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Patient would like to have information on the therapy and on the correctness of the therapy/surgery recommendedA male patient, 35 years of age, in good physical health. No known occupational hazards. No known family history. In August 2007, the following diagnosis was made: There are no significant pathologies in the patient’s history, except for recurring otitis, apparently not treated. September 06, CAT scan of petrosal bones: signs of bilateral chronic otomastoiditis characterized by mastoid sclerosis and presence of material of soft tissue density occupying antrum, epi-, meso- and hypo-tympanum. Maintained the ossicular chain; normal structures in the inner ear. August 2007, ENT visit: Diagnosis of bilateral chronic otomastoiditis, deviation of the right septum and chronic catarrhal pharyngolaryngitis; recommended cycles of thermal crenotherapy, mild climate work and avoid any exposure to cold temperatures. October 2007, ENT visit with another specialist: a bilateral catarrhal tubotympanitis caused by tubal dysfunction; recommended a septoplasty and transtympanic drainage. Therapy: Deltacortene forte (Prednisone, TN) 1 cp/day for 8 days, then ½ cp for 4 days; Aircort nasale 100 (Budesonide, TN) 1 puff per nostril/day for 15 days; avoid cold climates. November 2007, CAT scan of petrosal bones: Presence of hypodense tissue occupying bilaterally the entire middle ear; this tissue reaches the aditus ad antrum and spreads inside the mastoid cells. Partial sclerosis of mastoid cells. Pattern suggests chronic otomastoiditis, unchanged compared to the visit of September 06. QUESTIONS: The patient would like to have information on the therapy and on the correctness of the therapy/surgery recommended.
Second medical opinion report
Case history and clinical report: A male patient, 35 years of age, in good physical health. No known occupational hazards. No known family history. In August 2007, the following diagnosis was made: There are no significant pathologies in the patient´s history, except for recurring otitis, apparently not treated. September 06, CAT scan of petrosal bones: signs of bilateral chronic otomastoiditis characterized by mastoid sclerosis and presence of material of soft tissue density occupying antrum, epi-, meso- and hypo-tympanum. Maintained the ossicular chain; normal structures in the inner ear. August 2007, ENT visit: Diagnosis of bilateral chronic otomastoiditis, deviation of the right septum and chronic catarrhal pharyngolaryngitis; recommended cycles of thermal crenotherapy, mild climate work and avoid any exposure to cold temperatures. October 2007, ENT visit with another specialist: a bilateral catarrhal tubotympanitis caused by tubal dysfunction; recommended a septoplasty and transtympanic drainage. Therapy: Deltacortene forte (Prednisone, TN) 1 cp/day for 8 days, then Y2 cp for 4 days; Aircort nasale 100 (Budesonide, TN) 1 puff per nostril/day for 15 days; avoid cold climates. November 2007, CAT scan of petrosal bones: Presence of hypo dense tissue occupying bilaterally the entire middle ear; this tissue reaches the aditus ad antrum and spreads inside the mastoid cells. Partial sclerosis of mastoid cells. Pattern suggests chronic otomastoiditis, unchanged compared to the visit of September 06. QUESTIONS: The patient would like to have information on the therapy and on the correctness of the therapy/surgery recommended. ANSWER: I provide the following opinion based purely on the review of the material provided and detailed above. I have not evaluated the patient and, therefore, this opinion represents suggestions for future treatment that the patient may choose to explore with his treating physician. The initial treatment I would propose considering is the placement of ventilation tubes in both ear drums. Based on the information described above, there may well be persistent fluid in both middle ears that would be alleviated with the placement of ventilation tubes. Other potential treatments should this intervention fail would include tympanomastoidectomy or assessment for allergic disease. If I can be of any further help to the patient, please have the patient contact me through Medical Opinion. Sincerely yours, __________________ Residency Program Director Otology, Neurotology, Skull Base Surgery |
