NASAL HIRUDINIASIS IN A TODDLER Nasal hirudiniasis poses a significant challenge to the patient and the attending physician, especially when involving a toddler. Herein, we report a three-year-old child who presented with unilateral spontaneous epistaxis, with witnessed leech in the left nostril. We highlight a simple technique of nasal leech removal using an application of lignocaine nasal spray in the child under adequate sedation. The challenge in removing a leech from a toddler’s nasal cavity is attributed mainly to the combination of anxious parents, an uncooperative child, and the characteristics of the leech, such as its slimy surface. A simple bedside technique using lignocaine nasal spray may be adequate and may reduce the necessity of admission and the risk of general anaesthesia.

Relapsing polychondritis (RP) is a disease that confounds clinicians worldwide due to the difficulty in confirming its diagnosis and determining the best treatment plan. We report a case of a 34-year-old lady who presented with bilateral inflamed auricular swelling and red eyes, which turned out to be relapsing polychondritis. The patient was successfully treated with long-term oral steroids and is on regular follow-up. This report highlights how the subtle signs of her condition were picked up, leading to her diagnosis of RP and the treatment regime that successfully reversed her symptoms. The challenge of picking up subtle signs of the disease is best met by working as a team in a multidisciplinary setting. A literature study shows that RP is a rare disease that can present with many symptoms.
Polychondritis, Relapsing

Sporotrichosis is regarded as the most common subcutaneous fungal mycosis, which occurs following traumatic inoculation of Sporothrix schenckii complex. Albeit rare, sporotrichosis, also known as 'rose gardener's disease', has been reported to involve children whereby active or passive transmission through a vector such as domestic animals has been identified as the main culprit. Herein, we report sporotrichosis in a pair of siblings who presented to the outpatient Otorhinolaryngology clinic in University Malaya Medical Centre with a lower lips skin lesion and submental swelling after kissing their domestic cat. Sporotrichosis was diagnosed following the fungal culture of the skin scrapings of the lower lip’s pustular lesions. Prompt treatment with oral itraconazole (8 mg/kg/day) for six weeks showed the resolution of symptoms. We highlight the pathophysiology of zoonotic sporotrichosis and the mode of management of this entity. Additionally, the management of sporotrichosis should include the veterinarian's assessment of the infected animal.
Sporotrichosis

Evidence suggests that otologic injury from ototopical aminoglycoside preparations is infrequent when used to treat ear infections with an intact tympanic membrane. Meanwhile, parenteral administration of aminoglycosides, is well known to be associated with a significant incidence of cochlear and vestibular damage. The discrepancy between topical and parenteral ototoxic effects is thought to result from a combination of factors, including the protective function of debris overlying the round window membrane, low antibiotic concentrations of topical antibiotic preparations, length of exposure and inability to detect subtle hearing or vestibular changes. Herein, we present a case of acute vestibulopathy following a 2-week course of topical gentamicinotic drops. Awareness of vestibulotoxicity following topical gentamicin therapy is prudent as vestibulopathic symptoms can be severely debilitating.
Aminoglycosides ; Ototoxicity

Temporal bone rhabdomyosarcoma is an aggressive entity that simulates chronic otitis ear infection. It is the most common soft tissue sarcoma amongst pediatric patients. Herein, we would like to report a case of temporal bone rhabdomyosarcoma involving a 2-year-old boy who presented with a one-month history of otorrhea with facial asymmetry. Early treatment led to remission of this severe neoplasm

A 12-year-old boy was referred to our ENT clinic with an incidentally discovered left supraclavicular mass that was suspected to be malignant. He was asymptomatic and had no prior illnesses. Neck examination found a fixed, hard, non-pulsatile, and non-tender mass measuring 2 cm in diameter in the left supraclavicular fossa. Rest of the ENT assessment, chest and upper limb neurovascular examinations were unremarkable. The patient’s full blood count was within the normal range.