Tuberculosis remains one of the most challenging infectious diseases, which rarely manifests in the middle ear cleft exclusively. Typical symptoms of tuberculosis have become more and more confusing due to the genetic evolution of different Mycobacterium species. In the diagnosis of tuberculous otitis media (TOM), clinical suspicion plays a fundamental role, when topical and/or systemic antibiotic treatment cannot lead to improvement in ear discharge and inflammation. If there is no other reason of persisting otorrhea, microbiological sampling and culturing are the subsequent steps of diagnosis. These investigations, however, have low sensitivity; therefore a canal wall-up mastoidectomy is recommended, which includes the removal of necrotic bone and multiple histological sampling from various locations. Currently, histopathological analysis is the most robust and reliable method in the diagnosis of TOM. Tuberculin skin test, Mycobacterium-specific PCR and interferon-gamma release assay cannot distinguish between active, inactive or post-infective conditions. According to these considerations, these methods may serve as supplementary assays for the final diagnosis. Having the appropriate diagnosis after surgical intervention and laboratory analysis, medical management should be continued by anti-tuberculosis chemotherapy. Hereby, we demonstrate two cases with primary TOM and provide an overview of the literature in the light of diagnostic and therapeutic guidelines in the management of TOM.
The Journal of International Advanced Otology (J Int Adv Otol) is an international, peer reviewed, open access publication that is fully sponsored and owned by the European Academy of Otology and Neurotology and the Politzer Society. The journal is published triannually in April, August, and December and its publication language is English. The scope of the Journal is limited with otology, neurotology, audiology (excluding linguistics) and skull base medicine. The Journal of International Advanced Otology aims to publish manuscripts at the highest clinical and scientific level. J Int Adv Otol publishes original articles in the form of clinical and basic research, review articles, short reports and a limited number of case reports. Controversial patient discussions, communications on emerging technology, and historical issues will also be considered for publication. Target audience of J Int Adv Otol includes physicians and academics who work in the fields of otology, neurotology, audiology and skull base medicine.
Infections in the neck layers and spaces are potentially life-threatening diseases causing further complications, like mediastinitis, airway obstruction, or sepsis. Despite of the need for a conservative approach, they still regularly require surgical intervention. Records of 17 patients with severe neck infections that were treated by wide external incision and open wound management were retrospectively analyzed. The aim of the study was to clinically characterize these most serious neck infections. The most common presenting symptoms were neck pain and tense neck mass (94-94%) regularly with fever (65%), always accompanied by a marked elevation of C reactive protein level (average 192 uG/l). These findings were constant and very similar among both the deep neck infection and necrotizing fasciitis cases. More than half of the patients (53%) had at least one systemic co-morbidity. The parapharyngeal space was most commonly affected (83%), but extended disease involving more than two major neck regions was found in 13 cases (76%). Dental (29%) was the most common primary infection, followed by peritonsillar abscess (23%), Microbiological results showed a wide variety of corresponding bacteria. Mediastinitis was developed in three cases (18%), and airway obstruction requiring tracheostomy in two cases (12%). All the patients survived. Severe neck infections are a heterogenous group of diseases regarding to the primary site of infection, microbiology, localisation and host reaction. However, rapidly developed, painful, tense neck mass with a highly elevated CRP level should always alert for an extended or phlegmonous process in the layers or spaces of the neck.
Absztrakt: A mal de débarquement szindróma ritka, vestibularis kórkép; legfőbb jellegzetessége az utazás, mozgó járművön (hajón, repülőn) tartózkodás után vagy spontán kialakuló tartós, hintázó, billegő egyensúlyzavar. A tünetek átmenetileg megszűnnek ismételt járműre szállás, például autóval utazás során. A krónikus fáradtság, szorongás, depresszió gyakran társuló panaszok. A diagnózis felállítása kihívást jelent, sokszor a páciensek maguk ismerik fel a betegséget. A pontos patofiziológia és definitív kezelési mód nem ismert, az optokineticus stimulációval végzett kezelés és a transcranialis mágneses stimuláció új terápiás perspektívát kínál. Tanulmányunkban 5 beteget mutatunk be, akiknél tartós, hónapokon át fennálló, folyamatos, imbolygó jellegű egyensúlyzavar alakult ki. Vizsgálatuk során normál belsőfül-funkciót vagy nem specifikus eltéréseket, továbbá negatív koponya mágneses rezonanciás vizsgálati leletet regisztráltunk. A kórlefolyás bemutatásán keresztül feltárjuk azokat a differenciáldiagnosztikai kérdéseket, amelyek segítségül szolgálnak a kórkép felismerésében. Ismertetjük az etiológiai háttérre vonatkozó elméleteket, a különböző kezelési módokkal elért nemzetközi eredményeket, továbbá a saját beteganyagunkon alkalmazott terápiás próbálkozásokat. A mal de débarquement szindróma diagnózisa kizáráson alapul, gyakran nem kerül felismerésre. Típusos kórtörténet, negatív vagy nem specifikus vizsgálati eredmények mellett érdemes megfontolni e kórkép diagnózisát. A korai diagnózis csökkentheti az orvosi vizitek és a nélkülözhető vizsgálatok számát. A gyakori diagnosztikus tévedés tovább fokozhatja a betegséggel társuló romló életminőséget, szorongást, depressziót. Orv Hetil. 2020; 161(20): 846–851.
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