Precise ENT

Cholesteatoma

🛑Case. A 9 year old child has been complaining of continuous offensive right ear discharge for the last 3 years. A month ago he began to suffer from headache, fever and some vomiting for which he received symptomatic treatment. The patient's condition was stable for a while, then after 2 weeks he started to suffer from severe headache and drowsiness. The patient also noticed difficulty going up and down the stairs. A week later, he developed weakness in the left arm and left leg, and became markedly drowsy. He became comatose the next day. ✔️Diagnosis and reasons. Right atticoantral "cholesteatoma" chronic suppurative otitis media "continuous offensive ear discharge for 3 years" complicated by right temporal lobe abscess "manifestations of increased intracranial tension with weakness in the opposite side of the body on the left arm and leg". ✔️Explanation of some manifestations. •Initial headache fever and vomiting: indicates the initial stage of a brain abscess formation in the stage of encephalitis. •Stable condition of 2 weeks: latent phase of brain abscess with decreased symptoms. •Severe headache and vomiting after 2 weeks: manifestations of a formed brain abscess leading to increased intracranial tension. •Difficulty going up and down the stairs: due to hemiparesis (weakness) in the opposite left leg to the diseased ear. •Comatose: final stage of brain abscess.

Mastoiditis

🛑Case. A 10 year old child complained of a right mucopurulent otorhea for the last 2 years. He suddenly became feverish and this was associated with diminution of the ear discharge. There was also tenderness on pressure behind the auricle. The retroauricular sulcus was preserved. There was no retroauricular fluctuation. ✔️Diagnosis and reasons. Right chronic suppurative otitis media "mucopurulent discharge of 2 years duration" complicated by mastoiditis "fever with decreased ear discharge, tenderness behind the auricle with preservation of retroauricular sulcus; it is not an abscess because there is no retroauricular fluctuation". ✔️Explanation of some manifestations. •Diminution of ear discharge: reservoir sign discharge decreases but is still there and whenever discharge decreases fever and other constitutional symptoms increase in intensity. •Tenderness behind the auricle: due to inflammation of the bone of the mastoid process and its overlying periosteum. •Retroauricular sulcus preserve: as the inflammatory process is subperioteal. •No retroauricular fluctuation: it is mastoiditis and so is not a mastoid abscess yet.

Chronic suppurative otitis media

🛑Case. A 10 year old child was having a right mucopurulent otorrhea for the last 4 years. A week ago he became dizzy with a whirling sensation, nausea, vomiting and nystagmus to the opposite side; his deafness became complete and his temperature was normal. Three days later he became feverish, irritable and continuously crying apparently from severe headache. Also he had some neck retraction. The child was not managed properly and died by the end of the week. ✔️Diagnosis and reasons. Right chronic suppurative otitis media "mucopurulent otorhea of 4 years duration "complicated by suppurative labyrinthitis "dizziness, nausea and vomiting with nystagmus to the opposite side and complete loss of hearing" and then complicated by meningitis "fever, severe headache and neck retraction". ✔️Explanation of some manifestations. •Whirling sensation: vertigo due to inner ear inflammation. •Nystagmus to the opposite side: suppurative labyrinthitis leading to fast phase of eye movement to the opposite ear and slow phase to the diseased ear, nystagmus direction is called according to the fast phase.In serous labyrinthitis with no inner ear cell destruction the direction of nystagmus is toward the diseased ear. •Severe headache: increased intracranial pressure due to meningitis. •Neck retraction: due to meningeal inflammation.

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Good evening batch 21, don't worry exam will be easy ان شاء الله Relax and trust your abilities. Never lose hope; one day you will be someone hero; someone hope ❤️ ربنا يوفقكم ويسدد خطاكم🙏🏻❤️

https://www.researchgate.net/profile/Abusufian-Elhaj-2/achievement/65b0e397669f07074dfc8ad2 via @researchgate https://www.researchgate.net/profile/Abusufian-Elhaj-2/achievement/65b0e397669f07074dfc8ad2

Results happen over time, not overnight.Work hard, stay consistent and be patient🙏❤️

Know the differences between them🙏

Cauliflower ear 🌚

Perichondritis ear.

•Blunt trauma to the ear causes its separation, allowing for blood to collect and form a hematoma. •If the blood is not drained, the collection causes infection or cartilage necrosis, leading to perichondritis, and ultimately causing the cosmetic complication of what is known as cauliflower ear.

Auricular Hematoma. A 22 year old male with no significant past medical history presents with left ear pain for the past hour.The patient is a college wrestler and was in a wrestling match when his ear was injured.

Common ototoxic drugs. 🖇Aminoglycoside antibiotics. -Streptomycin. -Gentamycin. -Tobramycin. -Neomycin. -Kanamycin. -Amikacin. 🖇Diuretics. -Loop diuretics. 🖇Antimalarials. -Quinine. -Chloroquine. 🖇Cytotoxic drugs. -Cisplatin. -Carboplatin. 🖇Analgesics. -Salicylates. -Indomethacin. -Iboprofen. 🖇Chemicals. -Alcohol. -Tobacco. -Marijuana. 🖇Miscellaneous. -Erythromycin. -Ampicillin. -Propranolol.

Best wishes🙏❤️

-What is the diagnosis? -Name the possible differential diagnosis.

A child 4 years old presented to an ENT specialist because of snoring of two years duration.His mother reported that her son has persistent mucoid nasal discharge that becomes sometimes purulent. For the last month, she began to notice that he does not respond…