Patient details :

Ms. Devika Dilkushi 32 yrs./F

Chief complaints :

- Both ear foul smelling discharge on and off since > 3 months.
- Decreased hearing both ears since 3 months.
- Occasional dizziness and headache.

Relevant history:

- There is no h/o trauma, ear surgery or previous such afflictions.

- There are no comorbidities.
- There is no h/o ear pain, fever, headache or tinnitus .

Examination & Investigations :

- Left ear : Dull opaque TM with granulation around attic area and foul smelling scanty discharge.
- Right ear : Impacted cerumen in attic area was removed to show scutum erosion .
- Rest of ENT examination was within normal limits.
- Hearing acuity as tested by tuning forks is within normal limits.
- CT B/L Temporal bones reported B/L cholesteatoma with possible ossicular erosion on both sides.
Incidental note of b/l maxillary and ethmoidal sinusitis was also made.

Provisional Diagnosis :

- B/L CSOM with ? Atticoantral disease

Further Investigations / Procedure:

Audiometry should be obtained to establish hearing level.
Given the clinical and CT findings, the patient is advised to undergo surgery of both ears. Decision on
which ear to operate first can be made after assessment of hearing and further consultations.