Case 1 Ear

Case 1: A 10 year old child was having a right mucopurulent otorhea for the last 4 years. A week ago he became dizzy with a whirling sensation, nausea, vomiting and nystagmus to the opposite side; his deafness became complete and his temperature was normal. Three days later he became feverish, irritable and continuously crying apparently from severe headache. Also he had some neck retraction. The child was not managed properly and died by the end of the week.

CASE 1
Diagnosis & reasons	Right chronic suppurative otitis media (mucopurulent otorhea of 4 years duration) complicated by suppurative labyrinthitis (dizziness, nausea and vomiting with nystagmus to the opposite side and complete loss of hearing) and then complicated by meningitis (fever, severe headache and neck retraction).
Explain the following manifestations	Whirling sensation: vertigo due to inner ear inflammation Nystagmus to the opposite side: suppurative labyrinthitis leading to fast phase of eye movement to the opposite ear and slow phase to the diseased ear nystagmus direction is called according to the fast phase. In serous labyrinthitis with no inner ear cell destruction the direction of nystagmus is toward the diseased ear. Severe headache: increased intracranial pressure due to meningitis Neck retraction: due to meningeal inflammation
Further examination &/or investigations	Otologic examination possible finding of a marginal perforation of atticoantral CSOM (cholesteatoma) Audiogram to reveal SNHL in the affected ear Kernig's and Brudzinski's signs Fundus examination to show papilledema Lumbar puncture: turbid high pressure CSF with pus rich in proteins Complete blood picture
Treatment	Antibiotics that cross the blood brain barrier Analgesics Repeated lumbar puncture to drain infected CSF and to relieve symptoms and to inject antibiotics Treaetment of the underlying otitis media appropriately according to its type