Malignant Otitis Externa- Managment Discussion.

Dr. Shakuntala Ghosh: Would be happy if anyone shares a fool-proof
complete treatment schedule for an elderly diabetic with possible
malignant Otitis Externa. He has granulation floor of EAC wth pus,
moderate pain, culture report Pseudomonas sensitive to Pipericillin' tazo?
Cefoperazone- sultamicin.
He has taken the latter combo for 7 days. I have ordered a Ct Mastoids

Duration of symptoms 2 months, treated outside

Dr. Kvss Sastry: Peptaz 10 days

4.5 GM TID 10 days

Please look into fungi also

Aftèr CT temporal bone

Dr. Kiranbir Singh: Ceftazidime 1 gm bd for 10 days. Followed by
Moxifloxacin 400 od for two weeks.
All u need to see response and accordingly change the regime .

Dr. Aru Handa: Most often need to continue antibiotic for weeks or
months even beyond pain and local inflammation  relief.

Dr. Anandabrata Bose: Agree completely and strict control of diabetes

Dr. Madhusudan Rao: My experience Shakunthala,

Inj. Ceftazadime 1gm twice a day

Tab. Ciprofloxacin 500 mg thrice or iv Ciprofloxacin

Topical Ciplox drops hourly for a minimum of 7 days

Followed by

Ciprofloxacin for one month.

As Sastry suggested fungal???

If you can keep ciprofloxacin ointment with dexa as cotton wick will do
wonders twice daily

Dr. Shakuntala Ghosh: Thank u Sir but the aural swab culture showed
Pseudomonas resistant to all
Quinolones.

Dr. Madhusudan Rao: Still it works on long run with higher doses.
Sometimes tge culture test may be
false positive or negative.

Qunalones resistance is a very rare phenomenon. May be false negative

Dr. Amar Singh (Muscat)

Sharing our huge experience of treating Malignant Otitis Externa(MOE) in over
250 patients in diabetic pt successfully in a single institution with  a well defined
Al Nahdha management protocol which is a now a national protocol in Oman followed by all institutions. Hope this helps Dr. Shakunthala and others. Treat this sinister condition in bits and pieces carries high morbidity and morbidity.

Dr.Amar Singh

Senior Consultant 

ENT Al Nahdha Hospital,

Muscat,Oman.

Watering of Eyes in babies (Epiphora)

Doc, Why my newborn has excessive watering from his/ her eyes?  

Ans. Watering of eyes from new born is of serious concern to parents. Usually the passage between eyes and nose for tear drainage is formed by the age of 6 months of fetus. In few cases, this may persist after birth. Most of such cases responds to special massage over lacrimal sac area known by name Criggler hydrostatic massage.

Technique is important. It should be behind the anterior lacrimal crest. search video on youtube. 

Till what age should parents do massage?

Ans.  1 year

When to refer such cases to eye doctor? 

Depends upon severity of symptoms 

Does early probing has any contraindication? 

No

Concerns

How to check vision in babies 🤱 

Can be done with special cards

Infantile glaucoma can also cause epiphora and photophobia

Botox dosages in spasmodic dysphonia

Botox dosages are practioner dependent.

To start with, use low dosage. 1 U for women and 1.5 Unit for man. 

Average dose 3 units per side. 

This maximize benefits (fluency) 

And minimize side effects (breath voice) 

Basal cell carcoma (Atrophic Variant)

Paediatric auditory brainstem implant

Implant is placed in the lateral recess of the 4tb ventricle close to foramen of Luschka and stimulates dorsal and ventral nuclei. 

The cochlear nucleus has tonotopicity. 

Flocculus of cerebellum is variable in size and hides the entry into lateral recess.

Switch on of cochlear Auditory brainstem implant is done after 3-4 months.

Vestibular dysfunction is seen I. Few patients.

Indication of cochlear implant

(From lecture of Dr. Mohan Kameshwaran)


It take 2-3 year for child to learn after implant and it varies. This is unlike Cochlear implant where it takes less than 1 year.

Fasting guidelines prior to Anaesthesia

Latest guidelines on Fasting prior to Anaesthesia.

Clear liquids allowed upto 2 hours prior to Anaesthesia.

Other liquids allowed upto 4 hours prior to Anaesthesia

Light diet allowed upto 6 hours prior to Anaesthesia.

If a patient has taken a heavy meal,then 10 hours must elapse prior to Anaesthesia.

Endoscopic excision of right maxillary sinus Odontogenic cyst having a tooth within it. 

Nose pack with airway is best

in laying down of fears of suffocation. 

Did Total thyroidectomy with modified neck dissection for a papillary carcinoma of thyroid patient. 

50 year female presented with foul smell in nose for 2 months. 

Nasal endoscopy showed purulent discharge coming form left middle meatus and going to Naso pharynx. 

After uncinectomy, fungal muck seen on floor of left maxillary sinus causing purulent postnatal drip. 

Congenital Cholesteatoma as seen behind intact ear drum causing facial palsy and complete hearing loss

A small thornwaldt cyst detected incidentally on MRI