1. Symptoms
   1. Cholesteatoma
      1. erosion of the scutum & apidermization of attic mesotympanium
   2. Aural Polyp
      1. Dfn
      2. Causes
      3. S & S
      4. Examination
      5. Treatment
   3. discharge culture
      1. Maroxella Catarrhalis
   4. Rinners test positive on right
   5. Weber's test lateralizing to the left side
   6. Audiometry 80 dB conductive hearing loss in Lt ear and 40 dB loss in Rt ear
2. Assessment
   1. Chronic Suppurative Otitis Media
      1. Definition
      2. Pathophysiology
      3. Microbiology
         1. Pseudomonas aeruginosa
         2. Staphylococcus aureus
         3. Proteusspecies
         4. Klebsiella pneumoniae
         5. Diphtheroids
      4. S & S
      5. Management
         1. Pharmacological
            1. aminoglycosides
            2. flouroquinolones
         2. Surgical
            1. myringoplasty
      6. Complications
         1. Intratemporal
         2. Intracranial
         3. Sequelae
      7. Prognosis
   2. Cholesteatoma
      1. Types
         1. Congenital
         2. Acquired
            1. Primary
            2. Secondary
      2. Clinical Manifestations
         1. Painless otorrhea
         2. Refractory/recurrent ear infections
         3. Conductive hearing loss
      3. Diagnosis
         1. History
         2. P/E
            1. Auditory function
            2. Rinne test
            3. Webber test
            4. Audiometric tests
            5. Vestibular function
         3. Otoscope
         4. Audiogram
         5. X-ray
         6. CT scan of the temporal bone
      4. Treatment
         1. Pharmacological
            1. Ofloxacin (topical)
            2. Steroids
         2. Surgical (first option)
            1. Mastoidectomy
      5. Complications
         1. Vertigo and tinnitus .
         2. Labyrinthine fistula .
         3. Sensorineural and deafness
         4. Facial nerve paralysis
         5. CNS infections
         6. Brain herniation/CSF leak
3. Plan
   1. Diagnosis
      1. History taking
      2. Physical examination
      3. Investigations
   2. Treatment
      1. Non-pharmacological
      2. pharmacological
         1. Gentamycin ear drops and oral Amoxycillin
      3. Surgical
         1. Mastoidectomy for the Cholesteatoma
4. Signs
   1. Purulent otorrhea associated with earache
   2. tinnitus
      1. DDx
   3. vertigo
      1. DDx
   4. nausea and vomitting
   5. Diminished hearing of 5 years duration
   6. otorrhoea
      1. causes
         1. Otitis media
         2. Otitis externa
         3. An impediment in the ear canal
         4. Brain injury/trauma
   7. Earache
      1. causes
         1. Otitis externa
         2. infected hair follicle in the ear canal
         3. Eczema
         4. Blockages of earwax
         5. Throat infections
         6. Jaw pain
         7. Trigeminal neuralgia or facial nerve pain
   8. following episodes of common cold
5. Demographics
   1. Ahmed, a 13 yrs old boy living in Sharjah
   2. History
      1. Myringotomy
         1. procedure: incision is created in the eardrum to drain pus from the middle ear