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.

Feasibility of a bilateral regional sternocleidomastoid muscular flap in the closure of a persistent acquired tracheopharyngeal fistula.

An acquired persistent tracheopharyngeal fistula secondary to an infected tracheopharyngeal voice prosthesis is a common cause of recurrent aspiration pneumonia in a postlaryngectomy patient. We report a case of a successfully treated tracheopharyngeal fistula whereby both the sternocleidomastoid muscles were used as muscular flaps to close the defect and its outcome.

Study of epithelial migration in the tympanic membrane and bony external auditory canal wall in patients with irradiated nasopharyngeal carcinoma.

OBJECTIVE: The objectives of this study were to determine the presence of epithelial migration in patients with postirradiated nasopharyngeal carcinoma (NPC) and to compare the rate of epithelial migration in the tympanic membrane (TM) and the bony external auditory canal (EAC) of postirradiated NPC ears with normal ears by means of the ink dot method. STUDY DESIGN: Prospective, nonrandomized case-control study involving patients with NPC and control subjects with healthy ears seen in an otorhinolaryngology outpatient clinic. SETTING: Otorhinolaryngology Outpatient Clinic, University Malaya Medical Centre, Kuala Lumpur. PATIENTS: Patients with NPC who have completed radiotherapy and patients with normal ear presenting with other complaints. INTERVENTION: Patients who fulfilled the inclusion and exclusion criteria were chosen for this study. All the selected patients' ears were visualized under a microscope and were cleaned, and ink dots were applied at the umbo and annulus. They were followed up on a 2- to 3-weekly basis until the ink dots reached the specified landmarks. The distance and pattern of migration were recorded and calculated. The mean radiation dose received by both the right and left TM and EAC was mapped and calculated. MAIN OUTCOME MEASURES: Rate and pattern of epithelial migration in the NPC group compared with that in the control group. RESULTS: The mean radiation dose to both the TM and EAC did not show a significant difference (p > 0.05). The entire TM study group showed epithelial migration from the umbo toward the annulus and EAC, except in 1 ear. The mean rate of epithelial migration on the TM of the study group was 51.35 µm/d compared with that on the control group, which was 64.68 µm/d, and this difference was statistically significant (p < 0.05). Of the ears in the control group, 42.5% showed a migration pattern toward the posterior-superior direction, whereas 45% of the ears in the study group showed a migration pattern toward the posterior-inferior direction. In the EAC of the study group, the mean epithelial migration was noted to be accelerated compared to that of the control group (144.75 and 94.33 µm/d, respectively; p < 0.05). The mean rate of migration between the TM and the EAC was also different. Both the study and control groups showed a significant difference in migration, with a faster rate of migration in the EAC (p < 0.05). CONCLUSION: We noted a significant delay in the rate of epithelial migration in the TM of patients with postirradiated NPC and an accelerated rate of migration in the EAC of patients with postirradiated NPC. In addition, epithelial migration in the EAC was also noted to be faster than that in the TM of the control population.

Congenital cholesteatoma presenting with Luc's abscess.

Congenital cholesteatoma (CC) rarely presents with Luc's abscess. As a result of widespread usage of antimicrobial agents, Luc's abscess is hardly encountered in current clinical practice. Herein, we report a case of Luc's abscess as the first presenting symptom in a 5-year-old boy with underlying CC. Patient's clinical findings, radiological investigations and treatment were also discussed.