The erroneous appearance of silver nitrate on computerised tomography imaging in patients with severe otitis externa; a case series

Abstract

Silver nitrate has been used in surgical practice for centuries. It was first described in 1829 by Higginbottom for the management of inflammatory wounds and ulcers. 1 Silver nitrate is an inorganic compound and when exposed to water, it ionises into free silver ions, which acts on tissues and blood vessels causing coagulation necrosis and thrombus formation. 2 Its antiseptic action is now described as being primarily related to apoptosis leading to cell death. 2 Because of these antiseptic and wound healing properties, it is commonly used as a topical agent for cauterising bleeding points; especially over mucosal surfaces, burning granulations and even cauterising the non-healing ulcers for acceleration of the healing process. 3 Granulations in necrotizing otitis externa (OE) are very common and are considered to be one of the diagnostic criteria. 4 These lesions are often managed by applying silver nitrate especially after taking biopsies due to its dual effect. 5 Silver nitrate not only provides haemostasis but further inhibits fibroblast proliferation resulting in rapid resolution of the granulation tissues. 3