How dangerous can a small fish be? A greater weever attack.

BACKGROUND: Thraconian fish (weever fish) are poisonous fish found mostly in the eastern Mediterranean region, but also in the eastern Atlantic Ocean, the North Sea and European coastal areas. Greater weever fish belong to the Trachinus draco family; these fish have spines on their dorsal fins and gill covers that secrete a high dose of dracotoxin venom. METHODS: This paper reports a 35-year-old female who presented with widespread body aches, respiratory distress and hoarseness following a greater weever attack. It discusses respiratory distress and other findings that occur after a greater weever attack in rare otolaryngological emergency cases. CONCLUSION: While greater weever fish are more likely to attack limbs such as arms and legs, patients stung on the neck who develop respiratory distress are considered an ENT emergency.

An unusual pneumatisation of turbinates.

OBJECTIVE: To report an extremely rare case of pneumatisation of all turbinates. CASE REPORT: A 17-year-old male patient presented with nasal obstruction. Anterior rhinoscopy and nasal endoscopic examination revealed left middle turbinate and bilateral inferior turbinate hypertrophy, septal deviation to the right. A coronal computed tomography (CT) scan of the paranasal sinuses showed pneumatisation of both superior and inferior turbinates and a left middle turbinate, and also showed pneumatisation of the right middle turbinate. The patient underwent endoscopic sinus surgery of the left side with lateral lamellar resection of the middle turbinate under local anaesthesia. CONCLUSION: We present the first case in the world literature of the pneumatisation of all six turbinates.

Nasopharyngeal tuberculosis: an unusual cause of nasal obstruction and snoring.

OBJECTIVE: To report an extremely rare case of nasopharyngeal tuberculosis. CASE REPORT: A 35-year-old male patient presented with nasal obstruction and snoring. Nasal endoscopic examination with a rigid endoscope revealed a large mass on the posterior wall and roof of the nasopharynx. A computed tomography scan of the nasopharynx revealed a polypoid mass in the posterior nasopharyngeal wall. Histopathological examination of a biopsy taken from the posterior nasopharyngeal wall revealed granulomatous lesions with caseation necrosis. Treatment was decided after histopathological examination and intradermal positive reaction to tuberculin test, and started a week later. The patient was treated with antituberculosis drugs including isoniazid, rifampicin, pyrazinamide, and ethambutol. After six months, the nasopharyngeal examination was absolutely normal, and the patient was also symptom free. CONCLUSION: This case highlights that nasopharyngeal tuberculosis should be considered in the differential diagnosis of a nasopharyngeal mass, especially in patients from regions of the world where tuberculosis is endemic.

Preliminary results on correlation between neural response imaging and 'most comfortable levels' in cochlear implantation.

During cochlear implantation, precise placement of the cochlear electrodes against the cochlear nerve is one of the most important steps, necessary to enable the patient to be aware of the stimulus from the implanted device. Neural response imaging (NRI) is a new tool which measures the evoked compound action potential generated as a result of electrical stimulation of the cochlea by properly placed electrodes during surgery. The aim of this study was to examine the correlation between intra-operative NRI recordings and 'most comfortable levels' (M levels) measured during standard fitting with the SoundWave fitting software, in cochlear implantation patients. Seven adult subjects were included in the study. The average duration of profound bilateral deafness was seven years (range = 19 years) and the mean age at implantation was 24 years (range = 17-34 years). All subjects underwent implantation and reached the one-month fitting session; one patient reached the two-month fitting session. The intra-operative NRI threshold (tNRI) was observed to be much higher than the first fitting M levels. The tNRI was 203 per cent of the sequential M value and 246 per cent of the paired M value. All but one intra-operative tNRI values were greater than 150 clinical units (CU), and all first fitting M levels were on average below 100 CU. No obvious correlation was found between individual intra-operative tNRI and first fitting M levels. The M levels at one month were much higher than the first fitting M levels, with much more dispersion.