Clinical Audiogram of the Week: vol5, no10

This case was presented in a recent (vol5,no10) issue of otorhinolaryngology news:

A 37-year old female presented with 1 year history of right aural tinnitus, hearing loss, and initial vertigo which had since resolve. The only significant medical history is allergic rhinitis which is seasonal. Clinical examination including Otoscopy was negative. Pure Tone Audiometry revealed the audiogram demonstrated here:

Diagnosis: Right Meniere's Syndrome. 'Syndrome' and not 'Disease' because the underlying aetiology suspected here is allergy. Hearing loss in Meniere's disease is thought to be caused by distortion of the basilar membrane by fluid pressure an effect maximized at its widest point. This point is at the apical turn, hence the low frequency character of the typical hearing loss. In our experience, this hearing loss is the most difficult to correct of the triad that characterize this syndrom

RE: Case of The Week - Vol6, No2

This case was presented in a recent edition of the otorhinolaryngology news:

A 27-year-old female presented with hoarseness of 5 months duration. Symptom dated to last delivery that was complicated, necessitated prolonged intubation and nasogatric tube feeding for over a week. Hoarseness has been persistent since then. No associated cough or breathlessness. Indirect Laryngoscopy revealed the features shown here.

Post intubation laryngeal polyp of the type seen here is presumably rare. At direct micro-laryngo-bronchoscopy, supraglottic polypoidal masses, on either side, and with ball-valve effects were seen and excised. Immediate post op disappearance of hoarseness was noted.

Clinical Photo of The Week: Vol3,No9

The following case was presented in vol3,No9 of otorhinolaryngology newsletter:
A 41-year old male presented with recurrent epistaxis and persistent sero-sanguinous rhinorrhoea following radiotherapy treatment for a lesion biopsied from his right gingivo-buccal sulcus, and histologically diagnosed as squamous cell carcinoma. Examination revealed the sign demonstrated in this picture and negative orbital or neurological signs. CT-Sinuses showed soft tissue opacity completely filling right maxillary sinus with extension to right ethmoidal air cells, nasopharynx, right nasal cavity and erosion of anterior wall of right maxilla. An opaque ipsilateral sphenoid sinus was also found. No orbital extension was found and ipsilateral pterygoid plate was free. Vision was good in both eyes.

The Best Management Option? Well, On account of nasopharyngeal involvement, some authorities advocate irresectability. However, on account of the young age of this patient, and the fact that vision was excellent both eyes, we offered him right extended Denker's approach combined with right infrastructure maxillectomy. Cheeck flap margin was free, nasal septal margin was involved. We have followed him up for 4 months now with good healing and no reccurence so far.

Clinical Photo of The Week: Vol3, No8

This case waspresented in the recent edition (Vol3,N08) of the otorhinolaryngology news :
A 65-year old male presented with insidious onset of dysphagia, especially to saliva and solids of 3 months duration, and inability to properly open the left eye of one week duration. His medical history revealed well controlled hypertension. He had no nasal symptoms and denied preceding cervico-facial or cranial trauma. Examination revealed the sign shown in this picture. MRI brain was negative. CT-Sinuses showed isolated right maxillary polyp. A follow-up visit a week later revealed bilateral ptosis with additional complaints of muscle weakness and easy fatigability.
Diagnosis: Myasthenia gravis. It wasn't until weakness, proximal myopathy and ptosis involving the second eye appeared that the diagnosis became obvious. In the abscence of these, a strong differential will be extraocular mithochondrial myopathies.

Clinical Photo of The Week: Vol3,No6

This case was presented in the recent edition (Vol3No6) of otorhinolaryngology news :
A 48-year old male presented with a year history of diminished hearing on the left. He gave a history of left ear canal surgery 10 years earlier. The surgery was to correct post traumatic closure of left ear canal observed following a vehicular accident. Examination revealed the sign shown in this picture. CT-Scan showed normal distal 1/3rd bony canal, normal middle and inner ear, and soft tissue density in the outer 2/3rd ear canal. Audiometry revealed air-bone gap of 15-20dB across speech frequencies.
Diagnosis: Restenosis following initial surgically repaired acquired canal atresia

Clinical Audiogram of The Week - Vol3,No4

This case was presented in the recent (vol3No4) edition of otorhinolaryngology news: An 46-year old male presented with difficulty in hearing conversation speech of 12 years duration. He often resorted to carrying out 'Toynbee's maneuvre" - swallow against pinched nose, closed mouth in order to be able to hear in the right ear. He gave a history of unsuccessful ossiculoplasty both ears ten years previously. Examination revealed bilaterally normal EACs and Tympanic membranes. Tuning fork assessment revealed bilateral conductive hearing loss. Pure tone audiometry revealed the audiogram displayed here. You may click on the audiogram to view a larger picture of the audiogram.
Diagnosis: Bilateral Conductive Hearing Loss with wide air-bone gap. Otosclerosis was the initial diagnosis, but exploratory tympanotomy revealed loose PORP in the right middle ear. The patient demonstrated significant amplification gains and is doing well on binaural ITC Hearing aids.

Clinical Photo of The Week: Vol3, No3

The following case was presented in a recent (Vol3,No3) edition of otorhinolaryngology news:
An 11-year old female was referred on account of 3 weeks history of progressive right sided neck swelling not responsive to conventional antibiotics. she had associated fever, odynophagia and dysphagia, but no preceding dental or throat symptoms. Examination revealed high fever, (T=39.80Celsius), pallor, tinge of jaundice, dry coated tongue with thick adherent whitish plaque on the dorsum, trismus and the neck sign demonstrated in this picture. Her ESR was markedly elevated, Her PCV was 20, Only anomaly on E/U/Cr was hypokalemia (K+ = 2.5 mEq/L). Her retroviral screen was negative.
Diagnosis: Deep Neck Infection (DNI). This patient had an initial parapharyngeal space infection which subsequently spread to the submandibular and masseteric spaces. Click Here for factors affecting the bacteriology in DNI.

Clinical Photo of The Week - Vol3, No2

This case was presented in the recent edition of the otorhinolaryngology news:
A 30-year old male was referred on account of 11 months history of right sided epistaxis, 3 months history of twisting of the face to the left side, and drooping of upper right eyelid. He had always done clerical jobs. Examination revealed right ptosis, right complete lower motor neuron facial nerve palsy, right soft palatal paralysis and the tongue sign demonstrated in this picture. EUA postnasal space revealed scanty soft tissue mass admixed with old blood clots. You may want to view his MRI of sinuses / brain findings for more detail.
Diagnosis: Parapharyngeal Tumour involving the skull bas with multiple cranial neuropathy