulsion of the cerumen. Impaction may occur especially when there is contact with water. Drying of  of the cerumen. Impaction may occur especially when there is contact with water. Drying of  the meatal skin and

the meatal skin and decrease in secretions may cause hardening of the decrease in secretions may cause hardening of the cerumen whichcerumen which causes retention especially in narrow

causes retention especially in narrow ear canals.ear canals.

Although impacted cerumen may cause vertigo and

Although impacted cerumen may cause vertigo and tinnitus, ear pressure symptomstinnitus, ear pressure symptoms such as ear fullness and

such as ear fullness and hearing difficulty in the hearing difficulty in the affected ear are the usual encounteredaffected ear are the usual encountered symptoms. It is

symptoms. It is mainly diagnosed by visualization through an otoscope mainly diagnosed by visualization through an otoscope wherein a yellowish,wherein a yellowish, brownish to blackish material is observed to

brownish to blackish material is observed to obstruct the ear canal. Impacted cerumen alsoobstruct the ear canal. Impacted cerumen also sometimes lead to otitis externa. It may be removed via a

sometimes lead to otitis externa. It may be removed via a small instrument such as a hooksmall instrument such as a hook or curette or be flushed away by

or curette or be flushed away by aural cleaning with irrigaaural cleaning with irrigation jet or tion jet or a syringe.a syringe.

37. Alano, Alpha Grace 23/F 37. Alano, Alpha Grace 23/F

 This is the case of

 This is the case of A.A., a 23 year old female who A.A., a 23 year old female who sought for decrease hearing on leftsought for decrease hearing on left ear. After examination and tests were done,

ear. After examination and tests were done, patient was diagnosed withpatient was diagnosed with chronicchronic tympanomastoiditis left ear

tympanomastoiditis left ear. . Patient was sPatient was status post radicatatus post radical mastoidectomy, of rigl mastoidectomy, of right earht ear (2001) and grafted right

(2001) and grafted right tympanic membrane. Patient was prescribed with Ciprofloxacin +tympanic membrane. Patient was prescribed with Ciprofloxacin + Dexamethas

Dexamethasone otic drops 2-3 one otic drops 2-3 drops on both ears three times a drops on both ears three times a day for 7 day for 7 days. Also, patientdays. Also, patient was advised to come back on Monday

was advised to come back on Monday for CP clearance. Mastoiditfor CP clearance. Mastoiditis is the is is the inflammatiinflammation of on of  the air cells in

the air cells in the mastoid process involving the the mastoid process involving the mucus membrane. It usually originatesmucus membrane. It usually originates from an infection of the

from an infection of the middle ear and is actually the most common complication of middle ear and is actually the most common complication of otitisotitis media. Pathogenetic factors include degree of

media. Pathogenetic factors include degree of mastoid pneumatisation, infecting organism’smastoid pneumatisation, infecting organism’s virulence, host’s immune system and treatment for

virulence, host’s immune system and treatment for otitis media especially if antibioticotitis media especially if antibiotic treatment is inadequate. Wegener’s disease can also cause mastoiditis as well as infections treatment is inadequate. Wegener’s disease can also cause mastoiditis as well as infections and abscess formation. Local pain and

and abscess formation. Local pain and fever are the most fever are the most frequent complaints. A prominentfrequent complaints. A prominent auricle with retroauricular swelling, mastoid tenderness and otorrhea compose

auricle with retroauricular swelling, mastoid tenderness and otorrhea compose the classicthe classic clinical triad of mastoiditis. The triad may not always be present hence mastoiditis should be clinical triad of mastoiditis. The triad may not always be present hence mastoiditis should be investigated in opatients treated for otitis media who fails to improve or worsens in 2-3

investigated in opatients treated for otitis media who fails to improve or worsens in 2-3 weeks. Complications include epidural abscess, brain abscess, meningitis, subdural abscess, weeks. Complications include epidural abscess, brain abscess, meningitis, subdural abscess, thrombophlebitis

thrombophlebitis, bezoid abscess in , bezoid abscess in the SCM, and the SCM, and subperiosteasubperiosteal abscess. Definitivel abscess. Definitive treatment includes mastoidectomy, with IV antibiotics. In early stages of

treatment includes mastoidectomy, with IV antibiotics. In early stages of mastoidectomy, IVmastoidectomy, IV antibiotics and inpatient assessment may

antibiotics and inpatient assessment may suffice.suffice.

38. Lacasa, Danica Fe 6/F 38. Lacasa, Danica Fe 6/F

 This is the ca

 This is the case of D.L. a se of D.L. a 6 year old f6 year old female emale who came in who came in for ear pafor ear pain. Patient win. Patient wasas diagnosed with

diagnosed with diffuse otitis externa right eardiffuse otitis externa right ear. Aural cleaning was done. Patient . Aural cleaning was done. Patient waswas advised to continue Cloxacillin 200 mg/5ml and for daily cleaning of ear.

advised to continue Cloxacillin 200 mg/5ml and for daily cleaning of ear.

Diffuse Otitis Externa is an acute bacterial infection of the ear canal skin with a mixed Diffuse Otitis Externa is an acute bacterial infection of the ear canal skin with a mixed flora of gram

flora of gram negative organisms and anaerobes. It is usually precipitated by annegative organisms and anaerobes. It is usually precipitated by an

inflammatory condition of the EAC

inflammatory condition of the EAC such as eczema, allergies, dermatitis etc. The Tympanicsuch as eczema, allergies, dermatitis etc. The Tympanic membrane is also usually involved and its development is promoted by a warm, moist membrane is also usually involved and its development is promoted by a warm, moist environment. Itching is the primary symptom. Pain

environment. Itching is the primary symptom. Pain is also observed as well is also observed as well as crusting,as crusting, purulent discharge and obstruction which may lead to

purulent discharge and obstruction which may lead to conductive hearing loss.conductive hearing loss.

Complications include perichondritis

Complications include perichondritis, cellulitis, abscess formation , cellulitis, abscess formation or necrotizing otitisor necrotizing otitis externa in predisposed patients. Treatment includes

externa in predisposed patients. Treatment includes meticulous aural cleaning and hygienemeticulous aural cleaning and hygiene while keeping the ear dry. Antibiotics with steroids as otic drops may be given for

while keeping the ear dry. Antibiotics with steroids as otic drops may be given for not morenot more than 2 weeks.

than 2 weeks.

39. Fabros, Elmar M. 3/M 39. Fabros, Elmar M. 3/M

 This is the case of E.F a 3 y

 This is the case of E.F a 3 year old male ear old male who came for mass on the R poswho came for mass on the R post auriculart auricular area. Patient was diagnosed with

area. Patient was diagnosed with impacted cerumenimpacted cerumen. Aural flushing was done on the . Aural flushing was done on the rightright ear, mineral oil of 2-3 drops QID was prescribed for the left ear and patient was advised to ear, mineral oil of 2-3 drops QID was prescribed for the left ear and patient was advised to follow up on Saturday.

follow up on Saturday.

Cerumen is the result of mixing skins cells of

Cerumen is the result of mixing skins cells of the outer ear canal with glandularthe outer ear canal with glandular secretions that protect the ear against infections by cleaning and trapping dirt in the ear secretions that protect the ear against infections by cleaning and trapping dirt in the ear canal. The amount of

canal. The amount of ear wax produced varies by ear wax produced varies by individual. Some individuals produce veryindividual. Some individuals produce very little wax; others overproduce ear wax to the point that blockage may occur. Cerumen little wax; others overproduce ear wax to the point that blockage may occur. Cerumen normally works itself out of the ear; however, there are situations when ear was begins to normally works itself out of the ear; however, there are situations when ear was begins to plug up the outer ear

plug up the outer ear canal. When ear wax blocks the ear canal so that it begins to canal. When ear wax blocks the ear canal so that it begins to causecause problems, it results in impacted ear wax, or cerumen impaction. Impacted ear wax is a problems, it results in impacted ear wax, or cerumen impaction. Impacted ear wax is a common phenomenon. It is most

common phenomenon. It is most likely caused when an individual cleanlikely caused when an individual cleans the outer ear withs the outer ear with a cotton-tipped applicator, which ends up pushing the wax down so

a cotton-tipped applicator, which ends up pushing the wax down so much that it plugs themuch that it plugs the outer ear canal. This condition is also prevalent among the population who wear hearing outer ear canal. This condition is also prevalent among the population who wear hearing aids. Individual

aids. Individuals who have impacted ear wax often s who have impacted ear wax often complain about hearing loss, pain in thecomplain about hearing loss, pain in the ear, tinnitus, cough, vertigo, or itching of the ear. Cerumen accumulation can occur if there ear, tinnitus, cough, vertigo, or itching of the ear. Cerumen accumulation can occur if there is an overproduction of ear wax in response to

is an overproduction of ear wax in response to infections or loud noises. An individual withinfections or loud noises. An individual with an abnormally shaped ear canal may also encounter ear wax build-up. It may be removed by an abnormally shaped ear canal may also encounter ear wax build-up. It may be removed by flushing after softening the ear

flushing after softening the ear wax with oil-based agents such as wax with oil-based agents such as mineral oil. Docusatemineral oil. Docusate sodium may also be used to

sodium may also be used to soften the impacted cerumen prior to flushing.soften the impacted cerumen prior to flushing.

40. Ynot, Andrew Emerson 40. Ynot, Andrew Emerson

 This is the case of

 This is the case of A.Y. who came in due to eaA.Y. who came in due to ear pain on both ears. Par pain on both ears. Patient wastient was diagnosed with

diagnosed with Acute Otitis MediaAcute Otitis Media on both earson both ears. Patient was prescribed with Amoxicillin. Patient was prescribed with Amoxicillin 250/5ml to 6.5 ml

250/5ml to 6.5 ml every 8 hours if with pain every 8 hours if with pain and was advised for follow-up after 1 week.and was advised for follow-up after 1 week.

Acute Otitis Media

Acute Otitis Media is an acute infection (<3 weeks) causing inflammation of theis an acute infection (<3 weeks) causing inflammation of the middle ear space It is the second most

middle ear space It is the second most common disease in children (upper respiratorcommon disease in children (upper respiratoryy infection is the most

infection is the most common). Its pathophysiology includes eustachian tube dysfunctioncommon). Its pathophysiology includes eustachian tube dysfunction which results in negative middle ear pressures leading to

which results in negative middle ear pressures leading to transudativtransudative fluid e fluid collection in thecollection in the middle ear space and subsequent infection. Common

middle ear space and subsequent infection. Common pathogens includepathogens include S. pneumoniaeS. pneumoniae (most common),

(most common), H. influenzaH. influenza,, Moraxella (Branhamella) catarrhalis;Moraxella (Branhamella) catarrhalis; gram negative bacilli andgram negative bacilli and Group B

Group B StreptococcusStreptococcus may be found in infants; viral pathogens are often present alonemay be found in infants; viral pathogens are often present alone (sterile otitis media) or

(sterile otitis media) or concurrently with bacterial pathogens.concurrently with bacterial pathogens.

Risk factors that may

Risk factors that may contribute to eustachian tube dysfunction include craniofacialcontribute to eustachian tube dysfunction include craniofacial or skull base abnormalities, recurrent upper respiratory infections, nasal allergy, attendance or skull base abnormalities, recurrent upper respiratory infections, nasal allergy, attendance

Risk factors that may contribute to eustachian tube dysfunction include craniofacialcontribute to eustachian tube dysfunction include craniofacial or skull base abnormalities, recurrent upper respiratory infections, nasal allergy, attendance or skull base abnormalities, recurrent upper respiratory infections, nasal allergy, attendance

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