We report the clinical case of a female patient who presented to our emergency department due to a septal abscess caused by the displacement of a dental implant into the nasal septum. The patient underwent surgical treatment for endoscopic foreign body excision and septal abscess drainage. Despite the presence of septal cartilage destruction, the L-shaped structure was preserved and no reconstruction was required. Postoperative healing was uneventful.

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ObjectiveDeep neck infections (DNI) are responsible for significant morbidity in children and healthcare expenditures. Few studies exist specifically addressing the clinical and epidemiologic characterization and management of DNI's in the pediatric population. Our goal was to analyse the demographic characteristics, clinical presentation, diagnostic and therapeutic approaches of peritonsillar and DNI in pediatric patients.MethodsThe medical records of patients, aged up to 18 years, admitted for peritonsillar and DNI at our department, from 2011 to 2016, were retrospectively reviewed and compared with the literature available. Ninety‐eight patients were enrolled.ResultsThe mean age was higher in patients with peritonsillar abscess and lower in patients with retropharyngeal and parapharyngeal infections. Admissions have significantly increased from 2011. There was a seasonal variation for DNI incidence, with a peak incidence in Summer and Spring. All patients included were treated as inpatient and received empirical intravenous antibiotic therapy and steroids regardless of drainage procedures. Incision and drainage was performed in 72 patients. The hospital length of stay was higher among patients with retropharyngeal abscess and in the group with complications. Only 2 patients developed complications during hospital stay. The most common microbiological pattern was monomicrobial and the most commonly isolated pathogens were Streptococcus Pyogenes, Streptococcus Mitis and anaerobic bacteria.ConclusionsSurgical incision and drainage followed by intravenous antibiotic and steroids proved to be successfull with low morbidity related to surgical approach. However, in selected cases, medical therapy may be an alternative to surgical management in uncomplicated infections.

Introduction: Eustachian tube dysfunction is a common cause of morbidity in both adults and children, associated with nasal and otologic symptoms. Symptomatic evaluation is very important for the correct diagnosis and evaluation of the treatment efficacy of this entity. The “7-item Eustachian Tube Dysfunction Questionnaire” was described and validated by McCoul et al and proved to be a useful tool, easy to apply, with good validity in the evaluation of eustachian tube dysfunction symptoms. This study presents the validation process of the European Portuguese version of the “7-item Eustachian Tube Dysfunction Questionnaire”. The aim of this study was to translate and validate the European Portuguese version of “Eustachian Tube Dysfunction Questionnaire-7”.Material and Methods: The “7-item Eustachian Tube Dysfunction Questionnaire” was adapted and translated to European Portuguese using standard validation methodology. The European Portuguese version of “7-item Eustachian Tube Dysfunction Questionnaire” was completed by a group of 50 consecutive adult patients diagnosed with eustachian tube dysfunction and 25 healthy patients who served as a control group. All respondents in the Eustachian tube dysfunction group repeated the “7-item Eustachian Tube Dysfunction Questionnaire” in a two week-period. Statistical analysis was performed to determine its psychometric properties (reliability -internal consistency and test–retest reproducibility, and discriminant validity).Results: Face and content validity were confirmed, and reliability testing revealed similar internal consistency for the entire instrument as the original questionnaire, and strong correlation between individual items and total score. The questionnaire was easy and quick to administer. Test-retest reliability of the European Portuguese version was adequate, with excellent intraclass correlation coefficients and without significant differences between the total score from the first and second evaluations. Discriminative validity was confirmed by statistically significant differences between scores of the test and control groups.Discussion: This study presents the European Portuguese version of the “7-item Eustachian Tube Dysfunction Questionnaire” questionnaire, an adapted, validated and well-accepted instrument to evaluate the symptoms of eustachian tube dysfunction in the European Portuguese speaking population.Conclusion: The European Portuguese version of the “7-item Eustachian Tube Dysfunction Questionnaire” is recommended as a routine procedure in the assessment of patients with eustachian tube dysfunction in the European Portuguese speaking population and for the evaluation of treatment outcome.

Post-traumatic pneumolabyrinth is an uncommon clinical entity, particularly in the absence of temporal bone fracture. We report the case of a patient who presented to our emergency department with a headache, sudden left hearing loss and severe dizziness which began after a traumatic brain injury 3 days earlier. On examination, the patient presented signs of left vestibulopathy, left sensorineural hearing loss and positive fistula test, normal otoscopy and without focal neurological signs. The audiometry confirmed profound left sensorineural hearing loss. Cranial CT revealed a right occipital bone fracture and left frontal subdural haematoma, without signs of temporal bone fracture. Temporal bone high-resolution CT scan revealed left pneumolabyrinth affecting the vestibule and cochlea. Exploratory tympanotomy revealed perilymphatic fistula at the location of the round window. The sealing of defect was performed using lobule fat and fibrin glue. He presented complete resolution of the vestibular complaints, though the hearing thresholds remained stable.

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Gradenigo’s syndrome was firstly described in 1907 by Giusseppe Gradenigo and is defined as the clinical triad of suppurative otitis media, ipsilateral abducens nerve palsy, and pain in the distribution of the first and the second branches of the trigeminal nerve. Since the advent of antibiotics, the incidence of this potentially life-threatening complication has diminished, but occasional cases still occur. We herein report a pediatric case of otitis media associated with Gradenigo’s syndrome complicated by ipsilateral septic cavernous sinus thrombosis and infectious arteritis of the internal carotid artery.

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