Dysphagia due to necrotizing otitis externa

2021 ◽  
Author(s):  
Rajesh Dwivedi ◽  
Melroy Rasquinha ◽  
Rowan Harwood
Keyword(s):  
External Auditory Canal ◽  
Otitis Externa ◽  
Sinus Thrombosis ◽  
Oropharyngeal Dysphagia ◽  
Lower Cranial Nerve ◽  
Venous Sinus Thrombosis ◽  
Necrotizing Otitis Externa ◽  
Intravenous Antibiotics ◽  
Patient Reported ◽  
High Index Of Suspicion

Abstract An 88-year-old man presented with delirium, and subsequently developed hoarseness and oropharyngeal dysphagia. This was due to skull-based osteomyelitis from necrotizing otitis externa (NOE), causing lower cranial nerve (X, XII) palsies and venous sinus thrombosis. Diagnosis was delayed as the patient reported no otalgia, had an almost normal looking external auditory canal and was not diabetic. He deteriorated and died despite intravenous antibiotics. We need a high index of suspicion for NOE and its complications in patients presenting with otolaryngeal symptoms.

scholarly journals Case Report: Cerebral Venous Sinus Thrombosis and COVID-19 Infection

2021 ◽  
Vol 8 ◽  
Author(s):  
Manasa Anipindi ◽  
Amanda Scott ◽  
Li Joyce ◽  
Salman Wali ◽  
Mark Morginstin
Keyword(s):  
Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Oral Anticoagulants ◽  
Endothelial Activation ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Initial Symptom ◽  
Venous Sinus Thrombosis ◽  
High Index Of Suspicion ◽  
The Brain

Coronavirus disease-2019 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). Coronavirus disease-2019 (COVID-19) was declared a pandemic in March 2020 and has changed our lives in many ways. This infection induces a hypercoagulable state leading to arterial and venous thrombosis, but the exact pathophysiology of thrombosis is unknown. However, various theories have been postulated including excessive cytokine release, endothelial activation, and disseminated intravascular coagulation (DIC). We present a patient diagnosed with cerebral venous sinus thrombosis (CVST) with COVID-19 infection. A 66-year-old man presented to a hospital for evaluation of persistent headaches. He tested positive for COVID-19, and MRI of the brain and CT venogram revealed CVST. He was started on heparin drip in the hospital and transitioned to oral anticoagulants at the time of discharge. His headaches improved with treatment. Even though headache is the most frequent and initial symptom of cerebral venous thrombosis, it is rarely the only symptom. A high index of suspicion is therefore required to diagnose CVST especially if the patient presents with a simple complaint like a headache. Common complaints can delay the diagnosis leading to disease progression. Considering the high mortality rates in patients diagnosed with CVST, we suggest the importance of knowing the association between COVID-19 infection and CVST, especially in susceptible patients.

scholarly journals Synchronous Malignant Otitis Externa and Squamous Cell Carcinoma of the External Auditory Canal

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
R. Y. Chin ◽  
T. B. V. Nguyen
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
External Auditory Canal ◽  
Otitis Externa ◽  
Concomitant Treatment ◽  
The Third ◽  
Intravenous Antibiotics ◽  
Malignant Otitis Externa ◽  
Synchronous Tumour

Objectives. To discuss the management of a squamous cell carcinoma in the presence of malignant otitis externa.Study Design. We present only the third reported case in the literature of a synchronous tumour with malignant otitis externa in the literature.Methods. A case report and review of malignant otitis externa and squamous cell carcinomas of the external auditory canal are discussed.Results. A 66-year-old female is presented here with a 2-month history of a painful, discharging left ear refractory to standard antibiotic therapy. Computerised tomography, magnetic resonance imaging, technetium 99 m, and gallium citrate Ga67 scans were consistent with malignant otitis externa. Biopsy in the operating theatre revealed a synchronous squamous cell carcinoma of the external auditory canal. Primary resection of the tumour and surrounding tissues was performed with concomitant treatment with intravenous antibiotics.Conclusions. This is only the third case to be reported in the literature and highlights several important diagnostic and management issues of these two rare conditions. Both conditions may present in a similar manner on clinical assessment and radiological investigations. Aggressive management with surgical resection and treatment with appropriate intravenous antibiotics is necessary to give the best chance for cure.

Necrotizing Otitis Externa During Induction Therapy for Acute Lymphoblastic Leukemia

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 882-885
Author(s):  
Lawrence J. Wolff
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Induction Therapy ◽  
Otitis Externa ◽  
Lymphoblastic Leukemia ◽  
Severe Neutropenia ◽  
Ear Canal ◽  
Necrotizing Otitis Externa ◽  
Intravenous Antibiotics ◽  
External Canal ◽  
Gram Positive Cocci

In three children who were receiving acute lymphoblastic leukemia induction therapy and were severely neutropenic, necrotizing otitis externa developed. Two patients had a probing maneuver to their ear canal. Pseudomonas aeruginosa was isolated in heavy growth from the external canal of three patients and other tissues of one patient. Staphylococcus aureus was cultured from the ear canal and tissues of one patient and Streptococcus faecalis from the ear canal of another patient. Necrotizing otitis externa resolved in two patients after 2 weeks of intravenous antibiotics, debridement, and resolution of neutropenia. One patient required prolonged intravenous antibiotics and several surgical procedures. The occurrence of necrotizing otitis externa in children with acute lymphoblastic leukemia and severe neutropenia, the association of Gram-positive cocci with necrotizing otitis externa, and the importance of protecting anatomic barriers like the external ear canal in immunocompromised patients are emphasized.

scholarly journals The Erroneous Appearance of Silver Nitrate on CT Imaging in Patients with Severe Otitis Externa; A Case Series

2022 ◽  
Author(s):  
Hafsa Javed ◽  
Salman Hashmi ◽  
Asad Qayyum
Keyword(s):  
Foreign Body ◽  
Silver Nitrate ◽  
Granulation Tissue ◽  
External Auditory Canal ◽  
Otitis Externa ◽  
Case Series ◽  
Symptomatic Improvement ◽  
Ct Imaging ◽  
Intravenous Antibiotics ◽  
Granulomatous Tissue

Introduction Silver nitrate is commonly used within otolaryngology to treat granulation tissue in severe otitis externa. It appears radio-opaque on CT (computed tomography) imaging and therefore can mimic bony fragments and foreign bodies. This is particularly cumbersome when the phenomena correlates to the clinical complaint. Discussion We report two cases of 73-year-old and 75-year-old males who presented with chronic otalgia and discharge. Granulation tissue in the external auditory canal was identified and chemically cauterised with silver nitrate. Subsequent CT petrous bones demonstrated an unidentified foreign body in the canal with extensive soft tissue swelling giving an impression of a wick in situ and “minor bony erosion in the left external acoustic canal” respectively. An additional CT of a 57-year-old female who had been treated with silver nitrate for granulomatous tissue reported “multiple highly radiopaque foci in the external auditory canal, suggestive of foreign body”. Though relatively unknown, this phenomenon has been reported in literature. However, there are few reports of silver nitrate artefacts in CT images of the head no cases in the context of otitis externa. Our patients avoided further imaging or surgery following clarification with the radiologists and symptomatic improvement with long-term intravenous antibiotics. Conclusion Given the prevalence of CT imaging and cauterization in otolaryngology, we recommend contemporaneously documenting the use of silver nitrate and highlighting this on request forms to avoid alarming erroneous reports, unnecessary investigation and surgical procedures. We also recommend, where clinically acceptable, to use silver nitrate prior to imaging.

scholarly journals Case Report on Cerebral Venous Sinus Thrombosis

2021 ◽  
pp. 419-424
Author(s):  
Gaurav Mujbaile ◽  
Vaishali Tembare
Keyword(s):  
Sinus Thrombosis ◽  
Thrombus Formation ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Mri Imaging ◽  
Thrombotic Risk ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
Headache Severity ◽  
Patient Reported

Introduction: Cerebral venous sinus Thrombosis is the unusual cause of a stroke affecting both reproductively old and genetically or thrombotic risk factors (CVST). The superior sagittal sinus and the cross sinus are two most common places for thrombus formation. A 26-year-old Man was taken to the Acharya Vinoba Bhave Rural Hospital with a new-onset complex-partial convulsion with secondary generalization, headache, and emesis seven days before presentation. Later on he experienced headache which was acute in onset and continuous in nature which was associated with fever. Patient had 1 episode of seizers lasting for 3-4 mints. Which was associated with fall on ground. He complained about weakness in left upper limb. The patient was then transferred to our care institution for definitive management. On arrival, the patient’s neurological examination was done and he reported a severe headache. MRI imaging performed at our institution. The patient was followed clinically, and no posttreatment imaging studies were performed. Following a 3-day hospital stay, the patient reported a significant reduction in headache severity and was discharged home.

scholarly journals Case study of thrombosis and thrombocytopenia syndrome following administration of the AstraZeneca COVID-19 vaccine

2021 ◽  
Vol 50 ◽  
Author(s):  
Ashraf Saleh ◽  
Joel Collins
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
High Index ◽  
Venous Sinus ◽  
Post Vaccination ◽  
Venous Sinus Thrombosis ◽  
High Index Of Suspicion ◽  
Persistent Headache

Cerebral venous sinus thrombosis is a complication of the ChAdOx1 nCoV-19 vaccine that should elicit a high index of suspicion when patients present with persistent headache post vaccination.

Otitis Externa, Otitis Media, and Mastoiditis

2016 ◽  
Author(s):  
Susan Peterson ◽  
Staci Reintjes
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
External Auditory Canal ◽  
Otitis Externa ◽  
Sinus Thrombosis ◽  
Severe Disease ◽  
Topical Therapy ◽  
Resistant Bacteria ◽  
Mastoid Bone ◽  
First Line Therapy

Otitis Externa is an infection of external auditory canal. Infection typically occurs via penetration of the epithelial barrier. Patients typically present with inflammation of the auricle, external auditory canal, or outer tympanic membrane. First-line therapy includes topical acidic agents and antibiotic drops. Oral antibiotics should be considered for recurrent infections, those resistant to topical therapy, severe disease, extension beyond the external auditory canal, diabetics, or immunocompromised patients. Otitis Media is an infection of the middle ear. Patients typically present with otalgia, otorrhea, fever, irritability, anorexia, and hearing loss. Mastoiditis is an infection of the mastoid bone. Patients present with pain, swelling, and erythema over the mastoid bone. Fever, irritability, otalgia, and hearing loss are also often present. Infection can be serious and may lead to sepsis, sigmoid sinus thrombosis, and intracranial abscess if not treated appropriately. More common complications include chronic infection, resistant bacteria, and mild hearing loss.

scholarly journals Necrotizing Otitis Externa: A Disease Barely Known to Neurosurgeons

2016 ◽  
Vol 38 (03) ◽  
pp. 239-245
Author(s):  
Sérgio Augusto Vieira Cançado ◽  
Lucídio Duarte de Souza ◽  
Rodrigo Moreira Faleiro ◽  
José Maurício Siqueira
Keyword(s):  
Early Diagnosis ◽  
Skull Base ◽  
Otitis Externa ◽  
Clinical Presentation ◽  
Neurological Impairment ◽  
Diabetic Patients ◽  
Necrotizing Otitis Externa ◽  
Clinical Presentations ◽  
Malignant Otitis Externa ◽  
High Index Of Suspicion

AbstractNecrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe and rare infectious disease of the external auditory canal (EAC). Without treatment, it may progress to skull base involvement. The bacteria Pseudomonas aeruginosa is the most common causative agent (∼ 90% of the cases), and affects immunocompromised subjects, particularly diabetic patients. Severe chronic otalgia, otorrhea, and cranial nerve palsy are the most common clinical presentations. Patients with NOE are frequently referred to neurosurgery because of the neurological impairment and skull base compromise. The definitive diagnosis is frequently elusive, requiring a high index of suspicion. Several laboratorial tests, imaging modalities, and the histologic exclusion of malignancy may be required. An early diagnosis and aggressive treatment reduce morbidity and mortality. We present four NOE cases to illustrate the spectrum of clinical presentation and complementary exams. According to the literature, more effort for early diagnosis and treatment is required, and neurosurgeons play an important role in this task.

scholarly journals Facial nerve palsy in otitis externa: A red flag?

2021 ◽  
Vol 16 (1) ◽  
pp. 117-120
Author(s):  
Aliyya Badaruddin ◽  
May May Choo
Keyword(s):  
External Auditory Canal ◽  
Facial Palsy ◽  
Otitis Externa ◽  
Facial Nerve Palsy ◽  
Early Recognition ◽  
Invasive Infection ◽  
Necrotizing Otitis Externa ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Red Flag

Otitis externa is an infection of the external auditory canal. It rarely results in facial palsy except in severe cases such as necrotizing otitis externa, which is a life-threatening invasive infection of the external auditory canal. Early recognition with prompt and appropriate treatment of necrotizing otitis externa is crucial to prevent more sinister complications. Here we report a case of an elderly gentleman who presented with otitis externa and developed facial palsy a month later. We identified possible problems that may have led to the complication so that such an occurrence can be prevented in the future.

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