Infection

Non-otogenic lateral sinus thrombosis: A complication of acute sphenoid sinusitis

August 27, 2014     Jessica M. Somerville, MD; Erik Lyman, MD; Jerome W. Thompson, MD, MBA; Rosemary Stocks, MD, PharmD
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Abstract

The consequences of intracranial spread of sinus infection can be dismal. The subtle presentation of sphenoid sinusitis often leads to a delay in diagnosis. The disease may go unrecognized until complications are severe enough to cause more localizing symptoms. Often infections in the head and neck spread into the cranial cavity, leading to a localized effect. For example, otogenic infections can spread to the mastoid or lateral venous sinus. We report a case of sphenoid sinusitis complicated by lateral and sigmoid venous sinus thrombosis.

Otologic manifestation of Samter triad

July 13, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
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It is important for otolaryngologists to be aware of the mucoid quality of these middle ear effusions, as they tend to be persistent and they do not respond well to myringotomy and tube placement, which usually results in tube obstruction.

Rhinosporidiosis: An unusual presentation

July 13, 2014     Borlingegowda Viswanatha, MS, DLO, PhD
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Abstract

Rhinosporidiosis is a chronic granulomatous disease that primarily affects the mucous membranes of the nose and nasopharynx. It is caused by Rhinosporidium seeberi. Clinically it presents as a reddish, bleeding, polypoid mass with a characteristic strawberry-like appearance on its surface, which is caused by the presence of mature sporangia. In the case described here, a 35-year-old man presented with a 6-month history of a slowly growing polypoid mass in his left nasal cavity. The surface of the mass was smooth, pale, and covered with nasal mucosa. It was attached to the nasal septum. Fine-needle aspiration cytology was suggestive of a parasitic cyst. The mass was excised with the use of local anesthesia. Histopathologic examination of the resected specimen revealed rhinosporidiosis. Prior to this diagnosis, the patient had not exhibited most of the typical clinical features that are suggestive of rhinosporidiosis. In the case of a nasal mass, a diagnosis of rhinosporidiosis is important to establish prior to any surgery because bleeding during and after surgery is usually profuse and can be life-threatening. The site of the excised mass should be cauterized to prevent recurrence.

Invasive primary aspergillosis of the larynx presenting as hoarseness and a chronic nonhealing laryngeal ulcer in an immunocompetent host: A rare entity

July 13, 2014     Mimi Gangopadhyay, MD; Kaushik Majumdar, MD; Arghya Bandyopadhyay, MD; and Anup Ghosh, MS(ENT)
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Abstract

Primary aspergillosis usually affects the paranasal sinuses, orbit, ear, and lower respiratory tract. Laryngeal aspergillosis usually occurs as a result of secondary invasion from the tracheobronchial tree, more commonly in immunocompromised hosts. Primary laryngeal localization of Aspergillus infection is seldom encountered. We report the case of an immunocompetent 42-year-old man who presented with hoarseness and a laryngeal ulcer of fairly long duration. A malignancy was initially suspected clinically, but a laryngoscopic biopsy led to a diagnosis of invasive primary laryngeal aspergillosis. No other focus of aspergillosis was found on x-ray and computed tomography. After identification of Aspergillus niger on culture, inquiries revealed no exposure to steroids, cytotoxic drugs, or irradiation, and workups for malignancy, human immunodeficiency virus infection, tuberculosis, and diabetes were negative. Although isolated laryngeal involvement is rare, aspergillosis may be considered in the differential diagnosis of a chronic nonhealing laryngeal ulcer that is clinically suggestive of a malignancy, even in an immunocompetent host.

Bacteriology and antimicrobial susceptibility of ENT infections in a tropical hospital

June 8, 2014     Yok Kuan Chew, MBBS; Jack Pein Cheong, MBBS; Nambiar Ramesh, MBBS; Mohamad Din Noorafidah, MPath; Sushil Brito-Mutunayagam, MS; Abdullah Khir, MS; Narayanan Prepageran, FRCS
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Abstract

We conducted a retrospective observational study to determine the spectrum and antibiotic sensitivity pattern of organisms isolated in otorhinolaryngologic (ORL) infections. We reviewed the laboratory culture and sensitivity records of 4,909 patients-2,773 males (56.5%) and 2,136 females (43.5%), aged 2 to 90 years (mean: 45.3 ± 12.6)-who had been seen at two government hospitals in Malaysia. Of this group, 4,332 patients had a respiratory tract infection (88.2%), 206 had an ear infection (4.2%), 188 had a deep neck infection (3.8%), and 183 had an oropharyngeal infection (3.7%). The most common isolated organisms were Klebsiella spp, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, methicillin-susceptible S aureus, coagulase-negative S aureus, and Acinetobacter baumannii. We also identified the antimicrobial susceptibility of these organisms. We conclude that since the spectrum of causative pathogens in some infections differs between tropical and nontropical areas of the world, tropical hospitals should not completely adopt the antibiotic guidelines for ORL infections that have been recommended for hospitals in nontropical regions. We hope that our review and analysis of local data will help practitioners in Malaysia develop an appropriate prescribing policy with respect to ORL pathogens and antimicrobial susceptibility. The goal is to reduce the morbidity and mortality associated with these infections.

Condyloma acuminatum of the buccal mucosa

June 8, 2014     Rashmi Jaiswal, PhD; Manoj Pandey, MS; Mridula Shukla, DipNB; Mohan Kumar, MD
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Abstract

Condyloma acuminatum is a human papillomavirus (HPV)-induced disease. It is usually transmitted sexually, and it frequently occurs in the anogenital area. A finding of condyloma acuminatum in the oral cavity is rare. Besides HPV, other risk factors for oral condyloma include chewing betel quid and smoking. We report the case of a 52-year-old man who presented with a 2 x 2-cm verrucous white patch on his buccal mucosa. He was habituated to both betel quid and cigarette smoking. A biopsy of the lesion identified it as a verrucous hyperplasia of the squamous epithelium with HPV-related koilocytic changes. The lesion was excised, and further histopathology identified it as condyloma acuminatum. The patient was disease-free 9 months postoperatively. The possibility of condyloma acuminatum should be considered in the differential diagnosis of an oral white lesion. The most common treatments are surgical excision, cryosurgery, electrocautery, and laser excision. There is no known role for antiviral therapy.

Necrotizing fasciitis of the ear: An unusual case

March 18, 2014     Jessica L. Gullung, MD; Jacob E. Smith, MD; April D. Hendryx, DO; Krishna G. Patel, MD, PhD
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Abstract

We describe a rare case of necrotizing fasciitis of the ear in an otherwise generally healthy 39-year-old man. The ear is rarely involved in this often-fatal disease. The diagnosis was suspected on the basis of clinical examination and confirmed by computed tomography and pathology of a biopsy specimen, which revealed subcutaneous gas formation and dermal infiltration of inflammatory cells, respectively. The patient was promptly treated with surgical debridement, intravenous antibiotics, and hyperbaric oxygen. He recovered well and subsequently underwent otoplastic reconstruction with very satisfactory results. By documenting this case, we aim to heighten awareness of necrotizing fasciitis of the head and neck in an effort to improve survival rates.

Fungal necrotizing fasciitis of the head and neck in 3 patients with uncontrolled diabetes

March 18, 2014     Saravanam Prasanna Kumar, DNB; Arunachalam Ravikumar, MS; Lakshmanan Somu, MS
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Abstract

Necrotizing fasciitis is an uncommon, rapidly progressive soft-tissue infection that is associated with a high incidence of morbidity and mortality. It is usually caused by bacteria and rarely caused by or complicated by a fungus. We report 3 cases of necrotizing fasciitis of the head and neck in patients with uncontrolled diabetes. Fungi were isolated in all 3 cases. In 1 fatal case, the invasive zygomycete Apophysomyces elegans was isolated. Keys to the management of this condition are (1) early isolation of the causative organism by fungal smear and culture, (2) adequate control of diabetes, (3) maintenance of electrolyte balance, and (4) controlled aggressive surgical debridement at an early stage. We emphasize the importance of fungal smears and cultures in the management of this rapidly spreading infection.

Descending necrotizing mediastinitis: A conservative approach

March 18, 2014     Sriram Iyer, MRCP; Joseph Collum, MRCP; Marta Babores, FRCP
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Abstract

Descending necrotizing mediastinitis (DNM) is a now-rare complication of dental and pharyngeal infections. Reports in the literature have emphasized the need for early, aggressive surgical intervention. We present a case of DNM with bilateral empyemas that arose secondary to a perforated pharyngeal abscess. The patient was successfully managed conservatively with intravenous antibiotics and intercostal drainage. We conclude that conservative management with antibiotics and image-guided percutaneous pleural drainage may be initially appropriate for the stable patient.

Recurrent auricular perichondritis in a child as the initial manifestation of insulin-dependent diabetes mellitus: A case report

February 12, 2014     Andria M. Caruso, MD; Macario Camacho Jr., MD; and Scott Brietzke, MD
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Abstract

An 8-year-old boy presented to our otolaryngology clinic three times in a 3-month period for treatment of acute auricular perichondritis. At each visit he was treated with an antibiotic, and he responded quickly in each case, with a complete resolution of his infection. The results of standard autoimmune laboratory tests were negative. Three months after his initial presentation, the patient developed the classic signs and symptoms of diabetes mellitus, including polydipsia, polyuria, and weight loss. He was diagnosed with and treated for type 1 (insulin-dependent) diabetes, and his recurrent infections ceased. There has been no recurrence over a 4-year follow-up period. This case report serves to illustrate the fact that recurrent infections may be the first sign of diabetes. Since diabetes and perichondritis are known to be associated, we recommend that for patients who present with recurrent episodes of perichondritis, a basic metabolic panel and measurement of the glycosylated hemoglobin level be added to standard autoimmune laboratory testing to possibly identify undiagnosed diabetes.

Melioidosis of salivary glands with coexisting diabetes: Management of a difficult case

January 21, 2014     M. Panduranga Kamath, MS, DLO; Kiran Bhojwani, MS; Mahabala Chakrapani, MD; Katara P. Vidyalakshmi, MD; K.P. Vishnuprasad, MBBS
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Abstract

Melioidosis is an infectious disease caused by the gram-negative bacillus Burkholderia pseudomallei. Melioidosis is endemic in Southeast Asia and northern Australia. An important risk factor for the development of melioidosis is the presence of diabetes mellitus, which may increase the relative risk of infection by as much as 100-fold. We report a rare case of melioidosis of the parotid and submandibular gland with coexisting diabetes. This was successfully managed conservatively with intravenous ceftazidime followed by trimethoprim/sulfamethoxazole and doxycycline.

Concha bullosa mucocele and mucopyocele: A series of 4 cases

January 21, 2014     Khalid H. Al-Sebeih, MD, FRCSC, FACS; Mohd H. Bu-Abbas, MD
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Abstract

Concha bullosa is an aerated turbinate in the nose. It is a common anatomic variant that can develop a mucocele if obstructed, which can further progress to become a mucopyocele if infected. A mucopyocele can expand and cause destruction of neighboring tissues. A review of the literature revealed only 10 cases previously reported. We describe 2 cases of mucocele and 2 cases of mucopyocele.

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