Dear Swati,
It is the Right Ear.That is the answer to first question.I would like to believe that the condition is NOT ACUTE SUPPURATIVE OTITIS MEDIA but it is SECRETORY OTITIS MEDIA.Patient named CB presented with c/o blocking sensation in the ear following cold.PAIN as we always claim, is conspicous but its absence.The TM as per my clinical experience is not bulging,congested but retracted....Subtle indicators of the same are 1) A Prominent LATERAL PROCESS OF MALLEUS; 2)The UMBO is not exactly in the center but it is foreshortened; 3)The CONE OF LIGHT is not reaching upto the Annulus; 4) The General Appearance of the TM is dull.....All these points go in favour of SOM.....Can be confirmed by checking the mobility of the TM (Valsulva or Siegelisation).
In Absence of any sign of infection in the focal region/s,my treatment would essentially include Decongestant,decongestant Nasal Drops and rarely oral Steroids (if not contraindicated).
sir,
ReplyDeletein the absence of history,based on only observation of the tympanic membrane,how do we differentiate between SOM(with a retracted TM)
and a retracted TM without SOM(for example in eustachian tube blockage without associated SOM). are air bubbles on valsalva seen even if the eustachian tube is blocked(as eustachian blockage is seen is SOM)? if yes,how does the air from the nasopharynx reach there to give air bubbles?wont valsalva be futile in eustachain tube blockage?