Oral propranolol therapy for benign capillary hemangiomas in a series of adult and pediatric patients

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe outcomes of oral propranolol therapy in a series of adult and pediatric patients diagnosed with benign capillary hemangioma of the head and neck.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Prospective Case Series<br /><strong>Setting:</strong> Tertiary Government Teaching Hospital<br /><strong>Participants:</strong> Ten (10) patients representing all patients clinically diagnosed with benign capillary hemangioma of the head and neck enrolled in the study from 2012 to 2015.<br /><strong>RESULTS:</strong> Two (2) adults and eight (8) children were enrolled in the study. Although a decrease in lesion size was observed in half of the participants starting at three months, only one (1) attained complete resolution of the lesion-- a 12-year-old girl with hemangioma of the right parotid gland that attained clinical resolution of symptoms after four months of treatment. The remaining nine out of ten (9/10) participants did not attain complete clinical resolution; but there was a decrease in lesion size in four (4) of these participants. For the remaining five (5) participants, there was neither a decrease nor an increase in lesion size. Altogether, of the two adult participants, only one responded to therapy while only 4 out of 8 pediatric participants responded to therapy. There were no noticeable differences between adult and pediatric patients in terms of resolution and plateau. Aside from mild bradycardia expected with propranolol, no adverse reactions were observed during the course of treatment.<br /><strong>CONCLUSIONS:</strong> Although half of our participants responded to oral propranolol therapy whether these observations may be attributable to oral propranolol alone cannot be concluded.</p>

Surgical management of chronic suppurative otitis media with intracranial complications

@#Intracranial abscess is a serious, life-threatening condition with a dire prognosis. Although the advent of the antibiotic era has drastically reduced the incidence of the disease, predisposing factors such as untreated ear infections, poor personal hygiene, significant trauma with violation of the sterile cranial environment as well as existing co-morbidities such as an immunocompromised state make intracranial abscess a horrifying reality. Ear infections, in particular, are notorious for being the origin of roughly 50% of cerebellar abscesses.1 Chronic suppurative otitis media (CSOM) is one of the leading causes of brain abscess. Shaw and Russell2 reviewed 47 cases of cerebellar abscess and showed that 93% were caused by CSOM; the most common mechanism of entry into the brain parenchyma being direct extension. Chronic infection in the middle ear space could erode through the tegmen tympani and into the temporal lobe or through the tegmen mastoidei into the cerebellum. Neurological symptoms may be delayed as the abscess ‘grows’ in areas around the cerebellum that are regarded as ‘silent’, until vital areas such as those responsible for coordination and balance are violated. We describe a case of cerebellar abscess secondary to CSOM and discuss the possibility of performing ear surgery with simultaneous drainage of a contiguous abscess through a transmastoid approach in cases of chronic suppurative otitis media with intracranial complications.