Infection

Recurrent post-tympanostomy tube otorrhea secondary to aerobic endospore-forming bacilli: A case report and brief literature review

February 25, 2013     James J. Jaber, MD, PhD; Matthew L. Kircher, MD; Eric Thorpe, MD; Ryan G. Porter Sr., MD; John P. Leonetti, MD; Sam J. Marzo, MD
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Abstract

We report a unique case in which a 57-year-old man with an 8-year history of late recurrent post-tympanostomy tube otorrhea (PTTO) was found to harbor Bacillus subtilis, an aerobic endospore-forming bacillus that is typically resistant to chemical and physical agents because of its unique life cycle. Removal of the patient's tympanostomy tube resulted in complete resolution of his long-standing otorrhea. We also review the etiologies of and treatment strategies for early, late, chronic, and recurrent PTTO. We conclude that regardless of the etiology, a patient with persistent or recurrent PTTO should consider undergoing removal of the ventilation tube.

Hyperplastic epiglottis caused by chronic inflammation

January 24, 2013     Mark D. Wilkie, MBChB; Samuel C. Leong, MPhil; Alessandro Panarese, FRCS; Arnab Banerjee, FRCS
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Due to the development of Hib vaccines, the epidemiology of epiglottitis has shifted dramatically back toward adult presentations, with a marked decline in the incidence among children.

Chromobacterium violaceum necrotizing fasciitis: A case report and review of the literature

October 31, 2012     Jonathan K. Seigel, MD; Michael E. Stadler, MD; Jennifer L. Lombrano, DDS; Jeffrey S. Almony, MD, DDS; Marion E. Couch, MD, PhD; and Thomas H. Belhorn, MD, PhD
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Abstract

Necrotizing fasciitis is a severe, rapidly progressive infection of the subcutaneous tissue that causes significant destruction. It is rarely encountered in the pediatric population. We describe the case of a 14-year-old boy who was diagnosed with Chromobacterium violaceum necrotizing fasciitis and subsequently found to have autosomal recessive chronic granulomatous disease.

Middle ear atelectasis

October 31, 2012     Min-Tsan Shu, MD; Kang-Chao Wu, MD; Yu-Chun Chen, MD
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Tympanic membrane retraction caused by long-term eustachian tube dysfunction may lead to erosion of the ossicles and cholesteatoma.

Otogenic pneumocephalus as a complication of multiple myeloma

September 7, 2012     Melissa J. Maguire, MD; Uma Nath, MD; Guiseppe E. Bignardi, MD
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Abstract

We report a case of otogenic pneumocephalus in an 80-year-old woman with multiple myeloma. The pneumocephalus was associated with Haemophilus influenzae otitis media and reactive meningitis in the absence of an intracranial brain abscess. Myeloma causes thinning of bone trabeculae and destructive lytic bone lesions. This can predispose to a risk of pathologic fractures and, in patients with skull vault involvement, to the rare complication of pneumocephalus. Therefore, pneumocephalus should be considered in the differential diagnosis of acute headache in patients with multiple myeloma, especially those with skull vault involvement. Prompt computed tomography and liaison between the otolaryngology and neurology teams may assist in making an early diagnosis and preventing life-threatening intracranial complications.

Endoscopic view of secretion transport in the maxillary sinus following a long-term inferior meatal antrostomy

August 10, 2012     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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It is important to remove any obstruction of the natural ostium of the maxillary sinus or the ethmoid infundibulum because maxillary sinus secretions will be transported toward the natural ostium even when a previously placed large and patent inferior meatal antrostomy is present.

Staphylococcus aureus cavernous sinus thrombosis mimicking complicated fungal sinusitis

July 5, 2012     Murat Songu, MD; Nazan Can, MD; Kazim Onal, MD; Secil Arslanoglu, MD; Nezahat Erdogan, MD; Aylin Kopar, MD; Ejder Ciger, MD
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Abstract

Septic cavernous sinus thrombosis is a rare and potentially life-threatening complication of infections involving the paranasal sinuses or the middle one-third of the face. We report a challenging case of cavernous sinus thrombosis to familiarize otolaryngologists with its clinical features, diagnosis, and management. The patient was a 45-year-old diabetic woman whose signs and symptoms mimicked those of complicated fungal sinusitis. She presentedwith fever, nausea without vomiting, frontal headache, bilateral ptosis and swelling, double vision, a partial loss of visual acuity in the left eye, and restricted lateral ocular movements. Her Snellen visual acuity had been reduced to 8/10 on the right and 6/10 on the left. Radiologic investigation revealed cavernous sinus extension of sphenoid sinusitis and a fungus-ball appearance in the sphenoid sinus. On the second day of her admission, the patient’s vision was further reduced to 6/10 on the right and 2/10 on the left. She then underwent urgent bilateral anterior and posterior ethmoidectomy and sphenoidectomy. At postoperative follow-up, her vision had stabilized at 10/10 bilaterally. At 2 months after discharge, she exhibited no evidence of abducens nerve palsy, and her ocular function had returned to normal. The diagnosis of cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging. The favorable outcome in our case was attributable to early diagnosis, prompt initiation of appropriate intravenous antibiotic therapy, and surgical drainage by the skillful surgical team.

Acute candidal pharyngolaryngitis

July 5, 2012     Andrew Mallon, DO; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
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Use of inhaled steroids has been identified as a risk factor for the development of laryngeal candidiasis. Therefore, if dysphonia, cough, and general laryngeal irritation occur in a patient using inhaled steroids, the possibility of laryngeal candidiasis should be considered.

Mycoplasma an unlikely cause of bullous myringitis

June 4, 2012     Lisa Cramer, BA; Dina M. Emara, MBBCh; Arun K. Gadre, MD, FACS
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Despite common belief, Mycoplasma pneumoniae is an extremely rare causative agent for bullous myringitis. Instead, it is caused by the same organisms responsible for acute otitis media.

A case of a giant submandibular gland calculus perforating the floor of the mouth

June 4, 2012     Raffaele Rauso, MD; Giulio Gherardini, MD, PhD; Paolo Biondi, MD; Gianpaolo Tartaro, MD; Giuseppe Colella, MD, DDS
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Abstract

Sialolithiasis is characterized by the obstruction of salivary gland secretion by a calculus. It is associated with swelling, pain, and infection of the affected gland. More than 80% of all salivary calculi occur in the submandibular gland. One reason for this is the makeup of the saliva in the submandibular gland, which includes a higher mucus content, a greater degree of alkalinity, and greater concentrations of calcium and phosphate salts compared with the saliva of the parotid and sublingual glands. Other factors are that its duct is longer and its saliva flows against gravity. Sialoliths that reach several centimeters in diameter (megaliths, or giant calculi) are rare. Perforation of the floor of the mouth by a giant calculus is extremely rare. We report such a case in a 56-year-old man who presented with a 2-day history of severe pain in the left sublingual area and painful swelling in the left submandibular area. Removal of the stone and the left submandibular gland was performed via an extraoral incision. On gross examination, the sialolith measured 5.6 cm.

Spectrum of paranasal sinus mycoses in coastal India

June 4, 2012     Jyoti R. Kini, MD; Spoorthy S. Shetty, MBBS; Hema Kini, MD
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Abstract

Fungal infections of the nose and paranasal sinuses are uncommon, and the disease they cause can be identified from their histopathologic appearance. The aim of this study was to assess the incidence of fungal infection and histopathologic changes in specimens sent for evaluation of chronic sinusitis and correlate with culture findings wherever possible. The records of 200 consecutive cases coded as paranasal sinuses over a period of 3 years were retrieved from the Department of Pathology, Kasturba Medical College, Mangalore, India. Twenty nine out of a total of 200 specimens (14.5%) were positive for fungal elements on histopathologic examination. The most common etiologic agents in our study were Aspergillus spp (37.9%); only 1 culture (3.4%) was positive for a Candida species. Eight of 29 patients with fungal sinusitis (27.6%) had diabetes, and 1 patient was being treated for rheumatoid arthritis. Eight of the 29 patients had allergic fungal sinusitis, 8 had chronic granulomatous sinusitis, and 1 had acute fulminant invasive sinusitis. Fungi have been increasingly recognized as an important pathogen in chronic sinusitis. It is imperative for patient management not only that paranasal sinus mycoses be diagnosed but also that the specific histologic category be identified.

Huge middle ear adenoma with delayed facial nerve paralysis

June 4, 2012     Seung Ho Lee, MD; Hoseok Choi, MD, PhD; Young Chae Chu, MD; Young Hyo Kim, MD; Kyu-Sung Kim, MD, PhD
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Abstract

Middle ear adenoma is a rare disease that arises from the mucosa of the middle ear. Only a few cases of associated facial nerve paralysis have been reported. Facial nerve involvement is most likely related to nerve compression rather than tumor invasion of the nerve. We describe a case of a huge middle ear adenoma in a 63-year-old man. He presented with a 1-month history of right-sided otalgia, otorrhea, and facial palsy; he also had a 10-year history of right-sided hearing loss. A tympanomastoidectomy was performed. Intraoperatively, the tumor was found to fill the middle ear cavity as well as the entire diameter of the external auditory canal. The tumor had eroded the wall of the facial canal at the second genu, and it was tightly adherent to the epineurium. Focal inflammation around the tumor was observed at the exposed facial nerve. The tumor was removed and the facial nerve was decompressed. Immediately after surgery, the patient’s aural symptoms resolved. The final pathology evaluation established the diagnosis of a middle ear adenoma. At the 3-year follow-up, the ear cavity was completely healed and facial nerve function was improved.

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