Bilateral spontaneous hemotympanum: Case report

BACKGROUND: The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head. Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media. A rare case of spontaneous bilateral hemotympanum in a patient treated with anticoagulants is presented herein. CASE PRESENTATION: A 72-year-old male presented with acute deterioration of hearing. In the patient's medical history aortic valve replacement 1 year before presentation was reported. Since then he had been administered regularly coumarinic anticoagulants, with INR levels maintained between 3.4 and 4.0. Otoscopy revealed the presence of bilateral hemotympanum. The audiogram showed symmetrical moderately severe mixed hearing loss bilaterally, with the conductive component predominating. Tympanograms were flat bilaterally with absent acoustic reflexes. A computerized tomography scan showed the presence of fluid in the mastoid and middle ear bilaterally. Treatment was conservative and consisted of a 10-day course of antibiotics, anticongestants and temporary interruption of the anticoagulant therapy. After 3 weeks, normal tympanic membranes were found and hearing had returned to previous levels. CONCLUSION: Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder

THE LEVELS OF IGG IN THE BLOOD SERUM OF CHILDREN WITH SECRETORY OTITIS MEDIA

THE AIM OF THIS STUDY WAS TO MEASURE THE LEVELS OF THE TOTAL IGG AND ITS SUBCLASSES IN THE BLOOD SERUM OF CHILDREN WITH SECRETORY OTITIS MEDIA. WE STUDIED THE VALUES OF IGG IN SERUM OF 60 CHILDREN AND WE CLASSIFIED THEM IN FOUR GROUPS. WE FOUND THAT THE VALUES OF THE TOTAL IGG WERE INCREASED IN ALL OF GROUPS.THE IGG1 VALUES WERE SIGNIFICANTLY INCREASED AS WELL AS THE IGG4 VALUES. THEIGG2 AND IGG3 VALUES HAVE NOT APPEARED ANY CONSISTENT STATISTICALLY EVALUATED DIFFERENCES. WE MEASURED OUT, ONE YEAR LATER, THE IGG LEVELS IN THE SERUMS OF 41 CHILDREN TREATED OF SECRETORY OTITIS MEDIA. THE VALUES OF THE TOTAL IGG AND ITS SUBCLASSES WERE NORMAL. THESE RESULTS WERE COMPARED TO THE VALUES OF THE IGG IN THE SERUMS OF A GROUP OF HEALTHY CHILDREN.ΣΚΟΠΟΣ ΤΗΣ ΜΕΛΕΤΗΣ ΑΥΤΗΣ ΕΙΝΑΙ ΝΑ ΜΕΤΡΗΘΕΙ Η ΟΛΙΚΗ ΤΙΜΗ ΚΑΘΩΣ ΚΑΙ ΤΟ ΕΠΙΠΕΔΟ ΤΩΝ ΥΠΟΟΜΑΔΩΝ ΤΗΣ ΑΝΟΣΟΣΦΑΙΡΙΝΗΣ G(IGG ΚΑΙ IGG1, IGG2, IGG3, IGG4) ΣΤΟΝ ΟΡΟ ΠΑΙΔΙΩΝ ΠΟΥ ΠΑΡΟΥΣΙΑΖΟΥΝ ΥΠΟΤΡΟΠΙΑΖΟΥΣΑ ΕΚΚΡΙΤΙΚΗ ΩΤΙΤΙΔΑ. ΜΕΛΕΤΗΘΗΣΑΝ ΣΥΝΟΛΙΚΑ ΕΞΗΝΤΑ ΜΙΚΡΟΙ ΑΣΘΕΝΕΙΣ ΠΟΥ ΤΑΞΙΝΟΜΗΘΗΚΑΝ ΣΕ ΟΜΑΔΕΣ ΤΩΝ ΔΕΚΑΠΕΝΤΕ ΑΤΟΜΩΝ ΑΝΑΛΟΓΑ ΜΕ ΤΗΝ ΗΛΙΚΙΑ ΤΟΥΣ. ΕΠΙΣΗΣ ΠΗΡΑΝ ΜΕΡΟΣ ΣΑΡΑΝΤΑ ΥΓΙΗ ΠΑΙΔΙΑ ΠΟΥ ΧΩΡΙΣΤΗΚΑΝ ΟΠΩΣ ΚΑΙ ΤΑ ΠΡΟΗΓΟΥΜΕΝΑ ΣΕ ΟΜΑΔΕΣ ΤΩΝ ΔΕΚΑ ΠΑΙΔΙΩΝ. ΑΠΟ ΤΑ ΑΠΟΤΕΛΕΣΜΑΤΑ ΔΙΑΠΙΣΤΩΣΑΜΕ ΟΤΙ ΕΧΟΥΜΕ ΑΥΞΗΣΗ ΤΗΣ ΟΛΙΚΗΣ IGG. ΑΥΤΟ ΔΕΝ ΣΥΜΒΑΙΝΕΙ ΣΕ ΟΛΕΣ ΤΙΣ ΥΠΟΟΜΑΔΕΣ ΤΗΣ IGG ΑΛΛΑ ΚΥΡΙΩΣ ΣΤΗΝ ΣΤΗΝ IGG1 KAI THN IGG4. ΟΣΟΝ ΑΦΟΡΑ ΤΙΣ IGG2 ΚΑΙ IGG3 ΔΕΝ ΕΥΡΙΣΚΟΜΕ ΕΝ ΓΕΝΕΙ ΣΤΑΤΙΣΤΙΚΑ ΣΗΜΑΝΤΙΚΕΣ ΔΙΑΦΟΡΕΣ, ΠΛΗΝ ΕΞΑΙΡΕΣΕΩΝ. ΗΜΕΤΡΗΣΗ ΤΩΝ ΑΝΟΣΟΣΦΑΙΡΙΝΩΝ ΣΤΑ ΙΔΙΑ ΑΤΟΜΑ ΕΓΙΝΕ ΚΑΙ ΕΝΑ ΧΡΟΝΟ ΜΕΤΑ ΤΗΝ ΘΕΡΑΠΕΙΑ ΤΗΣ ΩΤΙΤΙΔΑΣ. ΕΞΕΤΑΣΘΗΚΑΝ 41 ΠΑΙΔΙΑ ΠΟΥ ΧΩΡΙΣΤΗΚΑΝ ΣΤΙΣ ΙΔΙΕΣ ΟΜΑΔΕΣ ΗΛΙΚΙΑΣ. ΟΙ ΤΙΜΕΣ IGG ΕΙΧΑΝ ΕΠΑΝΕΛΘΕΙ ΣΤΑ ΦΥΣΙΟΛΟΓΙΚΑ ΕΠΙΠΕΔΑ ΠΛΗΣΙΑΖΟΝΤΑΣ ΤΑ ΕΠΙΠΕΔΑ ΤΩΝ ΜΑΡΤΥΡΩΝ

Submasseteric abscess

The masseteric space is an important tissue compartment of the neck, but disease in it is difficult to diagnose and treat. In this paper a case of a young adult male with an abscess of the submasseteric space is presented. Diagnosis was established by computed tomography (CT) of the neck, but the severity of the lesion was not accurately estimated. Surgical intervention was performed and a large quantity of pus was drained. A detailed medical history and clinical examination of the patient as well as CT are important tools in the accurate diagnosis and efficient treatment of the disease

Upper airway edema resulting from use of Ecballium elaterium

Objectives: To present a rare occurrence in ear, nose and throat practice of upper airway allergic edema from use of juice extracted from the fruit of Ecballium elaterium. Introduction: Ecballium elaterium is a plant indigenous to the Mediterranean region that bears the common name squirting cucumber. Many people in this region for the treatment of sinusitis use the juice of its fruit. However, allergy-prone patients after using it may sometimes present with edema at various sites of the upper respiratory tract. Otolaryngologists are frequently asked to diagnose and treat such an emergency situation. Study Design: Retrospective review of the records of 42 patients with this condition during the last 4 years. Methods: Patient records were retrospectively reviewed for age, sex, presenting symptoms, physical examination, and medical treatment. Seasonal distribution and data from the history of the patients were also considered. Skin prick and prick-to-prick testing to various allergens was performed in 12 patients. Results: Most of the patients presented with localized swelling of the uvula and the nasal mucosa, whereas in the remainder of the patients various sites of swelling of the upper respiratory tract were observed. Skin tests elicited positive reactions to pollen weeds and to various fruits of the Cucurbitaceae family. Treatment of the patients with corticosteroids and antihistamines resulted in an uneventful recovery, and we did not need to resort to therapeutic modalities, such as intubation or tracheotomy. Conclusions: We think a further study of the pharmaceutical properties of the plant's fruit juice is needed, especially regarding its curative properties of rhinitis and sinusitis. However, adverse reactions in some patients with a positive history of allergy should always be considered

Correlation of transiently evoked to distortion-product otoacoustic emission measures in healthy children

Objective: Transiently evoked (TEOAEs) and distortion-product otoacoustic emissions at the 2f1-f2 frequency (DPOAEs) are being used as a clinical toot for diagnosis of peripheral auditory pathology. Because both tests are fast and non-invasive, they may be an excellent method for hearing screening in infants and children. The purpose of this study was to compare the TEOAE and DPOAE measures obtained in a group of healthy children. Methods: Sixty-six school-aged children with normal hearing were included in the study. Subjects with recent otologic disease or abnormal tympanograms were excluded. TEOAEs and DPOAEs were performed using a DID Echoport ILO 292 Otodynamics analyzer connected to a portable personal computer. Correlation between TEOAE amplitudes and DPOAE levels was estimated. Results: Correlation between TEOAE amplitudes and DPOAE levels was highly significant across all measured frequencies. Correlation was more significant at the middle frequencies than at the tow and high frequencies. Conclusions: Although frequency specific information maybe obtained by both tests, most reliable results were obtained at the middle frequencies. TEOAE values were more prominent at low frequencies, whereas DPOAEs were more effective at high frequencies. Both methods are reliable, objective, fast and useful tests of the cochlear status and should be included in the standard audiological diagnostic work-up of children. (c) 2005 Elsevier Ireland Ltd. All rights reserved