MyMedR

Fulltext Postauricular swelling secondary to salmonella extradural abscess in a toddler: a near miss condition

Lim CC, Saniasiaya J, Kulasegarah J

BMJ Case Rep, 2021 Jul 01;14(7).

PMID: 34210704 DOI: 10.1136/bcr-2021-243412

Postauricular swelling is usually encountered in an emergency setting in otorhinolaryngology, resulting from complication of acute or chronic suppurative otitis media. Besides that, postauricular swelling may occur secondary to various other conditions including infectious disease, tumour, vascular malformation, granulomatous condition and even trauma. Children less than 2 years old are prone to fall and up to 10% sustain traumatic brain injury without any obvious signs of neurological deficit. We describe a rare case of a postauricular swelling in a toddler which turned out to be salmonella extradural abscess from an infected traumatic haematoma. The importance of high clinical suspicion especially in a child with a history of fall cannot be emphasised more because a missed brain abscess could lead to potentially life-threatening problems. We would like to highlight that meticulous history taking along with prompt assessment and intervention is prudent for a better prognosis and recovery.

Matched MeSH terms: Otitis Media, Suppurative*

Fulltext Cervical necrotising fasciitis consequent to mastoid infection

Chua HK, Chandra Segar CB, Krishnan R, Ho CK

Med J Malaysia, 2002 Mar;57(1):104-7.

PMID: 14569726

We present a case of cervical necrotising fasciitis in a 56 year old man, secondary to a rare mastoid infection. The patient had coexisting diabetes mellitus and hypertension. He was treated with early surgical debridement followed by neck and chest reconstruction and radical mastoidectomy. Aggressive antibiotic therapy and supportive care was given. He recovered well with minimal residual functional deficit.

Matched MeSH terms: Otitis Media, Suppurative/complications*; Otitis Media, Suppurative/pathology; Otitis Media, Suppurative/therapy

Fulltext Dural tear post mastoidectomy repaired with Dura Gen

Wong CY, Khairi MD, Mohamed SA, Irfan M

Med J Malaysia, 2010 Dec;65(4):307-8.

PMID: 21901952

Dural exposure may occur during the course of thinning the tegmen tympani and tegmen mastoideum in mastoid procedure. If large area of dura is exposed or lacerated, cerebrospinal fluid and brain herniation may enter the mastoid cavity. We report a case of a patient with injured dura mater and tegmen mastoideum during mastoidectomy for chronic suppurative otitis media with cholesteatoma managed by using DuraGen. The dura mater and tegmen defect healed totally showing the success of the procedure. A collagen matrix like DuraGen is an option for repairing dural tear in mastoid region.

Matched MeSH terms: Otitis Media, Suppurative/surgery*

Use of pre-reduced swabs in bacteriology of chronic suppurative otitis media

Indudharan R, Haq JA

J Laryngol Otol, 1996 Oct;110(10):950-1.

PMID: 8977860

A simple, safe and effective procedure for improving the bacterial isolation in chronic suppurative otitis media (CSOM) is described. It is most useful for the isolation of aerobes as well as anaerobes from the middle ear.

Matched MeSH terms: Otitis Media, Suppurative/microbiology*

Antibiotics in chronic suppurative otitis media: a bacteriologic study

Indudharan R, Haq JA, Aiyar S

Ann Otol Rhinol Laryngol, 1999 May;108(5):440-5.

PMID: 10335703

Conservative medical management of chronic suppurative otitis media (CSOM) is an important step in achieving a dry ear. Topical antibiotic ear drops and aural toilet form the mainstay of medical management of noncholesteatomatous CSOM. This study analyzes the causal organisms and their sensitivity to various antibiotics. Out of 382 swabs examined, the major organisms isolated were Pseudomonas aeruginosa (27.2%), followed by Staphylococcus aureus (23.6%). The sensitivity of P. aeruginosa was 100% to ceftazidime, 98.9% to ciprofloxacin, 96.3% to gentamicin, and 95.4% to polymyxin B, whereas the sensitivity of S. aureus was 98.6% to ciprofloxacin, 97.4% to cloxacillin sodium, 96.5% to cotrimoxazole, and 90.7% to gentamicin. Pseudomonas aeruginosa was almost completely resistant to ampicillin (97.6%) and chloramphenicol (96.6%), whereas S. aureus was almost completely resistant to ampicillin (73.8%) and polymyxin B (98.3%). Among the available topical antibiotic preparations for use in the ear, we found that ciprofloxacin and gentamicin are the best choices.

Matched MeSH terms: Otitis Media, Suppurative/drug therapy; Otitis Media, Suppurative/microbiology*

Complications of chronic suppurative otitis media: a left otogenic brain abscess and a right mastoid fistula

Chew YK, Cheong JP, Khir A, Brito-Mutunayagam S, Prepageran N

Ear Nose Throat J, 2012 Oct;91(10):428, 430.

PMID: 23076851

Otogenic brain abscess and postauricular fistula are complications of chronic suppurative otitis media. We describe a rare case of bilateral chronic suppurative otitis media that caused a left temporal lobe abscess and a right mastoid fistula.

Matched MeSH terms: Otitis Media, Suppurative/complications*; Otitis Media, Suppurative/microbiology; Otitis Media, Suppurative/therapy

Parotid Gland Carcinoma Masquerading as an Aural Polyp

Subha ST, Abu-Bakar S, Prepageran N

Iran J Otorhinolaryngol, 2019 Sep;31(106):315-318.

PMID: 31598500

Introduction: Parotid gland squamous cell carcinoma is an uncommon aggressive neoplasm with poor prognosis. Aural polyps are usually the presenting features of chronic suppurative otitis media, tuberculous otitis media, and adenoma or carcinoma. The malignant aural polyp is very rare. Parotid gland carcinoma masquerading as an aural polyp has rarely been described in the literature.

Case Report: We report a case study of parotid squamous cell carcinoma in a 29-year-old male masquerading as an ear polyp.

Conclusion: Parotid gland primary squamous cell carcinoma is a rapidly advancing neoplasm which carries poor prognosis despite multimodality treatment. Diligent clinical and histopathological evaluation is imperative to discriminate this rare aggressive disease from the metastatic and other primary cancers of the parotid. A high index of suspicion is crucial in refractory aural polyps to arrive at early diagnosis.

Matched MeSH terms: Otitis Media, Suppurative

Bilateral nontuberculous mycobacterial middle ear infection: a rare case

Tang IP, Singh S, Rajagopalan R

Ear Nose Throat J, 2014 Sep;93(9):390-4.

PMID: 25255345

Nontuberculous Mycobacterium (NTM) middle ear infection is a rare cause of chronic bilateral intermittent otorrhea. We report a rare case of bilateral NTM middle ear infection in which a 55-year-old woman presented with intermittent otorrhea of 40 years' duration. The patient was treated medically with success. We conclude that NTM is a rare but probably under-recognized cause of chronic otitis media. A high index of suspicion is needed for the diagnosis to avoid prolonged morbidity. Treatment includes surgical clearance of infected tissue with appropriate antimycobacterial drugs, which are selected based on culture and sensitivity.

Matched MeSH terms: Otitis Media, Suppurative/diagnosis*; Otitis Media, Suppurative/drug therapy; Otitis Media, Suppurative/pathology; Otitis Media, Suppurative/surgery

Fulltext Extensive dural sinus thrombosis and bilateral lateral rectus palsy as an uncommon complication of chronic suppurative otitis media

Balasubramanian A, Mohamad I, Sidek D

BMJ Case Rep, 2013;2013.

PMID: 23355565 DOI: 10.1136/bcr-2012-007414

Dural venous sinus thrombosis, especially of the sigmoid sinus, is a known but uncommon intracranial extradural complication of chronic suppurative otitis media. Even rarer is the simultaneous occurrence of bilateral abducens palsy in the same patient. We report the case of an adolescent male who presented with signs of raised intracranial pressure, diplopia and bilateral lateral rectus palsy associated with a history of left ear discharge and neck swelling. Extensive dural sinus thrombosis extending right up to the left internal jugular vein was confirmed on CT imaging. The patient was successfully treated with thrombolytic agents and antibiotic therapy. The pathophysiology of the concurrent complications is discussed.

Matched MeSH terms: Otitis Media, Suppurative/complications*; Otitis Media, Suppurative/diagnosis*

Role of glucocorticoids in ototopical antibiotic-steroid preparations in the treatment of chronic suppurative otitis media

Indudharan R, Valuyeetham KA, Raju SS

Arch Med Res, 2005 Mar-Apr;36(2):154-8.

PMID: 15847949 DOI: 10.1016/j.arcmed.2004.12.012

It is conventional to use antibiotic-steroid combination eardrops, although the advantage of steroid combination has not been substantiated. The present prospective randomized comparative study is designed to assess the role of glucocorticoids in ototopical antibiotic-steroid preparations in the treatment of chronic suppurative otitis media (CSOM).

Matched MeSH terms: Otitis Media, Suppurative/drug therapy*; Otitis Media, Suppurative/microbiology

Diagnostic challenges in tuberculous otitis media

Tang IP, Prepageran N, Ong CA, Puraviappan P

J Laryngol Otol, 2010 Aug;124(8):913-5.

PMID: 20426886 DOI: 10.1017/S0022215110000265

To demonstrate the different clinical presentations of tuberculous otitis media and the management of selected cases.

Matched MeSH terms: Otitis Media, Suppurative/diagnosis*; Otitis Media, Suppurative/etiology; Otitis Media, Suppurative/therapy

Fulltext Acute mastoid abscess secondary to partially treated upper respiratory tract infection: a case report

Halimuddin, S., Asma, A.

Medicine & Health, 2010;5(1):41-44.

MyJurnal

Acute mastoid abscess is common in daily practice. In children, it is usually caused by unsuccessful treatment or partially treated acute otitis media (AOM). Some authors had reported that chronic suppurative otitis media (CSOM) can be the source of infection but it is usually associated with the presence of cholesteatoma. A case of an acute mastoid abscess in a 7 year old girl is presented. She had a history of severe otalgia with left post auricular swelling for 3 days. Clinically she was febrile, the left otoscopy showed diffuse post auricular swelling and sagging of the posterior wall of the external canal. She underwent an emergency cortical mastoidectomy for the left mastoid abscess and had an uneventful recovery. In conclusion, this patient was partially treated with antibiotics which increased the risk for ‘masked mastoiditis’, and she later developed a mastoid abscess. Therefore we advocate that all AOM patients should be treated with antibiotics at least for a duration of one week.

Matched MeSH terms: Otitis Media, Suppurative

Microbiology of cerebral abscess: a four-year study in Malaysia

Pit S, Jamal F, Cheah FK

J Trop Med Hyg, 1993 Jun;96(3):191-6.

PMID: 8505776

A prospective study was carried out to determine the aetiology of cerebral abscess in relation to the primary source of infections. Seventy-five patients with cerebral abscess were included in the study in the period January 1985 to December 1988. More than half of the patients studied had single lesions and the overall most common sites were in the frontal and parietal regions. Chronic suppurative otitis media, cyanotic congenital heart diseases and meningitis were among the important predisposing conditions in these patients. Approximately 25% of the patients with cerebral abscesses had no documented antecedent infections. Pure cultures were found to be predominant (66.7%) and sterile cultures were obtained from 10 (13.3%) patients. Streptococci were isolated from 23 (30.7%) patients, the commonest species being Streptococcus milleri. Proteus sp, Pseudomonas aeruginosa, Pseudomonas putrifaciens and Bacteroides sp were almost exclusively found in cerebral abscesses secondary to chronic suppurative otitis media; these organisms were found in mixed cultures. Streptococcus milleri, Bacteroides sp and Eikenella corrodens were found in pure cultures in patients with cyanotic congenital heart disease. In patients with ventriculoperitoneal shunts in-situ, Staphylococcus aureus, Staphylococcus epidermidis and diphtheroids were common. Anaerobes were found in 15 (20.0%) patients, the majority in mixed cultures. Culture, as well as gas-liquid chromatographic analysis of volatile fatty acids of cerebral pus, was carried out to enhance the detection of the anaerobes. Based on these findings, an antibiotic regimen consisting of penicillin, chloramphenicol and metronidazole is recommended as an initial therapy while awaiting culture and sensitivity results.

Matched MeSH terms: Otitis Media, Suppurative/complications

Fulltext Clinical characteristic of vertigo in children

Rosdan S, Basheer L, Mohd Khairi MD

Med J Malaysia, 2015 Aug;70(4):220-3.

PMID: 26358017 MyJurnal

Objective: To review the clinical characteristic of vertigo in children.
Method: A retrospective observational study was done on children who presented to a specialised vertigo clinic over period of six years. The patients’ case notes were retrieved from the medical record unit and reviewed. All patients were seen by an otologist who thoroughly took down history, completed ear, nose, throat and neurological examination.
Result: Seven different causes were identified in 21 patients (86%) while no diagnosis was reached in three patients (12.5%). The most common cause of giddiness was childhood paroxysmal vertigo (33%) followed by benign paroxysmal positional vertigo (16.6%) and sensorineural hearing loss (12.5%). Other causes include chronic suppurative otitis media and anxiety disorder each accounting for 8.3%, one case of cholesteatoma and another case of ear wax each accounting for 4.1%.
Conclusion: It is not uncommon for the children to be affected by vertigo. Management of vertigo in children should include a detailed history, clinical examination, audiological and neurological evaluation. Imaging should be performed in selected patients. The main cause of vertigo in our series is CPV. The outcome of most of the patients is good.

Matched MeSH terms: Otitis Media, Suppurative

The association of allergy and chronic suppurative otitis media: A study in a tropical country

Mohd Khairi MD, Shahrjerdi B, Ramiza RR, Normastura R

Med J Malaysia, 2019 Jun;74(3):205-208.

PMID: 31256174

OBJECTIVE: Chronic suppurative otitis media (CSOM) usually begins as a spontaneous perforation of tympanic membrane due to an acute infection of the middle ear. This study was aimed to evaluate the association between allergy and CSOM.

METHODS: A case-control study was carried out among patients with CSOM (cases) and controls were those with no ear pathology. The presence of CSOM was made through a medical history and otoscopic examination. Allergen testing was done by the skin prick test.

RESULTS: In all 124 subjects were recruited in this study with equal number of the cases and controls. The commonest positive reaction in the skin prick test in both groups was to house dust mites. Among CSOM cases, half (50%) of them had an allergy to Blomia tropicalis and 48.4% to Dermatophagoides while in the control group, 27.4% to Dermatophagoides and 25.8% to B. tropicalis. There were significant associations between CSOM and allergy to B. tropicalis (p=0.005), Dermatophagoides (p=0.016) and Felis domesticus (p=0.040). The prevalence of allergy at 95% confidence interval (95%CI) in CSOM and control groups were demonstrated as 59.7% (95%CI: 47.5, 71.9) and 30.6 % (95%CI: 19.1, 42.1) respectively. There was a significant association between allergy and CSOM (p=0.001).

CONCLUSION: Indoor allergens are the most prevalent in our environment and therefore good control may difficult to achieve. The hypersensitivity states of the subject are likely to have a role in the pathogenesis of CSOM especially in the tropical countries where allergy occurs perennially.

Matched MeSH terms: Otitis Media, Suppurative

Determination of the biofilm formation capacity of bacterial pathogens associated with otorhinolaryngologic diseases in the Malaysian population

Khosravi Y, Ling LC, Loke MF, Shailendra S, Prepageran N, Vadivelu J

Eur Arch Otorhinolaryngol, 2014 May;271(5):1227-33.

PMID: 23880921 DOI: 10.1007/s00405-013-2637-3

This study aims to assess the association between microbial composition, biofilm formation and chronic otorhinolaryngologic disorders in Malaysia. A total of 45 patients with chronic rhinosinusitis, chronic tonsillitis and chronic suppurative otitis media and 15 asymptomatic control patients were studied. Swab samples were obtained from these subjects. Samples were studied by conventional microbiological culturing, PCR-based microbial detection and Confocal Laser Scanning Microscopy (CLSM). Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, coagulase-negative staphylococci (CoNS) and other Streptococcus species were detected in subjects of both patient and control groups. Biofilm was observed in approximately half of the smear prepared from swab samples obtained from subjects of the patient group. Most of these were polymicrobial biofilms. S. aureus biofilm was most prevalent among nasal samples while H. influenzae biofilm was more common among ear and throat samples. Results from this study supported the hypothesis that chronic otorhinolaryngologic diseases may be biofilm related. Due to the presence of unculturable bacteria in biofilms present in specimens from ear, nose and throat, the use of molecular methods in combination with conventional microbiological culturing has demonstrated an improvement in the detection of bacteria from such specimens in this study.

Matched MeSH terms: Otitis Media, Suppurative/microbiology

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