Otitis media: diagnosis and treatment.

Acute otitis media is diagnosed in patients with acute onset, presence of middle ear effusion, physical evidence of middle ear inflammation, and symptoms such as pain, irritability, or fever. Acute otitis media is usually a complication of eustachian tube dysfunction that occurs during a viral upper respiratory tract infection. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common organisms isolated from middle ear fluid. Management of acute otitis media should begin with adequate analgesia. Antibiotic therapy can be deferred in children two years or older with mild symptoms. High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin. Children with persistent symptoms despite 48 to 72 hours of antibiotic therapy should be reexamined, and a second-line agent, such as amoxicillin/clavulanate, should be used if appropriate. Otitis media with effusion is defined as middle ear effusion in the absence of acute symptoms. Antibiotics, decongestants, or nasal steroids do not hasten the clearance of middle ear fluid and are not recommended. Children with evidence of anatomic damage, hearing loss, or language delay should be referred to an otolaryngologist.

Intranasal meningoencephalocele presenting as a nasal polyp--a case report.

We present a case of an intranasal meningoencephalocele masquerading as an 'intranasal polyp' in a 17-month-old child. Nasal meningoencephaloceles are uncommon anomalies and require a high index of suspicion for their diagnosis. Biopsy of such lesions without prior imaging studies can be detrimental because of the risk of cerebrospinal fluid leak and meningitis, and is therefore contraindicated. This case reiterates the fact that any child with an intranasal mass should undergo appropriate imaging studies prior to excisional biopsy.