Microbiology and Drug Susceptibility Pattern of Bacterial Isolates from Patients with Chronic Suppurative Otitis Media at a Tertiary Care Hospital in Somalia.

Background: This study aimed to determine the microbiological profile and antibiotic susceptibility pattern of bacterial isolates obtained from patients with chronic suppurative otitis media (CSOM) presenting to the otorhinolaryngology clinic of a tertiary care hospital in Mogadishu, Somalia. Methods: A total of 225 patients diagnosed with chronic suppurative otitis media were included in the study. Samples of middle ear discharge were collected from each patient and cultured using standard microbiological techniques, and bacterial identification was performed. Drug susceptibility pattern was assessed according to the Clinical and Laboratory Standards Institute criteria. Results: The study sample (n=225) comprised 122 females and 103 males. Among 225 samples tested, bacterial growth was present in 200 (88.9%) and absent in 25 (11.1%) samples. Of 200 samples with bacterial growth, monomicrobial growth was detected in 176 (88%). Gram-positive bacteria were observed in 40 (22.7%) and Gram-negative bacteria in 136 (77.3%) samples. The bacteriology of the samples with monomicrobial growth consisted of (in decreasing frequency) Pseudomonas spp, Staphylococcus aureus, Escherichia coli, Coagulase-negative staphylococci, Proteus mirabilis, and Klebsiella sp. A high rate of resistance was detected against penicillin antibiotics, erythromycin, tetracycline, and co-trimoxazole. Resistance to cephalosporins, clindamycin, vancomycin, linezolid, daptomycin, quinupristin/dalfopristin, levofloxacin, meropenem, and ertapenem was low. Conclusion: While the frequencies of isolated bacterial species were consistent with other reports from the region, differences were observed in the antibiotic resistance of bacterial isolates when examined individually for each antibiotic. Further studies are warranted in the same region and different parts of Somalia, coupled with ongoing assessment of antibiotic susceptibility patterns in CSOM.

Excessive reactive lymphoid hyperplasia in a child with persistent obstructive sleep apnea despite previous tonsillectomy and adenoidectomy.

Both lingual tonsil and adenoid are the lymphoid tissue members of Waldeyer ring. Enlargement of the lingual tonsil and adenoid occurs in children with persistent obstructive sleep apnea despite previous tonsillectomy and adenoidectomy relatively frequently.In this article, we present a case with upper airway obstruction and infection findings because of excessive lingual tonsil and adenoid tissue hyperplasia and, additionally, bilateral multiple cervical lymphadenopathies. The patient had had tonsillectomy and adenoidectomy 8 years ago. Etiopathogenetic mechanisms, clinical, radiologic, histopathologic aspects, and surgical therapeutic options for obstructive sleep apnea related to excessive reactive lymphoid hyperplasia in children are discussed reviewing the literature.

Composite cartilage island grafts in type 1 tympanoplasty: audiological and otological outcomes.

Tympanoplasty is a surgical procedure used for eradicating chronic middle ear infection and for reconstructing hearing in infected ears. Independent from the graft placing technique, the atrophy and the insufficiency of the graft material would be seen.For cases at high risk for failure, such as recurrent perforations, total perforations, and severely atelectatic tympanic membranes, many surgeons have used cartilage as a grafting material because of its increased stability and resistance to negative middle ear pressure. Various cartilage grafting techniques have been described, including the palisade, cartilage island, and cartilage shield.In our study, we investigated audiological and otological outcomes of tympanoplasty type 1 with composite cartilage island grafts. Between 2004 and 2008, 100 cases of composite cartilage island tympanoplasty were identified. A total of 74 patients were attended to in this study. Graft take was evaluated in all patients, and postoperative complications were noted. Hearing results were analyzed by comparing the preoperative and postoperative pure-tone average air-bone gap. Graft take was accomplished in 72 patients (97.29%). There was no graft lateralization or displacement in the middle ear. The mean postoperative pure-tone average air-bone gap improvement was 20.2 dB at 500 Hz, 23.58 dB at 1000 Hz, 22.23 dB at 2000 Hz, and 24.79 at 4000 Hz.Our study indicates that composite cartilage island tympanoplasty has a high degree of reliability and excellent hearing improvement especially in patients at high risk for graft failure.

Mandibular ramus epidermal inclusion cyst.

Epidermal inclusion cyst in the mandibular ramus is a very rare condition. Intraosseous epidermal cysts are benign cysts appearing clinically as radiolucent lytic bone lesions. Definitive diagnosis is made with histopathologic examination. Treatment is simple curettage and grafting if the defect is large. We present a case of a 78-year-old man who was admitted to our clinic with the complaints of swelling in the cheek and preauricular area of 8 years' duration. In computed tomography scan, a cystic mass measuring 6.5 × 4.5 cm with necrotic center causing expansion in the left ramus mandibula and thinning and rupture of the cortex was found. The mass was reported to extend to the zygomatic arch superiorly and masticator space minimally. Simple curettage was performed. Histopathologic examination revealed epidermal inclusion cyst. A case of mandibular ramus epidermal inclusion cyst is presented.

Laryngotracheal reconstruction at relapsing polychondritis.

Relapsing polychondritis (RP) is characterized by chronic, recurrent episodes of inflammation with eventual degeneration of cartilaginous tissues including the ears, nose, larynx, trachea, and so on. Tracheobronchomalacia and airway stenosis may be seen in RP. In this report, we describe 3 female patients presenting with progressive dyspnea owing to laryngotracheal involvement of RP who underwent laryngotracheal reconstruction.

Giant trichilemmal cyst at the neck region.

Trichilemmal cyst (TC) is an adnexal skin tumor that usually occurs on the scalp. There is a female dominance in this tumor. Proliferating pilar tumors or cysts arise from this lesion, and the clinical differential diagnosis from TCs must be taken because of aggressive behavior of proliferating pilar tumor. Trichilemmal cyst usually occurs in hair-bearing areas such as the neck, trunk, groin, and others. In this article, we report a case with giant TC involving the neck region.

Paradoxical vocal cord motion--haloperidol usage in acute attack treatment.

Paradoxical vocal cord motion (PVCM) is an uncommon disease characterized by vocal cord adduction during inspiration and/or expiration. It can create shortness of breath, wheezing, respiratory stridor, or breathy dysphonia. Possible etiological factors include asthma, underlying psychologic condition, gastroesophageal acid reflux disease, respiratory irritants exposure, central neurologic diseases, viral upper airway infections, and postsurgical procedures. Many treatment modalities were performed for acute attack of PVCM, including reassurance and onsite maneuvers, benzodiazepines, heliox, and so forth. We report a patient with PVCM who had stridor and dyspnea for 10 days and responded to intravenous haloperidol treatment.

Relapsing deep neck infection may indicate a coexisting esophagus cancer.

Neck abscess and deep neck infections are common diseases. Primary head and neck cancers may present initially with neck abscesses or deep neck infections. This presentation leads to delay of the diagnosis of underlying cancer. Head and neck cancers which present with deep neck infection initially have rarely been described. We report a case with relapsing deep neck infection who was diagnosed as proximal esophagus squamous cell carcinoma thereafter.