The Erroneous Appearance of Silver Nitrate on CT Imaging in Patients with Severe Otitis Externa; A Case Series

Introduction Silver nitrate is commonly used within otolaryngology to treat granulation tissue in severe otitis externa. It appears radio-opaque on CT (computed tomography) imaging and therefore can mimic bony fragments and foreign bodies. This is particularly cumbersome when the phenomena correlates to the clinical complaint. Discussion We report two cases of 73-year-old and 75-year-old males who presented with chronic otalgia and discharge. Granulation tissue in the external auditory canal was identified and chemically cauterised with silver nitrate. Subsequent CT petrous bones demonstrated an unidentified foreign body in the canal with extensive soft tissue swelling giving an impression of a wick in situ and “minor bony erosion in the left external acoustic canal” respectively. An additional CT of a 57-year-old female who had been treated with silver nitrate for granulomatous tissue reported “multiple highly radiopaque foci in the external auditory canal, suggestive of foreign body”. Though relatively unknown, this phenomenon has been reported in literature. However, there are few reports of silver nitrate artefacts in CT images of the head no cases in the context of otitis externa. Our patients avoided further imaging or surgery following clarification with the radiologists and symptomatic improvement with long-term intravenous antibiotics. Conclusion Given the prevalence of CT imaging and cauterization in otolaryngology, we recommend contemporaneously documenting the use of silver nitrate and highlighting this on request forms to avoid alarming erroneous reports, unnecessary investigation and surgical procedures. We also recommend, where clinically acceptable, to use silver nitrate prior to imaging.

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Airway Stenosis Related to Foreign Body Aspiration: An Under-recognized Long term Complication

Clinical Medicine Insights Case Reports ◽

10.1177/1179547619863816 ◽

2019 ◽

Vol 12 ◽

pp. 117954761986381 ◽

Cited By ~ 3

Author(s):

Ravindra M Mehta ◽

Nadakuditi Rashmi ◽

Pooja Bajaj ◽

Shyam Krishnan ◽

Lakshmipriya Srinivasan

Keyword(s):

Foreign Body ◽

Granulation Tissue ◽

Case Series ◽

Foreign Body Aspiration ◽

Areca Nut ◽

Tissue Formation ◽

Airway Patency ◽

Granulation Tissue Formation ◽

Airway Stenosis

Introduction: Sequelae of chronic foreign body aspiration include occlusive granulation tissue formation, which can cause delayed fixed airway stenosis. The aim of this study is to highlight this complication, which should be diagnosed early and treated proactively. Methods: We present a case series of areca nut aspiration, an organic foreign body commonly chewed in Southeast Asia, complicated by delayed airway stenosis and examine the peculiar nature of areca nut that predisposes to this complication. Results: Long-term sequelae of areca nut aspiration are granulation tissue formation, potentially complicated by airway stenosis due to the mechanical and chemical irritant nature of areca nut. Discussion: Organic impacted foreign bodies such as areca nut can cause delayed complications of airway stenosis. Both the sharp edges of the areca nut and chemical irritation caused by alkaloids released by the nut in constant contact with the airway mucosa can predispose to this long-term complication. Early diagnosis and appropriate therapeutic interventions such as balloon bronchoplasty can help restore airway patency and prevent lung damage.

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Masticator Space Foreign Body in a Child Presenting With Otorrhea and Granulation Tissue of the External Auditory Canal

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489416656204 ◽

2016 ◽

Vol 125 (10) ◽

pp. 854-857 ◽

Cited By ~ 4

Author(s):

Kareem O. Tawfik ◽

Colin R. Edwards ◽

Blaise V. Jones ◽

Charles M. Myer

Keyword(s):

Foreign Body ◽

Granulation Tissue ◽

External Auditory Canal ◽

Masticator Space

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Synchronous Malignant Otitis Externa and Squamous Cell Carcinoma of the External Auditory Canal

Case Reports in Otolaryngology ◽

10.1155/2013/837169 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

R. Y. Chin ◽

T. B. V. Nguyen

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

External Auditory Canal ◽

Otitis Externa ◽

Concomitant Treatment ◽

The Third ◽

Intravenous Antibiotics ◽

Malignant Otitis Externa ◽

Synchronous Tumour

Objectives. To discuss the management of a squamous cell carcinoma in the presence of malignant otitis externa.Study Design. We present only the third reported case in the literature of a synchronous tumour with malignant otitis externa in the literature.Methods. A case report and review of malignant otitis externa and squamous cell carcinomas of the external auditory canal are discussed.Results. A 66-year-old female is presented here with a 2-month history of a painful, discharging left ear refractory to standard antibiotic therapy. Computerised tomography, magnetic resonance imaging, technetium 99 m, and gallium citrate Ga67 scans were consistent with malignant otitis externa. Biopsy in the operating theatre revealed a synchronous squamous cell carcinoma of the external auditory canal. Primary resection of the tumour and surrounding tissues was performed with concomitant treatment with intravenous antibiotics.Conclusions. This is only the third case to be reported in the literature and highlights several important diagnostic and management issues of these two rare conditions. Both conditions may present in a similar manner on clinical assessment and radiological investigations. Aggressive management with surgical resection and treatment with appropriate intravenous antibiotics is necessary to give the best chance for cure.

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Dysphagia due to necrotizing otitis externa

Age and Ageing ◽

10.1093/ageing/afab034 ◽

2021 ◽

Author(s):

Rajesh Dwivedi ◽

Melroy Rasquinha ◽

Rowan Harwood

Keyword(s):

External Auditory Canal ◽

Otitis Externa ◽

Sinus Thrombosis ◽

Oropharyngeal Dysphagia ◽

Lower Cranial Nerve ◽

Venous Sinus Thrombosis ◽

Necrotizing Otitis Externa ◽

Intravenous Antibiotics ◽

Patient Reported ◽

High Index Of Suspicion

Abstract An 88-year-old man presented with delirium, and subsequently developed hoarseness and oropharyngeal dysphagia. This was due to skull-based osteomyelitis from necrotizing otitis externa (NOE), causing lower cranial nerve (X, XII) palsies and venous sinus thrombosis. Diagnosis was delayed as the patient reported no otalgia, had an almost normal looking external auditory canal and was not diabetic. He deteriorated and died despite intravenous antibiotics. We need a high index of suspicion for NOE and its complications in patients presenting with otolaryngeal symptoms.

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A case of malignant otitis externa following mastoidectomy

The Journal of Laryngology & Otology ◽

10.1017/s0022215100157986 ◽

1999 ◽

Vol 113 (12) ◽

pp. 1095-1097 ◽

Cited By ~ 9

Author(s):

S. K. Patel ◽

D. W. McPartlin ◽

J. M. Philpott ◽

S. Abramovich

Keyword(s):

Granulation Tissue ◽

Cranial Nerve ◽

Otitis Externa ◽

Cranial Nerves ◽

Complete Recovery ◽

Jugular Bulb ◽

Intravenous Antibiotics ◽

Cranial Nerve Palsies ◽

Malignant Otitis Externa ◽

Nerve Paresis

AbstractWe present a case of a 63-year-old diabetic male who developed malignant otitis externa following mastoidectomy. Extensive skull base osteomyelitis caused thrombosis of the jugular bulb and subsequent paralysis of cranial nerves VII, IX, X and XII. Hewas treated aggressively with intravenous antibiotics and debridement of granulation tissue in the mastoid bowl with full recovery of the cranial nerve palsies associated with recanalization of the jugular bulb. We believe this is the first reported case of malignant otitis externa to occur following mastoidectomy with complete recovery of the cranial nerve paresis.

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The Difference of External Auditory Canal pH in 3 Groups of Otitis Externa

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2012.55.10.628 ◽

2012 ◽

Vol 55 (10) ◽

pp. 628

Author(s):

Hong Jun Kim ◽

Kyung Jin Roh ◽

Ki Hoon Choi ◽

Seung Hwan Noh ◽

Joo Hyun Kim ◽

...

Keyword(s):

External Auditory Canal ◽

Otitis Externa ◽

The Difference

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Is the Acidic pH of the External Auditory Canal Playing a Significant Role in the Treatment of Acute Otitis Externa?

Revista de Chimie ◽

10.37358/rc.18.8.6521 ◽

2018 ◽

Vol 69 (8) ◽

pp. 2304-2305

Author(s):

Oana Ruxandra Iana ◽

Dragos Cristian Stefanescu ◽

Viorel Zainea ◽

Razvan Hainarosie

Keyword(s):

External Auditory Canal ◽

Otitis Externa ◽

Proton Pumps ◽

Acidic Ph ◽

External Ear ◽

Ph Values ◽

The World ◽

Subcutaneous Tissues ◽

Low Levels ◽

Value Changes

Variable pH values for skin have been reported in the literature, all within the acidic range, varying from 4.0 up to 7. 0. The origin of the acidic pH remains conjectural, and several factors have been incriminated with this role, such as eccrine and sebaceous secretions as well as proton pumps. Keeping low levels of pH prevents microbial dispersal as well as multiplication. The skin in the external auditory canal is also covered with this acidic mantle with antimicrobial value. Changes of pH in the external ear can lead to acute otitis externa. This condition is defined by the inflammation and infection of the cutaneous and subcutaneous tissues of the external auditory canal. 10% of the world�s population may suffer from acute otitis externa at least once in their lifetime. This paper aims to consolidate the relevance of an acidic pH in the healthy external ear and its relation to the pathogenesis and treatment of otitis externa through a prospective and interventional clinical study on 80 patients who presented to the outpatient department at Prof. Dr D. Hociota ENT Institute in Buch

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How we do it: impacted oesophageal foreign body removal using a dilatation balloon

The Journal of Laryngology & Otology ◽

10.1017/s002221512100178x ◽

2021 ◽

pp. 1-3

Author(s):

P D Chakravarty ◽

T Kunanandam ◽

G Walker

Keyword(s):

Foreign Body ◽

Granulation Tissue ◽

Foreign Bodies ◽

Fluoroscopic Guidance ◽

Tertiary Referral ◽

Foreign Body Removal ◽

Novel Technique ◽

Common Presentation ◽

Reproducible Technique ◽

Rigid Oesophagoscopy

Abstract Background Ingested foreign bodies are a common presentation to paediatric ENT services. Depending on the site, these are usually managed with flexible or rigid oesophagoscopy and retrieval. This paper presents a novel technique for removing a hollow foreign body that could not be removed using conventional means. Method and results After rigid and flexible approaches failed, a guidewire was passed through the foreign body under fluoroscopic guidance and a dilatation balloon passed through the lumen of the object. Inflating the balloon allowed dilatation of the inflamed mucosa above and below the object, facilitating straightforward removal under traction. Conclusion This is a novel and reproducible technique that uses equipment readily available in tertiary referral centres. Employed in this context, the technique enabled removal of an impacted object surrounded by granulation tissue, and would be appropriate for other objects with a lumen.

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The Gerbode defect: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa548 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Nicholas Sunderland ◽

Ahmed El-Medany ◽

Justin Temporal ◽

Laura Pannell ◽

Gemina Doolub ◽

...

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Case Series ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Cardiac Complications ◽

Low Grade ◽

Care Needs ◽

Intravenous Antibiotics ◽

Gerbode Defect

Abstract Background The Gerbode defect is a rare abnormal communication between the left ventricle (LV) and right atrium (RA). The lesion is either congenital or acquired. Acquired defects are largely iatrogenic or infective in origin. We present two cases of acquired Gerbode defects with similar clinical presentations but very different outcomes. Case summaries Patient 1 A 64-year-old male presented with features of decompensated cardiac failure and a low-grade temperature. Dehiscence of a recently implanted bioprosthetic aortic valve and high-velocity LV to RA jet (Gerbode defect) was found on echocardiography. Blood cultures grew Staphylococcus warneri and the diagnosis of infective endocarditis was established. The patient was treated with intravenous antibiotics and the aortic valve and Gerbode defect were successfully surgically repaired. Patient 2 An 81-year-old male presented after being found on the floor at home. On admission, he was clinically septic with evidence of decompensated heart failure. No clear infective focus was initially found. Transthoracic echocardiography revealed severe left ventricular impairment, with a normal bioprosthetic aortic valve. He was treated with intravenous antibiotics, but later deteriorated with evidence of embolic phenomena. Repeat echocardiography revealed a complex infective aortic root lesion with bioprosthetic valve dehiscence and flow demonstrated from the LV to RA. Unfortunately, the patient succumbed to the infection and cardiac complications. Discussion The Gerbode defect is a rare but important complication of infective endocarditis and valve surgery. Care needs to be taken to assess for Gerbode defect shunts on echocardiogram, especially in the context of previous cardiac surgery.

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