Hypoglossal paresis as the only complication of malignant otitis externa.

BACKGROUND: Ipsilateral hypoglossal nerve (XII) paresis has never been reported as the first and only complication of malignant otitis external (MOE). CASE REPORT: A 73-year-old diabetic male with persistent left temporomandibular joint ache and ear fullness was admitted with the diagnosis of MOE. He received intravenous ciprofloxacin for 14 days and then continued with oral administration (per os). After two months, he returned with otalgia, swallowing difficulty, and ipsilateral XII paresis. He was re-admitted, received intravenous ciprofloxacin for 6 weeks, and continued with per os ciprofloxacin for 6 months. A Ga67-scan 6 months after the first admission revealed no active infection. Two years after his last admission, the patient still has XII paresis. There is no other cranial nerve involvement and inflammatory markers continue to be normal. CONCLUSION: Doctors should consider MOE in the differential diagnosis when there is XII paresis, especially in diabetic and immunocompromised patients.

Mycoplasma pneumoniae and Chlamydophila pneumoniae: a comparative study in patients with nasal polyposis and healthy controls.

INTRODUCTION: The role played by Mycoplasma pneumoniae and Chlamydophila pneumoniae in the pathogenesis of chronic rhinosinusitis with nasal polyps has been the object of ongoing debate. We used real-time polymerase chain reaction to investigate the prevalence of both microorganisms in the nasal tissue samples of patients and controls. METHODS: We extracted DNA from nasal polyp samples obtained during functional endoscopic sinus surgery and the inferior turbinate samples of controls undergoing septoplasty. We used the highly sensitive real-time polymerase chain reaction to detect the presence of M pneumoniae and C pneumoniae DNA. RESULTS: Patients with chronic rhinosinusitis with nasal polyps consisted of 62 individuals (39 men; mean age 51 years); the control group consisted of 24 individuals (13 men; mean age 45 years). All samples from both groups were negative for M pneumoniae and C pneumoniae DNA. CONCLUSION: We have demonstrated that the likelihood of M pneumoniae and C pneumoniae acting as an ongoing inflammatory stimulus in chronic rhinosinusitis with nasal polyps is slim.

The use of the Ligasure vessel sealing system in head and neck surgery: a report on six years of experience and a review of the literature.

BACKGROUND: The Ligasure Vessel Sealing System (LVSS) is a bipolar electrosurgical device with integrated active feedback control, sealing vessels up to 7 mm in diameter. It facilitates surgery by achieving the efficient haemostasis of blood vessels encountered during dissection, and allowing the rapid and secure division of vascularised tissues, while minimising thermal injury to adjacent tissues. OBJECTIVE: To report on our experience and review studies relating to the use of LVSS in Otolaryngology-Head and Neck Surgery. TYPE OF REVIEW: Retrospective series. Search strategy and evaluation method: LVSS has been widely used in our department since 2002. All patient records relating to the use of LVSS were reviewed, and compared to surgical procedures done by our team without the use of LVSS, with special regard to operation time and post-operative complications. Furthermore, a Medline search and thorough review was conducted for all pertinent articles on LVSS in Otolaryngology-Head and Neck Surgery, and those articles were reviewed. RESULTS: In our department, LVSS is used for thyroidectomy, laryngectomy, neck dissection, parotidectomy, tonsillectomy procedures, congenital cysts, thryroglossal cysts, and excisions of submandibular gland and parapharyngeal space tumours. LVSS provided sufficient haemostasis, operating time was shorter, and post-operative complications did not differ compared to similar surgical procedures performed without the LVSS. The Medline search revealed 16 studies published by other colleagues regarding the use of LVSS in Otolaryngology Head and Neck Surgery procedures (15 studies in thyroid and 1 study in parotid surgery). The results published were similar to ours. CONCLUSIONS: The use of LVSS in Otolaryngology-Head and Neck Surgery may have several advantages over standard methods. It is a reliable and safe device, providing sufficient haemostasis and reducing operating time.

Tolosa-Hunt syndrome misdiagnosed as sinusitis complication.

OBJECTIVE: Tolosa-Hunt syndrome is a rare condition of painful ophthalmoplegia combined with ipsilateral ocular motor nerve palsies, caused by non-specific granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. A case of Tolosa-Hunt syndrome misdiagnosed as sinusitis orbital complication is reported. CASE REPORT: A patient suffering from left periorbital pain, upper eyelid oedema and ptosis, and horizontal diplopia, diagnosed as sinusitis orbital complication, was referred to our department. Clinical evaluation revealed only a left VIth nerve paresis. Haematological studies, cerebrospinal fluid tests and computed tomography scanning were negative. A magnetic resonance imaging (MRI) scan showed enhancement of the left cavernous sinus. Corticosteroid therapy was commenced, and within three days all symptoms disappeared. A diagnosis of Tolosa-Hunt syndrome was made. Follow-up MRI studies were normal. CONCLUSION: Tolosa-Hunt syndrome, although rare, is a nosological entity that otolaryngologists must bear in mind. Magnetic resonance imaging studies are essential in the diagnosis and follow up of these patients, in order to avoid a mistaken Tolosa-Hunt syndrome diagnosis.

Cocaine versus tetracaine in septoplasty: a prospective, randomized, controlled trial.

BACKGROUND: Successful local anaesthesia is of critical importance for the success of septoplasty, and many surgeons prefer to use cocaine for this purpose. The aim of this study was to evaluate the efficacy of cocaine 4 per cent solution, compared with tetracaine 2 per cent plus adrenaline, as a local anaesthetic for patients undergoing septoplasty. METHODS: From December 2002 to February 2005, a prospective, randomized, controlled trial was conducted. One hundred and eight patients underwent septoplasty under local anaesthesia. Patients were randomly classified into group A and group B, in which was used respectively cocaine 4 per cent solution and tetracaine 2 per cent solution plus adrenaline. A visual analogue scale was used to evaluate the severity of patients' pain during their procedure. RESULTS: Group B (tetracaine; mean rank=43.77) reported significantly less pain (p<0.001) compared with group A (cocaine; mean rank=65.23). CONCLUSIONS: On the basis of these findings, we recommend tetracaine as the first choice anaesthetic for nasal septoplasty; the use of cocaine should be limited.