1/445. Spontaneous CSF otorrhea caused by abnormal development of the facial nerve canal. In two patients with surgically proved CSF fistula through the facial nerve canal, MR and CT examinations showed smooth enlargement of the geniculate fossa with CSF signal. In the clinical setting of CSF otorrhea or rhinorrhea, the presence of an enlarged labyrinthine facial nerve canal and enlarged geniculate fossa on CT scans and CSF intensity on MR images strongly suggests a CSF fistula through the facial nerve canal. ( info) |
2/445. Anaphylactic reaction to oral cefaclor in a child. Adverse drug reactions are a common clinical problem. It has been estimated that 6% to 15% of hospitalized patients experience some sort of adverse drug reaction. Clinical manifestations of adverse drug reactions include skin rash; a serum sickness-like reaction; drug fever; pulmonary, hepatic, and renal involvement; and systemic anaphylaxis. Many of these adverse events are not immunologically mediated. Actual allergic or immunologic drug reactions probably account for <25% of adverse drug reactions overall. Antibiotics are one of the major contributors to drug hypersensitivity. cefaclor, an oral second-generation cephalosporin with a beta-lactam ring, is used against various infectious diseases of the respiratory tract, especially in children. Several cases of cefaclor hypersensitivity have been reported. The most common presentations are either erythematous or papular eruptions, although serum sickness-like reactions have also been described. Anaphylactic reactions, although rare, have been observed in adults. Here we report a case of anaphylactic reaction to cefaclor in a 21/2-year-old patient. ( info) |
| The purpose of this paper is to present a child with embryonal rhabdomyosarcoma involving the left middle ear, who initially presented with unilateral facial paralysis. A 5-year-old boy presented with a 4-week history of left-sided facial weakness, associated with persistent otitis media on that side. Examination revealed complete left lower motor neuron facial weakness and hearing loss. A myringotomy revealed a soft tissue mass behind the tympanic membrane. biopsy and oncologic assessment confirmed a stage II, group III left middle ear embryonal rhabdomyosarcoma. Despite debulking surgery, local irradiation and multiple chemotherapeutic courses the child deteriorated quickly. He developed carcinomatous meningitis and died 9 months after his initial presentation. In conclusion, middle ear tumors should be considered in the differential diagnosis of unresolving otitis media, particularly when associated with persistent ipsilateral facial paralysis. An ear mass, discharge, facial swelling, or systemic symptoms may be initially absent despite the presence of this aggressive malignancy. Careful examination of the middle ear is recommended in children with facial weakness. A myringotomy incision may be necessary including a complete assessment of the middle ear cavity, particularly when there is no fluid return. ( info) |
4/445. Gustatory otalgia and wet ear syndrome: a possible cross-innervation after ear surgery. HYPOTHESIS: The chorda tympani and Arnold's nerves have close approximation to each other and their cross-innervation is possible after ear surgery. STUDY DESIGN: A retrospective study was performed with a temporal bone pathology case and two clinical cases as representatives of such a possibility. patients had severe otalgia and wet ear during gustatory stimulation. methods: A temporal bone pathology case was studied under a light microscope. earache and/or wet ear were provoked during gustatory stimulation. Wet ear was tested with iodine-starch reaction after the subject tasted lemon juice. RESULTS: The temporal bone specimen has clusters of regenerated fibers in the tympanic cavity in the area of the chorda tympani and Arnold's nerves, suggesting a possibility of mixing. There are regenerated fibers in the iter chordae anterius, showing successful bridging of the chorda tympani nerves across a long gap. Detachment of the skin over the operated mastoid bowl obscured signs in one clinical case. Another clinical case of gustatory wet ear showed objective evidence of cross-innervation with iodine-starch reaction. CONCLUSION: The detachment procedure and iodine-starch reaction were the proofs that the signs were related to regenerated fibers. This is the first report of gustatory otalgia and wet ear after ear surgery. ( info) |
5/445. Acute necrotizing otitis media in an infant: a case report. Acute necrotizing otitis media (ANOM), an uncommon but severe form of bacterial otitis media, frequently causes distressing sequelae if not properly diagnosed and treated. A four-month-old female infant initially became ill with intermittent fever, followed by left facial nerve paralysis and left otorrhea four days later. Microscopic examination of the left ear revealed congestion and swelling of the external ear canal, perforation of the eardrum and erosions on the malleus. culture of pus from the otic lesion grew pseudomonas aeruginosa. The patient's condition did not improve despite systemic administration of antibiotics; thus, surgical intervention was arranged. During the operation, near-total perforation of the eardrum, a dislodged incus, cholesteatoma-like matrix around the stapes, and granulation tissue occupying the middle ear and mastoid cavities were noted. Radical mastoidectomy was conducted and pathologic examination of the surgical specimen disclosed necrotic changes in both soft and bony tissues. The patient recovered soon after surgery. Her fever subsided one day after surgery and the patient was discharged in a stable condition 12 days later. However, she still had left facial nerve paralysis six months later. ( info) |
6/445. Pseudomonas putrefaciens from clinical material. Three strains of Pseudomonas putrefaciens were isolated from routine clinical specimens at the University Hospital, Kuala Lumpur, malaysia. Their cultural and biochemical characteristic, and antibiotic susceptibilities are presented. Characteristics of diagnostic value were stressed. Two isolates appeared to have played a pathogenic role in chronic otitis media. ( info) |
7/445. Histological findings in infantile otoantritis. The histopathological findings in the granulation tissue removed at mastoidectomy from 34 infants between 1971 and 1974 are described. granulation tissue was present in every case, characterized by the histological features of chronic inflammation and fibrosis (sclerosis), although the process was of short duration. The great number of thick fibers was a surprising finding. To prevent fibrosis (sclerosis) to develop later on, it is advisable to operate as early as indicated. ( info) |
| I have reviewed aetiology, sex, age at time of treatment, clinical features, radiographic findings, anaesthetic techniques, surgical treatment, complications, and results in 32 patients with ankylosis of the temporomandibular joint. Trauma and infection were the commonest causes of ankylosis: 50% and 41%, (n = 13), respectively. The 21-30 year age group had the most trauma cases. Twenty (63%) of the patients presented with bilateral ankylosis. Failing to do jaw-opening exercises was the main cause of relapse. ( info) |
9/445. Factors affecting recovery of mastoid aeration after ear surgery. Fifty-six patients after tympanomastoid surgery were examined to determine recovery of mastoid aeration and various pre- and intraoperative factors such as eustachian tube (ET) function, how the mastoid mucosa had been treated during surgery and whether or not a large silastic sheet had been placed in the middle ear or a ventilation tube used. mastoid aeration recovery was confirmed by computed tomography in 27 of the 57 cases (47%) within 12 months of surgery. Among the factors examined, preservation of the epitympanic mucosa was found to be most important in mastoid aeration recovery. Use of a large silastic sheet to cover the area from the bony ET and tympanic cavity to epitympanum, aditus ad antrum or antrum was found to be of some help in recovery mastoid aeration after complete resection of the mucosa and mastoid air cells. Preoperative ET function, anterior tympanotomy and use of a ventilation tube did not influence recovery. ( info) |
| Involvement of the temporal bone in patients with malignant lymphomas is very rare. Most of the reported cases have been clinically asymptomatic and were diagnosed only by post-mortem examinations. We present a nasal, paranasal, nasopharyngeal lymphoma that occurred in a 12-year-old child and also involved the temporal bone. Clinical presentation began with bilateral chronic otitis media. Histopathologically, tumor was found to be an angiocentric lymphoma of B-cell origin. association with Epstein-Barr virus could not be demonstrated. Despite combination chemotherapy (with cyclophosphamide, vincristine, doksorubicine, prednisolone, L-asparaginase, cytosine arabinoside, metotraxate) and radiotherapy (to 40 Gy), disease progressed locally as well as to cervical lymph nodes and the lungs. ( info) |