Otolaryngology Head and Neck Surgery August 1995
At this time the patient was found to have a 10% posteroinferior marginal tympanic membrane perforation. Computed tomography demonstrated a dehiscent and edematous facial nerve within the tympanic segment. The eric drops were discontinued, the patient was given a 3-week tapering course of oral steroids, and her facial function recovered completely during the following 5 weeks. This paper will present an unusual case of facial paralysis following the use of otic drops for the treatment of otomycosis. A literature review will be provided with respect to the pathophysiology of this neuropraxia and the clinical significance of facial nerve dehiscence within the temporal bone. 152 Electrophysiologic Monitoring (ABR) of Coma Status LUIZ C. A. SOUSA, BENEDICTO O. COW, MARCUS A. FEREZ, and PAULO C. D. ANTONIAZZI, RibeirOo Preto, Brazil
Auditory brainstem response (ABR) has shown its usefulness in detecting different types of diseases. By working with neurologists and neurosurgeons who have started to use ABR as a method to analyze the integrity of the patient's brainstem auditory pathways, we have acquired experience in the use of ABR monitoring of the comatose patient regarding the prognosis of the coma status and as a method to diagnose cerebral death. Because cerebral death has become a criteria for indicating organ transplants, ABR has been used more and more as a secure and practical method to analyze brain function. Even in patients with hypothermia or those who are under deep sedation (such as those in barbituric coma or other central nervous system depressors), this noninvasive method can be used in a reliable way. We believe that ABR monitoring may be an important method among many that evaluate brain function of the comatose patient. In our experience of monitoring 50 patients with varied causes of coma, such as trauma or cerebral anoxia or hemorrhage, we have observed that the irreversibility of the neurologic status is associated with certain electrophysiologic patterns. We describe a patient who was monitored during her coma; pattern changes of her ABR waves and latencies were indicators of her neurologic status. 153 Escherichia coliOsteitis of the Skull Base ERIC M. GENDEN, MD, ROBERTBAHADORI, MD, and JOEL GOEBEL, MD, St. Louis, Mo.
Osteomyelitis of the skull base (OSB) commonly results from an external otitis in compromised patients via the fissures of Santorini to involve the periauricular tissue, parotid gland, and, finally, the base of skull. Overwhelmingly, the causative organism is pseudomonas aeruginosa or a
mixed infection, which, through its course, becomes dominated by this gram-negative aerobic rod. This case presentation describes an 80-year-old white man with non-insulindependent diabetes who underwent excision of a keratinous cyst in his right external auditory canal and soon thereafter presented with a right facial paralysis that ultimately was diagnosed as skull base osteitis (SBO) without malignant external otitis (MEO). Preliminary cultures of the ear were negative and the patient's condition progressively worsened, despite aggressive therapy with intravenous antipseudomonal therapy. Cultures obtained from an exploratory mastoideetomy revealed Escherichia cell as the etiologic organism of the SBO. The patient's antibiotic regimen was altered, and with the addition of hyperbaric oxygen and E. coil-directed antibiotic therapy, the patient had a slow but successful recovery. This is, to the best of our knowledge, the first reported case of SBO caused by E. cell in an adult. This report highlights the indolent course of SBO in the absence of external otitis and the possibility of other organisms, besides pseudomonas, as the infectious agent. An aggressive approach to obtain tissue for culture and culture-directed antibiotic therapy with hyperbaric oxygen treatment resulted in eventual recovery from this often fatal disease process. 154 Chronic Otitis Media: Common Complications AURA M. PALACIOS, MD, JUAN A. CHIOSSONE, MD, RICARDO MA1TEI, MD, and GERALDINE CAIBE, MD, Caracas, Venezuela
Chronic otitis media (COM) is a common cause of consultation in an otolaryngology office. Early diagnosis and treatment of the otitis media is important to prevent further complications of the disease. Clinical examination, radiology, and a well-performed surgical and medical treatment could prevent critical compilations such as sensorineural hearing loss, mastoiditis, and meningitis. With the outcome of new antibiotics, complications can be prevented. Lifethreatening complications of COM are less frequent, but when they occur, they are sometimes are misdiagnosed because of their low frequency in the daily practice. In this poster we present 190 cases of COM diagnosed and treated at the University Hospital in Caracas, Venezuela, in a 9year period. We present epidemiologic data, most common complications, microbiologic data, and outcome of medical and surgical treatment. The result of this investigation could be useful to compare with data from other areas of the world and their common complications of COM.