Otorrhea

A 30 years old patient with chief complaint of alternate otorrhea from the left ear since 10 years old,
especially when patient had runny nose and cough. There are yellowish thick discharge sometimes with
blood with foul odor. There are also complaint of hearing loss and fullness sensation of the ear. Patient
went to primary health care for his previos complaints and getting better after the medication given. The
patient had symptoms of unsteady and dizziness. Physical examination found: good general condition,
counsciouss, vital sign within normal limit. Otoscopy of the left ear found yellowish thick discharge with
foul odor, there are easily bleeding granulation tissue, tympanic membrane cnnot be evaluated.
Otoscopy of the right ear found wide ear canal, intact tympanic membrane, no discharge. Weber test
found lateralization to the left, Rinne found negative on the left ear and positive on the right ear.
Balance test: Gaze test within normal limit, Head Impulse found lack of control on the left eye, Romberg
test and Sharp Romberg test found sway, stepping test deviation to the left

Difficult words:
Webber test, otoscopy, lateralization, balance test

Problem:
1. Otorrhea
2. Hearing loss
3. Unsteady
4. Dizziness
5. Fullness sensation of the ear
6. Laterarilazation on Weber test

Hypotesis:
The patient had chronic ear infecton with hearing and balance disturbance

Topics:
1. Anatomy and Histology normal hearing system
2. Physiology of normal hearing (from outer ear to auditory cortex)
3. Anatomy and Histology of normal balance system
4. Physiology of normal balance system (from vestibular organ to vestibular centre)
5. To know the form of hearing disturbance
6. To know the form of balance disturbance
7. To know the pathophysiology of chronic middle ear infection
8. To know the complications of chronic middle ear infection
9. To know the correlation of hearing and balance disturbance
10. To know the predisposition factor of middle ear infection
11. Understanding general hearing examination
12. Understanding general balance examination
13. Able to make early diagnosis of middle ear infection
14. Able to treat middle ear infection
 Upper airway obstruction

Eustachian tube occlusion

Hyperemic phase

Secretory phase

Perforation phase

Infection continued Resolution phase

Otorrhea Complete resolution

Hearing disturbance (conductive)

Additional examination

Balance disturbance (labyrhintitis)

Treatment