If an insect enters the ear, the ear may be flooded with alcohol or water, either inebriating the critter or drowning it, and the insect flushed out. Why the ear? Whether the insect is making a random attack, looking for a warm space, or responding to an attractive smell, I don't know. ELLWOOD JONES, MD: Campers in sleeping bags on the ground, particularly in the wintertime or in the mountains, will occasionally find a ground squirrel or a snake crawling in with them for warmth. The patient's admission laboratory results are summarized in Table Table1 1. His motor strength and sensation were intact and so were his reflexes. He had decreased sensation in the right mandibular and axillary branch regions of cranial nerve V and a right peripheral VII lesion. Cranial nerves I, II, IV through VI, and VIII through XII were intact the right corneal reflex was absent. Neurologic examination revealed that the patient was alert and oriented with an obvious right facial droop. The extremities showed no clubbing, cyanosis, or edema, and distal pulses were intact. His abdomen was soft and nontender, his bowel sounds were normal, and there was no hepatosplenomegaly. His chest was clear to auscultation heart rate and rhythm were regular with normal S 1 and S 2 and no murmurs, rubs, or gallops. There was no fluctuance, crepitance, or evidence of meningeal irritation. The right side of his neck was erythematous and swollen down to the right scapula and was tender to palpation. The patient's nares were patent with white-yellow discharge, and the oropharynx was narrowed with the uvula deviated to the left. The external acoustic meatus was swollen, and the tympanic membrane was not visible. The right auricle was erythematous, swollen, and tender to palpation. The right pupil was 2 mm and the left pupil was 3 mm in diameter both were reactive to light, and extraocular movements were intact. The right side of his face was swollen and edematous from the supraclavicular notch to the right orbit. He was ill appearing and in obvious discomfort, clutching his right ear and neck. He denied using alcohol or illicit drugs and had no known drug allergies.Īt BUMC, his temperature was 36.1☌ (97.0☏) heart rate, 84 beats per minute respiratory rate, 24 breaths per minute and blood pressure, 170/90 mm Hg. He had been a 90-pack-year smoker but had quit 8 years before. The patient worked at a refrigerator plant, was married, and had 2 children. His past medical history included sinus surgery at age 25 and a questionable diagnosis of diabetes mellitus several years earlier for which he took no medications and made no dietary changes.
He denied fever, chills, night sweats, dyspnea, chest pain, fatigue, abdominal pain, constipation, diarrhea, urinary changes, or peripheral edema. New symptoms included dysphagia and a cough productive of white sputum. Upon transfer to BUMC, his symptoms had worsened despite these intravenous antibiotics. Two days prior to transfer, his antibiotics were switched to ceftazidime, tobramycin, and piperacillin/tazobactam. On day 2 of that hospitalization, an insulin sliding scale had to be initiated for elevated blood glucose.
He was given levofloxacin, ofloxacin otic solution, acyclovir, and dexamethasone.
He still had hearing loss and facial paralysis, and the facial swelling had extended into his neck. Despite these efforts, the patient's symptoms worsened, and a purulent right ear discharge developed.Īfter 1 week (5 days prior to transfer), he was admitted to a local hospital. The patient noted no improvement in symptoms and was evaluated 2 days later by an otolaryngologist who “drained his ear canal” and changed his antibiotics. The next day he was seen by his primary care physician, who prescribed an unknown antibiotic. Afterward, he began to experience increasing pain and swelling.
He spent approximately 1 hour removing the insect from his ear canal. The patient claimed that during a camping trip, an insect thought to be a centipede crawled into his right ear. The patient was in his usual state of health until 2 weeks prior to the first hospital admission. HASKELL KIRKPATRICK, MD: A 50-year-old, previously healthy white man with right ear pain and hearing loss, right facial swelling, right hemisphere headaches, slurred speech, and right-sided facial paralysis was transferred to Baylor University Medical Center (BUMC) from one of its affiliated hospitals.
0 kommentar(er)
