Congenital cholesteatoma (CC) of the middle ear is a rare entity that may be
undiagnosed for years. The lesion can grow undetected until it produces symptoms such as reduced
hearing or otalgia.
Eagle's syndrome is an uncommon condition resulting from an elongated styloid process, which causes cervico facial pain, tinnitus and otalgia. A 48-year-old female presented to the clinic with bilateral upper neck pain radiating to the ears with tinnitus for almost one-year duration. Examination of the oral cavity revealed atrophic tonsils and palpable bony projection deep in the tonsillar fossa. Plain lateral neck X-ray and CT scan confirmed the presence of bilateral elongated styloid processes, which were subsequently resected surgically through an oropharyngeal approach. The patient was asymptomatic at follow up at 2 years.
INTRODUCTION: Congenital cholesteatoma (CC) of the middle ear is a rare entity that may be undiagnosed for years. The lesion can grow undetected until it produces symptoms such as reduced hearing or otalgia.
METHOD: Case report.
RESULTS: We report two cases of young ladies with CC who presented with different otological symptoms. The first case complained of recurrent unilateral ear pain while the second case presented with unilateral reduced hearing. Examination of both cases revealed a whitish mass seen behind an intact tympanic membrane. Both cases underwent surgery and histopathological examinations; findings were consistent with cholesteatoma.
CONCLUSION: There are varieties of clinical presentations of CC and the diagnosis is based on clinical findings.
Tephrosia apollinea (Delile) DC (Leguminosae) has been used in folk medicine in Arabian countries to treat inflammatory disorders. The plant has been described to treat swelling, bone fracture, bronchitis, cough, earache and wounds.
Malignant melanoma is a rare malignancy of the external auditory canal. The vast majority of them occur in the areas of the body that are exposed to the sun. Early histological examination may possibly favor better prognosis. We report a case of a 38-year-old female who presented with a small mass in right ear canal, earache and minimum discharge since 4 months. Initially scraping was done in the ENT clinic. Subsequently she had a wide excision done by the end aural approach at a different hospital. A year later the patient presented with a swelling involving the ear canal which extended to the helix and supratemporal region with the histology report as malignant melanoma. A literature review of the disease, radiological findings, immunohistochemical features and treatment options are discussed.
Melanoma of the ear canal is extremely rare; due to its hidden area, most would present late in their history. We present the first case reported, of a black pigment foreign body mimicking a melanoma in the external auditory canal. A 14 year old Chinese male presented with right sided otalgia and itch. Otoscopic examination revealed an irregular black naevus in the right auditory canal. An intraoperative excision showed a black pigment foreign body giant cell reaction. Clinicians should be aware of the possibility of a foreign body granuloma of the ear canal that might mimic a melanoma.
Quinsy is a common encounter in family physician practice. It is defined as a collection of purulent material in the peritonsillar space, giving appearance of unilateral palatal bulge. Presenting symptoms include trismus, muffled voice, odynophagia, and ipsilateral otalgia. When the diagnostic needle aspiration reveals no pus, the diagnosis is changed into peritonsillar cellulitis or also known as perintonsillitis. Peritonsillitis is sufficiently treated with antibiotics unlike a quinsy which warrants surgical incision and drainage.
Acute mastoid abscess is common in daily practice. In children, it is usually caused by unsuccessful treatment or partially treated acute otitis media (AOM). Some authors had reported that chronic suppurative otitis media (CSOM) can be the source of infection but it is usually associated with the presence of cholesteatoma. A case of an acute mastoid abscess in a 7 year old girl is presented. She had a history of severe otalgia with left post auricular swelling for 3 days. Clinically she was febrile, the left otoscopy showed diffuse post auricular swelling and sagging of the posterior wall of the external canal. She underwent an emergency cortical mastoidectomy for the left mastoid abscess and had an uneventful recovery. In conclusion, this patient was partially treated with antibiotics which increased the risk for ‘masked mastoiditis’, and she later developed a mastoid abscess. Therefore we advocate that all AOM patients should be treated with antibiotics at least for a duration of one week.
Temporal bone cancer, a relatively rare disease, accounting for less than 0.2% of all tumors of the head and neck and is associated with a poor outcome; often presents in a subtle manner, which may delay diagnosis. It should be suspected in any case of persistent otitis media or otitis externa that fails to improve with adequate treatment. Despite advances in operative technique and postoperative care, long-term survival remains poor). It includes cancers arising from pinna that spreads to the temporal bone, primary tumors of the external auditory canal (EAC), middle ear, mastoid, petrous apex, and metastatic lesions to the temporal bone. Here is a report on a case of temporal bone carcinoma presenting with right otalgia, otorrhea and facial paralysis. The patient was initially diagnosed as mastoiditis and later the clinical impression was revised to temporal bone carcinoma (undifferentiated type), based on the pathologic findings.
Temporal bone carcinoma is a rare malignant tumor of the head and neck region. Its clinical presentations can mimic benign ear diseases, leading to inaccurate diagnosis and substandard management. We present the case of a 53-year-old female with a three-month history of progressive right otalgia, otorrhea, and hearing loss. Otoscopic examination revealed a mass occupying the right external auditory canal. However, the lesion was presumed to be an aural polyp by several clinicians previously. Multiple courses of oral antibiotics had been prescribed before she was referred to our clinic for the non-resolving aural polyp. Imaging studies showed an external auditory canal soft tissue mass with extradural and parotid extension. The mass was biopsied, and the result was reported as squamous cell carcinoma of the temporal bone. The patient was advised for a total temporal bone resection and parotidectomy; however, she declined the surgical intervention. Within a month, the tumor had metastasized to her lung, liver, and vertebral bodies. She was referred to the Oncology team for palliative chemo-radiotherapy. Temporal bone malignancy must be considered as a differential diagnosis in a middle-aged or elderly patient with a non-resolving aural polyp without a chronic discharging ear. Imaging studies and histopathological evaluation should be prompted to ascertain the diagnosis. Repeated course of oral antibiotic will delay treatment and subsequently may lead to poor prognosis.
Proper management of chronic otitis media may reduce the incidence of otogenic brain abscess. The aim of this study was to describe the clinical profile, treatment and surgical outcome of patients presenting with otogenic brain abscess. The medical record of patients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) with otogenic brain abscess were retrospectively analyzed from January 1997-January 2006. Within this eriod we had approximately 10,800 of follow up cases of chronic otitis media (COM) in our clinic. Ten patients (2 females, 8 males) with an average age of 42 (age range 11 to 69 years) were identified with otogenic brain abscess and included in this study. The mean follow-up period was 14 months. All patients had cholesteatoma. All patients had a history of chronic ear discharge, headache, otalgia and fever. Six of the 10 patients had cerebellar abscess and 4 had temporal lobe abscess. Cerebellar signs were present in 3 patients All the patients were treated with broad-spectrum antibiotics. In 5 patients, mastoid exploration was the primary surgical treatment and the brain abscesses were treated conservatively. In the other 5 patients, craniotomy and drainage were performed followed by mastoid exploration when their neurological conditions had stabilized. All our patients had uneventful recovery. There were no permanent cerebellar signs during the follow up and no mortality reported in our series. In this series we demonstrated that early diagnosis and proper treatment of otogenic abscess leads to good neurological outcome.
Upper respiratory tract infections (URTI) are the most common diseases treated in the primary health care centres in Kinta District, Perak. Thus, aretrospectiire study was undertaken to examine the documentation of the presentation of patients diagnosed with URTI and their antibiotic treatment at two health care centres in Kinta district, The randomly selected case notes of 700 patients documented the following symptoms, fever (43 .29%) , cough (68.14%) , no cough (24.43%), nasal symptoms (35 .29%) , sore throat (46.00%), headache (13 .57%) , bodyache (3 .57%) , earache (1 .86%) and gastrointestinal symptom (0, 14%) . Analysis of results using 'sore throat score' and isuggested appropriate management’ adopted from a study by Wawen et al. revealed poor correlation between diagnosis of URTI and the need for antibiotic therapy. Therefore, a clinical score for patients with sore throat can be introduced to overcome inappropriate prescription of antibiotics.
Klinik Kesihatan Gopeng, Klinik Kesihatan Malim Nawar, Kinta district, Perak, Malaysia
Stereospermum fimbriatum or locally known as "Chicha" is traditionally used for itchy skin, earache, stomachache and postpartum treatments. This study was designed to evaluate the antimicrobial potential of S. fimbriatum's stem bark against 11 pathogens and isolate its bioactive compound. Successive soxhlet extraction was conducted using n-hexane, dichloromethane (DCM) and methanol. Disc diffusion, minimum inhibitory and bactericidal concentration (MIC & MBC) assays were done to examine the antimicrobial activity. Bioassay-guided isolation was conducted on S. fimbriatum's extract. The DCM extract of stem bark (DS) was the most potent extract followed by n-hexane extract of the stem bark (NS). A novel compound was isolated and coded as C1 which demonstrated potent antibacterial effects with the MIC values as low as 3.13 µg/mL to 6.25 µg/mL, against S. epidermidis, MRSA and S. aureus. Thus, S. fimbriatum could be a potential source of antimicrobial agents for the treatment of skin infections, specifically, MRSA.
Myeloid sarcoma is a rare malignant extramedullary neoplasm of myeloid precursor cells. This disorder may occur in concomitance with or precede development of acute or chronic myeloid leukemia. Sometimes, it is the initial manifestation of relapse in a previously treated acute myeloid leukemia. We report a case of 11 years old boy with acute myeloid leukemia in remission state, presented with short history of right otalgia associated with facial nerve palsy. Diagnosis of right acute mastoiditis with facial nerve palsy as complication of acute otitis media was made initially. Patient underwent simple cortical mastoidectomy but histopathology from soft tissue that was sent revealed diagnosis of myeloid sarcoma. A leukemic relapse was confirmed by paediatric oncologist through bone marrow biopsy. Chemotherapy was commenced but patient responded poorly to the treatment.
To review cases of congenital external auditory canal anomaly with cholesteatoma, documenting clinical presentation, cholesteatoma site and extent, complications, and surgery.
To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles and the intraoperative findings of children with chronic otitis media with effusion who required surgical intervention. A prospective cross sectional study was undertaken in the otorhinolaryngology clinic of USM Hospital (HUSM) involving 25 cases (50 ears) of children with chronic otitis media with effusion requiring surgical intervention from June 1999 to September 2001. Their ages ranged from 3 to 12 years old. The gender distribution included males at 72 % and females at 28 %. The presenting symptoms noted were hearing impairment (52%), otalgia (18%), ear block (16%) and tinnitus (14%). The otoscopic findings were fluid in the middle ear (40%), dullness (32%) and retraction of the tympanic membrane (28%). On audiometry, 24 ears had moderate deafness (48%), 16 ears had mild deafness (32%) while 4 ears had severe deafness (8%). With tympanometry, 42 ears out of the total 50 had a flat type B curve (84%) while 6 ears had type As curve (12%). During myringotomy, middle ear secretion was seen in 38 ears (76%) out of the 50 ears; 22 ears had mucoid secretion while 16 ears had serous secretion. Clinically, the commonest presenting symptom was hearing impairment (52%) while the most common otoscopic finding was fluid in the middle ear (40%). Audiologically, most patients had moderate conductive hearing loss (48%) and a type B curve (84%) on tympanometry. On myringotomy middle ear fluid was found in 76 % of the ears.
Study site: otorhinolaryngology clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia