1/3. Cervical spine meningioma presenting as otalgia: case report.OBJECTIVE AND IMPORTANCE: Cervical spine meningiomas have not been reported to present as otalgia. It is important to include otalgia in the differential diagnosis and workup, especially when more common causes of ear pain have been excluded. CLINICAL PRESENTATION: A 66-year-old woman presented to her primary care physician with severe ear pain. She underwent routine diagnostic testing and eventually was referred to a neurologist. After conservative management failed, the patient underwent cervical spine magnetic resonance imaging, which revealed a large meningioma encompassing C2-C3. INTERVENTION: The patient underwent a cervical laminectomy with complete resection of the tumor. She experienced immediate postoperative resolution of her symptoms. CONCLUSION: This case illustrates the importance of aggressive evaluation of otalgia when routine diagnostic studies are inconclusive. Cervical meningiomas are associated with significant potential morbidity and should be excluded early in the diagnostic process.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Heterogeneity in the clinical presentation of Eagle's syndrome.OBJECTIVE: Eagle's syndrome (ES) or symptomatic elongated styloid process is an uncommon but important cause of chronic head and neck pain. This study reports our experience in the diagnosis and treatment of a series of patients with ES. STUDY DESIGN: Patient histories, radiographic tests, and operative reports of 3 patients over a 3-month period were prospectively collected. SETTING: Tertiary referral otolaryngology service. RESULTS: All patients had resolution of symptoms relating to their elongated styloid processes after surgical resection. CONCLUSION: Although sometimes clouded by coexisting symptoms, ES can be easily diagnosed based on good history taking and physical examination. If diagnosed appropriately, surgical treatment can be administered promptly. SIGNIFICANCE: patients with ES commonly have a long history of chronic pain treated by multiple physicians. Appropriate diagnosis can lead to prompt treatment of this condition. EBM rating: C-4.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. Cryptic otalgia: a case of munchausen syndrome in a pediatric patient.This paper reports a case of munchausen syndrome in a pediatric patient. The patient, a 13-year-old boy, presented with a complaint of persistent otalgia. As a result of the patient's deception of his physicians, he underwent numerous unnecessary investigations and two unnecessary operative procedures. The patient's deception included the simulation of a cerebrospinal fluid leak. The literature with respect to munchausen syndrome in the pediatric patient is reviewed. Emphasis is placed on the fact that physicians, by their investigations and treatments, inflict most of the morbidity on this group of patients. Specific warning signals as well as an approach for management of these patients are also reviewed.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |