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1.How to differentiate between an erdrum perforation from a retraction poccket?

Firstly, check whether you can see middle ear mucosa.  It will appear glistening and mucoid; usually pinkish if uninfected as seen through the perforation.

Secondly, look at the margin.  An eardrum perforation has sharp cut-off edge while a retraction looks like sunken lesion and the edge appears less sharp or sloping.

2.How to test the tympanic membrane mobility?

The eardrum is not visibly mobile in normal patient.  However,  it but can be so in a condition called patulous eustachian tube (PET).  Clinically, eardrum mobility is tested by asking the patient to blow the nose forcibly with his mouth close (outward movement- positive pressure) and by swallowing few times (inward movement- negative pressure). By performing siegelisation, a small amount of air is forced into the ear canal by squeezing an air-filled rubber ball connected to a tight fit ear speculum (inflating- positive pressure- inward movement; deflation- negative pressure- outward movement). Visualization of the eadrum is made possibe by viewing through the eyepiece of an attached otoscope or by using a specially designed otoendoscope accessory. 

3.What advice to be given to patient with CSOM?

Patient has to protect the ear from water or contaminants getting into the middle ear cavity.

They have to wear a tight-fit ear plug while taking shower.  The simplest is by using cotton ball and after in has nicely pack the introitus and conchal bowl, the outer surface is evenly coated with vaseline or olive oil. Patient can wear hair cap as well on top of the ear plug.  Commercial ear plug is available e.g., mouldable silicone which can be cleaned and re-use.

Water sports should be avoided especially swimming and diving.

Clear mucousy otorrhea may accompany upper respiratory tract infection.  Antibiotic is not necessary, unless secondarily infected as evidence by mucopus.

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