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