Challenges encountered in the diagnosis of tuberculous otitis media: case report and literature review.

OBJECTIVE: To report a rare case of tuberculous otitis media, and to highlight barriers to clinical and microbiological diagnosis. METHOD: Case report and literature review. RESULTS: Tuberculous otitis media is a rare cause of chronic ear infection in the UK. Its symptoms may mimic a range of other otological conditions, including otitis media, chronic suppurative otitis media, cholesteatoma and necrotising otitis media. CONCLUSION: This case report highlights the challenges of obtaining a clinical diagnosis of tuberculous otitis media, and emphasises the fact that screening for acid-fast bacilli is not sufficient, in isolation, to rule out mycobacterial infection.

The use of transient evoked otoacoustic emissions as a hearing screen following grommet insertion.

OBJECTIVE: This study aimed to evaluate the sensitivity of transient evoked otoacoustic emission testing as a screening tool for hearing loss in children, after grommet insertion. METHOD: A prospective study was conducted of 48 children (91 ears) aged three to 16 years who had undergone grommet insertion for glue ear. At post-operative review, pure tone audiometry was performed followed by transient evoked otoacoustic emission testing. Outcomes for both tests, in each ear, were compared. RESULTS: The pure tone audiometry threshold was ≤ 20 dB in 85 ears (93.4 per cent), 25 dB in two ears (2.2 per cent) and ≥ 30 dB in four ears (4.4 per cent). Transient evoked otoacoustic emissions were detected in 69 ears (75.8 per cent). The sensitivity of transient evoked otoacoustic emission testing for detecting hearing loss was 100 per cent for ≥ 30 dB loss but only 66.7 per cent for ≥ 25 dB loss. CONCLUSION: Transient evoked otoacoustic emission testing offers a sensitive means of detecting hearing loss of ≥ 30 dB following grommet insertion in children. However, the use of such testing as a screening tool may miss some cases of mild hearing loss.

Palato-pharyngo-laryngeal myoclonus: an unusual cause of dysphagia and dysarthria.

We describe a case of palato-pharyngo-laryngeal myoclonus, an unusual variant of palatal myoclonus, which presented with dysphagia and dysarthria. The aetiology and presenting features of myoclonus are discussed. Various treatment options are considered.

Tuberculous otitis media: a difficult diagnosis.

Two cases of tuberculous otitis media, both presenting with otorrhoea and facial paralysis, are reported. The difficulties of diagnosing this rare condition are highlighted, and a brief review of its clinical features from other series is presented.

External nasal nerve division: a treatment for post-traumatic neuralgia.

We present four patients complaining of neuralgic pains across the nasal bridge following trauma, who were successfully treated by division of the external nasal nerve. We believe it is a useful treatment in selected cases.

Ventilatory monitoring during microlaryngeal surgery using jet insufflation anaesthesia.

We describe a method for continuous measurement of end-tidal carbon dioxide concentration during jet insufflation anaesthesia for microlaryngeal surgery. This increases the safety of the technique by allowing closer monitoring of inspired and expired gases during anaesthesia.