Patient Overview

Patient Overview

Ear Disorders (Otitis Media, Hearing Loss) Treated by Prof. Dr. Ashequr Rahman Bhuiyan

Patient Profile:

• Name: Mr. X (pseudonym)
• Age: 35
• Gender: Male
• Medical History: No significant past medical history, non-smoker, no known allergies.

Presentation:

• The patient presented with ear pain in the right ear for the last 3 days, accompanied by reduced hearing in the same ear.
• He also reported a sensation of fullness and pressure in the ear, along with mild fever and a clear discharge from the ear.
• The patient mentioned a history of recurrent ear infections since childhood but did not seek medical care regularly.

Clinical Examination & Diagnostics:

• Physical Examination:
  • The patient appeared in moderate discomfort with complaints of ear pain.
  • On otoscopic examination, there was redness and swelling of the tympanic membrane with visible fluid behind the ear drum, indicative of otitis media.
  • The ear canal was free of any major obstructions.
• Investigations:
  • Tuning fork tests (Rinne and Weber tests) revealed a conductive hearing loss in the right ear.
  • Impedance audiometry confirmed the presence of middle ear effusion, suggesting acute otitis media.
  • Pure tone audiometry revealed a mild-to-moderate conductive hearing loss in the affected ear.

Diagnosis:

• Acute Otitis Media (AOM) with middle ear effusion.
• Conductive Hearing Loss secondary to otitis media.

Treatment Plan:

1. Medical Management:

   • The patient was started on oral antibiotics (Amoxicillin) to address the bacterial infection causing the otitis media.
   • Nasal decongestants and analgesics were prescribed to alleviate congestion and reduce ear pain.
   • Warm compresses were recommended for ear pain relief.
   • Ear drops (anti-inflammatory and antimicrobial) were advised to reduce inflammation and control any potential secondary infection.

2. Surgical Intervention:

   • If medical treatment failed to resolve the infection and fluid buildup, a myringotomy (small incision in the eardrum) might be performed to drain the fluid and relieve pressure.
   • The patient was advised that if the hearing loss persisted or worsened, a procedure to place a ventilation tube (grommet) in the eardrum might be necessary to allow airflow and prevent further fluid buildup.

3. Hearing Rehabilitation:

   • The patient was advised to follow up for audiometric evaluations to monitor any permanent hearing loss and to assess recovery.
   • If hearing loss did not improve after treatment, the use of hearing aids could be considered.

4. Follow-up and Rehabilitation:

   • The patient was scheduled for a follow-up visit to assess the resolution of the ear infection and hearing improvement.
   • Hearing tests would be performed regularly to monitor any changes in auditory function.
   • The patient was educated on preventing recurrent ear infections by avoiding water entry into the ear, especially while swimming, and seeking medical advice early if symptoms recur.

Outcome:

• After 10 days of antibiotic therapy, the patient reported significant reduction in pain, and the discharge from the ear stopped. The hearing improved, and he no longer experienced the feeling of fullness in the ear.
• A follow-up audiometry test showed a normal hearing level after the infection was resolved.
• The patient was advised to continue with the prevention strategies to avoid future ear infections and was given a scheduled appointment for a routine check-up in 6 months.

Conclusion: Prof. Dr. Ashequr Rahman Bhuiyan’s treatment of acute otitis media with middle ear effusion and conductive hearing loss was successful through a combination of medical management and close monitoring. His expertise in managing ear infections and hearing loss helped the patient achieve complete recovery with no long-term hearing impairment. The patient was able to return to his normal activities with restored hearing, demonstrating the effectiveness of timely intervention and proper treatment strategies.