Acute epiglottitis though relatively common in pediatric patients as compared to adults, present with almost similar clinical presentations. They include voice change, difficulty or painful swallowing and sometimes with upper airway obstruction. Physical finding of swollen epiglottis is difficult to be obtained owing to the danger of introducing laryngeal mirror into the oropharynx as to avoid contact spasm. The diagnostic thumb sign appearance on lateral neck radiograph is considered pathognomonic of epiglottitis. We report a case of an adult with clinical features and radiological finding of an acute epiglottitis, which did not resolve with antibiotic treatment. Subsequent imaging confirmed the presence of an abscess in the epiglottic mucosa.
Tinnitus is not a disease per se but it is a symptom. It can be either subjective or objective type and the
underlying cause varies such as tumour, infection, vascular abnormality or Meniere’s disease. Foreign body in the external ear is a common presentation especially in children. However, foreign body in the middle ear manifested with only symptom of tinnitus is a rare and unexpected presentation. Foreign body in the middle ear are commonly due to iatrogenic cause such as complication of myringotomy and ventilation tube insertion surgery. There are reported cases of complications of myringotomy and ventilation tube insertion, and they typically presented with the ear infection manifestation, myringosclerosis or permanent perforation of tympanic membrane. Currently, there are only few reported cases in literatures of foreign body in the middle ear following complication of medial migration of ventilation tube into a middle ear with intact tympanic membrane.