[Necrotizing otitis externa in a 5-month-old infant]. / Otitis externa necrotica öt hónapos csecsemon.

This report presents the case of a healed 5-month-old infant with necrotising (malignant) bilateral otitis externa from acute mastoiditis on the right side and sepsis caused by Pseudomonas aeruginosa infection. Despite of immediately performed mastoidectomy, targeted antibiotics and intensive local treatment, two third of both external auditory canal's epithelium had shown subcutaneous concentric necrosis and ejection which have been removed with repeated necretomies. After the remission of inflammatory symptoms, successful bilateral auditory canal reconstructions were performed. The observed right peripheral facial paresis at the beginning of disease remained stationary. The patient healed with residual symptoms after 2 months of treatment. Neither immune deficiency, nor diabetes could have been proven.

[Normal middle ear ventilation: a new theory]. / Az ép középfül szellozésének új elmélete.

UNLABELLED: According to our present knowledge, mainly due to O2 absorption the pressure continuously decreases in the normal middle ear, which is equalized by time to time opening of the Eustachian tube, so that air flows across the tube. AIM: The aim of the author is to revise this classic theory on the basis of his own research and the results of the last decades. The basic question is whether the pressure increases or decreases in the normal middle ear between two swallowings? PATIENTS AND METHODS: Middle ear pressure change was examined in 32 ears of 16 healthy children in the swallowing pause (between two swallowings) with tympanometry. The patients were 14 +/- 5.2 years old. RESULTS: According to the results of the examinations, the middle ear pressure increases between two swallowings in healthy individuals, which is statistically significant (p = 0.028). CONCLUSIONS: In his opinion this can only be explained by one factor, and that is CO2 diffusion. The pressure gradient of CO2 that is directed towards the middle ear cavity is upheld by the Eustachian tube - every time the tube opens the middle ear loses CO2 (the partial pressure of CO2 in the middle ear is higher, in the atmospheric air is very low), so after tube is closed, CO2 diffuses from surrounding tissue to the middle ear and the pressure increases. This CO2 loss can take place if we consider that gases not only flow according to their composition percent, but also diffuse according to their partial pressure difference through the tube.

[Successfully treated neck abscess secondary to peritonsillar abscess]. / Peritonsillaris abscessus szövodményeként kialakult nyaki tályog gyógyult esete.

The complications of peritonsillar abscess are potentially life-threatening conditions. The acute tonsillar infections frequently extend in the peritonsillar tissues from which the rare form of neck and mediastinal abscess can develop. The authors review the case of 17 years old boy, at whom the infection spread from peritonsillar space to the neck space. Complications of the peritonsillar abscess today are potentially life-threatening conditions. The wide incision performed at appropriate time resulted in complete healing and prevented the progress into the mediastinal space. The authors have not met similar case neither in their administrative area, nor in the Hungarian literature, however the number of reports in English is abundant.

[Rare case of congenital transsphenoidal meningoencephalocele causing respiratory problems]. / Légzési panaszokat okozó veleszületett transspheniodalis meningoencephalokele ritka esete.

INTRODUCTION: Congenital meningoencephalocele is a rare and severe malformation. AIMS: The authors describe the case of congenital, basal transsphenoidal meningoencephalocele associated with other neurological malformations, which projected between the margins of palatoschisis producing respiratory problems at neonatal age. METHOD: Presented with detailed photo-documentation. RESULTS: Cranial meningoencephalocele reconstruction with an approach of bifrontal craniotomy was performed. The base of skull was closed multilaminarly with auto-graft gained from parietal bone and Lyodura. The closure of nasopharyngeal sac was performed in second sitting. Postoperatively the progression of hydrocephalus was so extensive, that implantation of ventriculo-peritoneal shunt was unavoidable. Later on closure of tracheotomy performed for continued air passage support was done. The authors report the course of disease and the surgeries performed. CONCLUSIONS: Auto-graft from skull bone for closure of large basal-cranial defect proved to be ideal. Prognosis depends on other malformations. Successful treatment needs co-operation of different specialties.

[Orbital phlegmone caused by acute exacerbation of chronic fungal pansinusitis in a child]. / Krónikus gombás pansinusitis akut exacerbatiója következtében kialakult orbitaphlegmone gyermekkorban.

INTRODUCTION: Invasive fungal rhinosinusitis is an aggressive, destructive process most commonly affecting immunocompromised hosts with mortality rate of approximately 60-80%. AIM OF STUDY: The authors present a child's recovery of orbital phlegmone due to acute exacerbation of chronic fungal pansinusitis. They call the attention to the possibility of ever more frequent fungal sinusitis in our country. METHODS: Retrospective case report of an 8 years old boy presented with photos. RESULTS: The recovery was promoted by supposing the chance of fungal origin in time. No orbital abscess was found by surgery despite of typical clinical appearance and MRI results. After beginning of antibacterial treatment and functional endoscopic sinus surgery (FESS) the even worsening clinical status of orbital phlegmone raised the possibility of fungal origin, which was verified by mycological examination. The antimycotic treatment, which had been started in time was followed by complete recovery. Due to scarring in the medial rectus muscle, diplopia was the only complication which needs further ophthalmological controls. CONCLUSIONS: Supposition and verification of chance of fungal origin is essential in cases of chronic inflammation of paranasal sinus and/or their complications for complex recovery.