ENT OSCE sample

 STATION 6 

This patient has a 6-month history of ear discharge. 

INSTRUCTIONS TO CANDIDATE: 

A. Take a focused history. 

B. Examine the ear and present your findings as you proceed. 

C. The examiner will then ask you some questions. 

Sample Marking Scheme

Readings: 

Chronic suppurative otitis media (CSOM) is one of the most common childhood infectious diseases worldwide and is a common cause of hearing impairment in resource-limited settings. It is characterised by chronic drainage from the middle ear associated with tympanic membrane(TM) perforation and usually preceded from an acute otitis media (AOM.)

Clinical Presentation:

1. Ear discharge - chronic purulent middle ear discharge (typically >6 weeks) 

2. Hearing loss - due to TM perforation

3. Cholesteatoma

4. Physical Examination: 

- reveals TM perforation and purulent middle ear drainage, typically minimal to no edema of the external auditory canal. 

- otoscope 

Treatment:

1. Aural toilet along with and ototopical fluoroquinolone for initial therapy (eg, ciprofloxacin, ofloxacin). 

- The goal is to eradicate the infection by making sure the ear is dry hence preventing complications. The best goal would be to have the TM heal and improve their hearing. 

2. Advise strict water precautions (no swimming, prevent water to get into the ear) for prevention and management of recurrent disease

3. Tympanoplasty for patients without cholesteatoma who have recurrent disease despite water precautions, or a persistent tympanic membrane perforation for more than 6 to 12 months after resolution of CSOM.

Reference: 

1. https://pubmed.ncbi.nlm.nih.gov/16198004/

2. https://www.uptodate.com/contents/chronic-suppurative-otitis-media-csom-treatment-complications-and-prevention?search=csom&source=search_result&selectedTitle=1~20&usage_type=default&display_rank=1#H9146042

3.