Bacterial meningitis: a rare complication of an unrecognised nasal foreign body in a child.

We present an interesting case of a 7-year-old child who developed severe bacterial meningitis requiring admission to paediatric ICU. Initial investigations failed to identify the reason for this otherwise healthy child to develop this life-threatening condition. The child recovered fully with no long-term sequelae. Further on-going unilateral purulent rhinorrhoea lead to ENT referral. CT head from a previous admission showed mucosal thickening and fluid within paranasal sinuses. Reluctance to expose the child to further radiation meant that no formal scan of sinuses was organised and the child was diagnosed with chronic rhinosinusitis. Symptoms failed to improve despite the treatment. A subsequent CT scan of sinuses revealed a radiopaque foreign body in the nasal cavity. This is a rare presentation of a nasal foreign body causing bacterial meningitis. This case highlights the importance of comprehensive investigations to avoid delays in establishing a correct diagnosis and initiating the appropriate treatment.

Bean sprout impaction in the pharynx: two cases of this unusual foreign body.

We report 2 cases of bean sprout impaction in the pharynx. To the best of our knowledge, pharyngeal impaction of a bean sprout has not been previously described in the literature. We also comment on the theoretical infective risks associated with the long-term impaction of organic foreign bodies and the validity of a thorough ENT examination, even when the foreign body appears to be insignificant.

Acute stridor caused by a previously asymptomatic large oropharyngeal spindle cell lipoma.

Lipomas of the larynx, oropharynx and hypopharynx are rare, accounting for approximately 1% of benign laryngeal neoplasms. Spindle cell lipoma is a rarer histological variant characterised by mature adipocytes mixed with collagen-forming spindle cells. We present an unusual case of a 62-year-old lady who acutely presented to the emergency department with a large spindle cell lipoma arising from the vallecula. This lipoma was causing intermittent stridor unless traction was applied to it. Despite the size of the lesion, she had been completely asymptomatic prior to this single episode. To our knowledge, only one previous case of a spindle cell lipoma has been reported as specifically arising from the vallecula. This case also appears to be the largest reported from the oropharynx (17 cm length, 4 cm width). The tumour was completely removed endoscopically and the patient made an excellent recovery, returning home 3 days post-operatively. The histology, management and follow up of these lipomas are discussed.