Intractable Sneezing Unfolding a Hideous Truth.

Intractable sneezing is a diagnosis of exclusion and is mostly psychogenic. We reported a case of an 11-year-old girl who presented with uncontrollable bouts of sneezing for three weeks, which did not respond to conventional treatment. She was eventually diagnosed to have psychogenic intractable sneezing, which was triggered by an unfortunate family circumstance. She improved with psychotherapy and was discharged well. Literature review on intractable sneezing showed that patients were predominately female teenagers and mostly recovered after psychotherapy. Multidisciplinary team effort especially with a child psychiatrist is important for the treatment and follow-up of these patients. Imaging should also be routinely performed as some had underlying organic causes that presented as intractable sneezing.

Antibiotic Irrigation: A Promising Unconventional Method for Facial Carbuncle.

Carbuncle is conventionally treated with combinations of intravenous antibiotics and surgical intervention; be it saucerization or incision and drainage. Cosmesis outcome might be unfavorable following surgical intervention, especially when the facial region is involved. Skin grafting surgery may even be needed as a second-stage procedure for a larger wound. We reported a series of three facial carbuncles treated successfully with a new improvised method. Our method includes performing a stab incision prior to draining of pus, coupled with minimal wound debridement, followed by regular irrigation of the wound with antibiotics containing solution. Based on the three cases reported in this article, we conclude that this method is more superior as there is more skin preservation, better patient tolerance, shorter hospital stays, and favorable cosmesis outcome.

A Rhinolith Turning Out to Be an Intranasal Tooth.

A tooth in the nasal cavity is an uncommon phenomenon. The exact mechanism is unclear, and patients may present with non-specific nasal symptoms. We encountered a 24-year-old patient with history of cleft palate repair, presenting to us with unilateral nasal discharge not improving with conventional medications. Rigid nasal endoscopy revealed a rhinolith-like foreign body at the floor of the left nasal cavity. Removal of the rhinolith was done under general anesthesia, and it turned out to be an intranasal tooth. Intranasal tooth is often misdiagnosed due to its non-specific symptoms. Detailed dental and oropharyngeal examination as well as imaging studies are essential in diagnosing an intranasal tooth. Early surgical removal is the mainstay of treatment in order to prevent further complications. Patients with unilateral nasal symptoms not responding to conventional treatment require proper ear, nose, and throat (ENT) evaluation to rule out other pathology.

A Rare Case of an Undiagnosed Middle Ear Tumor Due to Late Referral.

Facial nerve tumors constitute about 5% of all facial nerve paralysis. As it is relatively uncommon, it could be misdiagnosed. We encountered an 18-year-old girl who had right facial weakness since the age of four, referred to otorhinolaryngology clinic for further evaluation only when her hearing deteriorated and the facial weakness worsened. Further investigation revealed facial nerve schwannoma. Facial nerve paralysis in the pediatric age group is uncommon and should be examined in detail to rule out other possible etiologies besides Bell's palsy.

A Rare Case of Pseudomembranous Tracheitis Presenting as Acute Stridor in a Patient after Extubation.

Pseudomembranous tracheitis is a rare life-threatening complication of endotracheal intubation. The exact mechanism of its formation is not well known, and it could mimic crusting or retained secretions in the trachea. We encountered a patient with history of recent intubation, presenting with acute stridor requiring emergency airway stabilization, and was eventually found to have pseudomembranous tracheitis.

Concurrent Mastoid Cellulitis and Langerhans Cells Histiocytosis: A Challenging Diagnosis.

Langerhans cell histiocytosis (LCH) is a rare proliferative disorder, which commonly arises in the bone and may involve other systems. To date, the diagnosis of temporal bone LCH remains a challenge as it may masquerade as a common ear infection. We report a case of a child who presented to us with persistent bilateral ear discharge for four months and was not responding to treatment. Her condition subsequently worsened, with clinical features and radiological findings suggestive of mastoid cellulitis. Nevertheless, further histopathology study revealed LCH.