ABSTRACT
Necrotising otitis externa (NOE) is an infection originating in the soft tissues of the external auditory canal (EAC) spreading to the surrounding bone and rarely causing intracranial complications. It is usually caused by Pseudomonas aeruginosa and has historically occurred in elderly patients with diabetes or immunodeficiency. EAC foreign body is a risk factor for otitis externa but has not been described in NOE. A healthy 31-year-old man presented with new-onset seizures and worsening left-sided otalgia and otorrhoea. Brain imaging revealed left temporal subdural abscesses superior to the petrous bone. A retained cotton bud was identified in the left EAC, along with osseocartilaginous junction and mastoid granulation tissue. The foreign body was removed; a cortical mastoidectomy performed and intravenous antibiotic administered. At 10 weeks, the patient remained well, with no neurological deficit and no residual ear symptoms, and CT demonstrated complete resolution of the intracranial abscesses.
Subject(s)
Ear Canal/microbiology , Empyema, Subdural/etiology , Otitis Externa/microbiology , Adult , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Ear Canal/pathology , Ear Diseases/complications , Earache/diagnosis , Empyema, Subdural/diagnostic imaging , Empyema, Subdural/drug therapy , Foreign Bodies , Granulation Tissue , Humans , Male , Mastoid/pathology , Mastoid/surgery , Mastoidectomy/methods , Necrosis/pathology , Otitis Externa/diagnosis , Otitis Externa/drug therapy , Otitis Externa/pathology , Seizures/diagnosis , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
Differentiated thyroid cancer is characteristically associated with an innocuous clinical course, but a minority of cases may manifest surprisingly aggressive behaviour. Such aggressive DTC are directly responsible for the majority of thyroid cancer related deaths. Moreover, they contribute indirectly to increased DTC-related morbidity, because our inability to differentiate these tumours from innocuous DTC at an early stage fuels a significant degree of DTC overtreatment around the globe. In the present paper we describe how improved understanding of the clinicopathological thyroid tumour progression model and optimization of clinical staging systems continues to improve our ability to diagnose and treat aggressive DTC. Early recognition of aggressive DTC allows instillation of an aggressive management strategy which is based upon surgical-oncologic completeness, and minimization of treatment-related sequelae through continued development of reconstructive options and focussed delivery of adjuvant treatments.
Subject(s)
Thyroid Neoplasms/pathology , Biomarkers, Tumor/blood , Decision Making , Disease Progression , Humans , Lymphatic Metastasis , Neoplasm Invasiveness , Neoplasm Staging , Prognosis , Risk Factors , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/therapyABSTRACT
A 10-year-old girl presented with signs and symptoms suggestive of Gradenigo's syndrome, a condition characterised by otorrhoea, diplopia due to abducens nerve palsy and pain in the region of the trigeminal nerve. This case examines the presentation of this condition, and the appropriate investigations. We also highlight the importance of the involvement of multiple specialities in discussing and devising a suitable management plan.
Subject(s)
Petrositis/diagnosis , Petrositis/therapy , Aspirin/therapeutic use , Ceftriaxone/therapeutic use , Child , Dexamethasone/therapeutic use , Drug Combinations , Female , Framycetin/therapeutic use , Gramicidin/therapeutic use , Humans , Treatment OutcomeABSTRACT
A 90-year-old woman presented with headache and diplopia, and a mass in the nasal cavity and paranasal sinuses was found on CT scan. The patient underwent examination under anaesthesia showing a mass arising from the ethmoid, apparently from the nasal septum. Biopsies taken showed an aneurysmal bone cyst. The patient opted against surgery and has been managed conservatively. A second CT scan 4 years later showed significant increase in size.
