Confronting multidrug-resistant Klebsiella meningitis after mid-clival Cerebrospinal Fluid leak repair: a therapeutic odyssey.

A man in his 40s with type 2 diabetes mellitus had persistent right-sided watery nasal discharge for 6 months following cerebrospinal fluid (CSF) leak repair at another hospital, prompting his visit to us due to recurring symptoms. Imaging revealed a CSF leak from the mid-clivus for which revision endoscopic CSF leak repair was done. Regrettably, he developed postoperative meningitis caused by multidrug-resistant (MDR) Klebsiella pneumoniaeManaging this complex case was a challenging task due to the pathogen's resistance to conventional drugs and the scarcity of scientific evidence. We initiated a culture-guided combination regimen with ceftazidime, avibactam, aztreonam and tigecycline. This decision stemmed from meticulous literature review and observed antibiotic synergy while testing for this organism.After 4 weeks of vigilant treatment, the patient's symptoms improved significantly, and CSF cultures were sterile. We present our approach to effectively confront and manage a challenging instance of postoperative MDR bacterial meningitis.

Criteria for Determining Hearing Disability: A Narrative Review of Global Perspective.

Hearing loss is a highly prevalent condition worldwide, affecting over 5% of the global population. Determining disability and eligibility for rehabilitation services due to hearing loss is complex, as countries employ differing audiometric criteria and methods. This report reviews current literature on audiometric thresholds used globally to determine hearing disability, highlighting challenging cases worldwide. Databases PubMed, Embase, and Web of Science were searched for articles on hearing disability criteria published from 2010-present in English. Overall, developed countries employ a pure-tone average (PTA) of ≥ 40 dB as disability criteria, while developing countries use ≥ 41 dB PTA. The World Health Organization uses ≥ 41 dB disabling hearing loss in better ear. Studies show widespread use of a single frequency threshold in some countries can exclude milder losses. Individualized approaches accounting for communication function, rather than fixed PTA cut-offs alone, enable more accurate disability determination. Further research on optimal, equitable criteria accounting for resource availability is needed. Standardized guidelines balancing sensitivity and specificity in disability determination worldwide would enable improved rehabilitation access and outcomes.

Unmasking the Masquerade: Lessons from a Case of Spontaneous Mid-Clival CSF Leak Mimicking an Ethmoidal Leak.

Spontaneous cerebrospinal fluid (CSF) leaks are an uncommon clinical entity, often challenging to diagnose accurately. We present a unique case of a patient with symptoms suggestive of an ethmoidal CSF leak, initially supported by radiological findings, but ultimately revealed to be a mid-clival CSF leak (from the posterior wall of the sphenoid sinus). This case underscores the complexities of diagnosing CSF leaks and highlights the importance of surgical exploration in cases where radiological evidence appears contradictory. The patient's Computed Tomography scan indicated a CSF leak in the cribriform plate, prompting a surgical approach to address this region. However, intraoperative findings surprisingly revealed no evidence of leak in the cribriform plate but instead a posterior wall of the sphenoid defect as the culprit. This report emphasizes the critical role of interdisciplinary collaboration, meticulous preoperative and intraoperative assessment, and adaptability in managing challenging cases of CSF leaks, ultimately leading to successful surgical repair and improved patient outcomes. It serves as a valuable reminder for clinicians to consider the possibility of a masquerading CSF leak when clinical and radiological findings do not align, thereby facilitating more precise diagnosis and targeted treatment.

Unilateral Fenestration of Internal Jugular Vein With a Radiological Clue: A Rare Case Report and Literature Review.

The intricacies of human anatomy continue to astound, as underscored by this unusual case of a 45-year-old female patient who presented to our esteemed otolaryngology department with T3N1MO squamous cell carcinoma of the lip. The preoperative diagnostic imaging of this patient divulged an enigmatic venous anomaly involving the internal jugular vein (IJV). Our team meticulously orchestrated a wide local excision of the primary tumor and modified radical neck dissection with Abbe Estlander flap reconstruction. Identification of the anomaly during the preoperative phase helped in meticulous planning and preparation. Thus, the surgical team was well-prepared for neck dissection and successfully navigated the rare IJV fenestration without incurring nerve or vascular injuries. This remarkable case accentuates the importance of maintaining a profound understanding of potential anatomical aberrations while performing intricate surgical procedures such as neck dissections. Heightened awareness can circumvent inadvertent damage to critical structures, ultimately safeguarding patient well-being. In this captivating report, we explain the preoperative suspicion, intraoperative identification, and subsequent outcome of a rare fenestration of the IJV encountered during a challenging neck dissection.