Subperiosteal orbital abscess (SPOA) is a rare but serious complication of acute sinusitis in infancy. We report a 3-month-old male infant who presented with a two-day history of progressive left periorbital swelling and fever. Examination revealed left-sided proptosis, ptosis, chemosis, and restricted extraocular movements. Contrasted CT of the orbit and paranasal sinuses demonstrated a rim-enhancing medial subperiosteal orbital collection with irregularity of the lamina papyracea and a superotemporal extraconal collection. Initial intravenous antibiotic therapy, clinical improvement was limited. Subsequent MRI brain, orbit and paranasal sinus confirmed a medially located SPOA with superior extension. The patient underwent endoscopic sinus surgery and left orbital decompression, resulting in complete resolution of orbital swelling and restoration of normal ocular function. This case report further elucidates critical considerations in managing such cases in early infancy, emphasising the balance between medical therapy and timely surgical intervention to mitigate potentially serious complications.
Cochlear implants (CIs) are an established treatment for the rehabilitation of profound sensorineural hearing loss. Although overall complication rates are low, postoperative infections and wound complications may require revision surgery or device explantation. A 27-year-old Black male with profound bilateral hearing loss since infancy underwent right cochlear implantation in 2013. Following head trauma in 2022, the patient developed magnet-related issues and subsequently experienced recurrent inflammation and purulent discharge at the implant site. He remained a non-user of the device for approximately two years. Due to persistent local infection and absence of auditory benefit, partial removal of the internal implant was performed. Delayed bone overgrowth around and over a CI receiver is a rare but important late complication that can lead to infection, skin breakdown, and device dysfunction. This case underscores the need for long-term follow-up and early surgical intervention when unexplained symptoms or implant failure occur.
Dermoid cysts, found in the lateral neck are uncommon and it is evident that fewer cases have been documented in the parotid gland and tonsillar fossa area. We would like to report a case of a 20-year-old male patient who has presented with a swelling measuring 7 × 8 cms, on the left side of the upper neck, extending inferiorly from below the pinna and angle of the mandible up to the upper third of the sternocleidomastoid along its anterior border. The patient was provisionally diagnosed with a second branchial cysts and was advised to go for surgical excision. The MRI findings revealed a T1 hyperintense lesion, and a tract that extended to the pharyngeal wall, both of which were missed during the initial evaluation. A lateral presentation in the neck involving the parotid gland is very uncommon, with PubMed and Google searches revealing very few cases.
Pott’s puffy tumor (PPT), defined by frontal bone osteomyelitis with a subperiosteal abscess, is a known sequela of bacterial rhinosinusitis. This case report highlights Mycobacterium tuberculosis as a cause for PPT, which had resulted in delayed diagnosis and treatment. Although previously described, extrapulmonary tuberculosis (TB) of the sinonasal cavity is an exceedingly rare cause for atypical PPT. A 76-year-old immunocompromised female with several days of isolated, progressive facial swelling, consistent with PPT, underwent urgent frontal sinus trephination and endoscopic sinus surgery. Intraoperative cultures and histopathology demonstrated Mycobacterium tuberculosis infection. The patient recovered without any complications after surgery and antitubercular therapy. TB is a rare but important differential in atypical PPT, particularly in immunocompromised patients or those with risk factors for TB. Given the nonspecific clinical and radiographic features, diagnosis often relies on a high index of suspicion. Delayed recognition carries significant public health implications, including further transmission and intracranial progression.
The objective is to describe contralesional horizontal video head impulse test (vHIT) hypergain in chronic unilateral M & eacute;ni & egrave;re disease and relate it to low-frequency rotational asymmetry. A 72-year-old man with definite left-sided M & eacute;ni & egrave;re disease, onset February-March 2020, underwent follow-up audiometry, horizontal and vertical HIMP/SHIMP, VVOR/VORS, and rotational chair testing. Horizontal HIMP gain was 1.04 left and 1.50 right; SHIMP gain was 1.26 left and 1.42 right. Vertical gains were broadly preserved. Symptoms remained left-sided, with no right aural fullness or tinnitus. The patient showed no frank ipsilesional high-acceleration canal deficit, but clear rightward horizontal hypergain. Rotational testing showed reduced low-frequency gain, mild rightward directional preponderance, and asymmetric post-rotatory time constants. Contralesional vHIT hypergain may represent the high-acceleration expression of residual slow-domain imbalance within an incompletely recalibrated horizontal vestibular network.
