Cases reported "Ear Diseases"

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1/6. A case of relapsing polychondritis involving the tragal and the conchal bowl areas with sparing of the helix and the antihelix.

    We describe a 65-year-old white man with a 21-year history of recurrent, afebrile episodes of painful, tragal, conchal bowl and eyelid swelling accompanied by occasional conjunctivitis. The remainder of the auricle was not involved. Episodes were both self-remitting and responsive to intramuscular steroid injections. Cutaneous and cartilaginous tissues were examined histologically following a therapeutic debulking procedure. The histologic features included dermal edema, vascular dilatation, and small vessel inflammation with a dense polymorphous inflammatory infiltrate rich in eosinophils. Perichondrial inflammation and cartilage degeneration with fibrosis were characteristically observed. Bacterial cultures demonstrated normal flora. This case fulfills the revised diagnostic criteria of relapsing polychondritis. It demonstrates an unusual presentation within the disease spectrum of relapsing polychondritis with tragal and conchal bowl involvement and sparing of the helix and the antihelix.
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2/6. pyoderma gangrenosum first presenting as a recalcitrant ulcer of the ear lobe.

    A 59-year-old Japanese man with pyoderma gangrenosum occurring at the unusual location of the ear lobe is herein reported. The patient was not associated with any other systemic diseases and had suffered from chilblains at the same site for ten years before the ulcer appeared. The ulcer followed the development of a purpuric exudative lesion and had neither an undermined nor a surpiginous border in the early lesion. It gradually increased in size after various conservative treatments, recurred within a month after being excised and became aggravated after the administration of potassium iodide. Repeated histopathology of the ulcer revealed a mixed inflammatory cell infiltrate with abscesses and an extravasation of red blood cells in the whole dermis, without showing leukocytoclastic vasculitis. A culture of the excised tissue yielded no growth. Laboratory tests were not specific and c-ANCA was also negative. The ulcer of the ear did dramatically respond to systemic predonisolone of 40 mg/day. The auricular and periauricular area are quite rare anatomical sites of this disease and the difference between pyoderma gangrenosum and cutaneous Wegener's granulomatosis is also discussed.
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3/6. actinomycosis of the middle ear.

    actinomycosis is an uncommon infection of the middle ear. Only 21 cases of actinomycosis of the middle ear have been reported in the English literature prior to this paper. The offending organism is actinomyces israelii, which is an anaerobic, filamentous organism that is difficult to grow in culture. The infection is chronic and is seldom diagnosed prior to tympanomastoidectomy. The identification of small, yellow, glue-like masses, which are called sulfur granules, is often the key to making the diagnosis of actinomycosis of the middle ear. Following tympanomastoidectomy, penicillin is given orally for 3-6 months.
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4/6. candida albicans and otorrhoea in children. case reports.

    5 cases of Nigerian children, all below 2 years of age are presented. Common to all is a history of treated ear infections with subsequent development of otorrhoea. Both smears and cultures of the ear swabs documented candida albicans, and all the patients responded well to oral nystatin. There is as yet little emphasis in published works on the relationship between candida albicans and draining ears.
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5/6. Necrotizing fasciitis originating from pinna perichondritis.

    NF is a potentially lethal infectious process usually found in the abdomen, perineum, or extremities. In the head and neck it usually starts from a dental infection but can be initiated from any source. One of the more serious sequelae is extension of the infection down the deep fascial planes of the neck leading to mediastinitis; this is associated with a higher mortality rate. The presence of an associated immunocompromising disease, such as diabetes, has been said to predispose an individual to NF, and the mortality rate has been shown to be higher (although perhaps not significantly so). When first described, NF was thought to be caused only by beta-hemolytic staphylococcus. Now it known to be a polymicrobial infection with anaerobes and facultative anaerobes found most frequently. Treatment involves broad-spectrum intravenous antibiotics as soon as possible, narrowing the coverage as the results of the gram stain and cultures become available. The importance of aggressive, prompt surgical management cannot be overemphasized in the treatment of NF. Once the diagnosis of NF is strongly suspected, debridement of the affected areas must be accomplished as soon as possible. Despite the advances in the recognition and treatment of NF, there is still significant morbidity and mortality associated with this disease. Continued vigilance must be practiced if the survival rate is to continue to increase.
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6/6. pyoderma gangrenosum: an unusual cause of periaural ulceration.

    A case of pyoderma gangrenosum affecting the pinna and neck of a diabetic patient is reported. Appearances were suggestive of malignant otitis externa. A small biopsy resulted in rapid and aggressive exacerbation of the lesion. pyoderma gangrenosum, although uncommon, should be considered as a cause of ulceration, particularly when the ulcer yields no growth on culture in a non-dependent area.
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