Tetanus is a fatal infection caused by the neurotoxin tetanospasmin released by the vegetative spores of Clostridium tetani. The high mortality rate is related to frequent tetanic fits with laryngeal spasm and airway obstruction. Numerous anticonvulsants are in use, with varying efficacy in controlling fits. This case report highlights the use of ketamine as adjunctive therapy in the management of tetanus.

A 20-year-old woman was admitted with a history of recurrent left ear pain, with bloody, purulent discharge, following a self-inflicted injury. She developed tetanic spasms 24 hours after admission. She had received no immunisations. A tracheostomy was established to relieve airway obstruction, and ketamine was added to the medication when breakthrough seizures were refractory to diazepam.

Ketamine is of proven safety as an anaesthetic agent, especially in cases in which an anaesthetist is not readily available. Its effectiveness in this case, in combination with diazepam, warrants further evaluation.

To present a case of a 60-year-old male with a history of sudden onset sensorineural hearing loss due to Churg–Strauss syndrome.

The patient had a 20-year history of asthma and recurrent right otitis media and a nasal polypectomy four years prior to presenting with ear symptoms. Ear, nose and throat involvement is common in Churg–Strauss syndrome, usually manifesting as allergic rhinitis and chronic rhinosinusitis with or without polyps.

Otolaryngologists play an important role in making an early diagnosis of this disease. To our knowledge this is the first case of Churg–Strauss syndrome primarily presenting with otological pathology: left sensorineural hearing loss and right otitis media.

Systemic autoimmune diseases, including ulcerative colitis, may involve the inner ear. Several ulcerative colitis cases presenting with sensorineural hearing loss have been reported. We report the T2-weighted, three-dimensional, inner-ear magnetic resonance imaging findings in the inner ears of two such patients.

Case reports and a review of the literature concerning autoimmune disease and sensorineural hearing loss are presented.

We describe two cases of ulcerative colitis with sensorineural hearing loss in which three-dimensional magnetic resonance imaging revealed obliteration of the inner ear. Those inner ears with obliteration had severe hearing loss, and responded poorly to steroid therapy.

To our knowledge, there has been no previous published report of the T2-weighted, inner-ear magnetic resonance imaging findings of cases of ulcerative colitis with sensorineural hearing loss. This paper represents the first published report in the world literature of inner-ear obliteration in such patients. Three-dimensional magnetic resonance imaging is beneficial in elucidating the pathophysiology of the inner-ear involvement seen in ulcerative colitis.

The aim of this report was to highlight the fact that hearing loss in thalassaemia patients can be related to marrow expansion affecting the ossicles, resulting in a conductive loss.

A six-year-old boy with transfusion-dependent beta-thalassaemia developed a unilateral hearing loss shortly after commencing desferrioxamine therapy. Otoxicity was assumed, but the deficit was later found to be of a conductive nature, due to marrow proliferation within the ossicular chain as a consequence of the disease process – a phenomenon previously unreported in the literature.

It is important to elucidate the precise nature of new onset hearing loss in patients receiving iron chelation therapy, in order to avoid unnecessary cessation of much needed medication, on the assumption of ototoxicity.

We report the first case of tongue base myolipoma associated with Gorlin's syndrome.

Case report and review of world literature.

A 39-year-old man with known Gorlin's syndrome presented with progressive dysphagia. Subsequent magnetic resonance imaging scan and biopsy confirmed the rare diagnosis of myolipoma arising from the tongue base. In view of the benign nature of this mass, it was debulked rather than completely excised in order to preserve swallowing function.

To our knowledge, this is the first report of the coexistence of two rare conditions in an atypical fashion. This case appears to represent a new variant in the broad spectrum of features of Gorlin's syndrome.

We aimed to highlight a rare anatomical variation involving the recurrent laryngeal nerve, and to emphasise its implications for thyroid surgery.

Over a period of 13 years, 993 patients underwent thyroid surgery; 1557 recurrent laryngeal nerves (887 on the right side) were exposed.

Three non-recurrent laryngeal nerves were found on the right side, associated with a retro-oesophageal subclavian artery. One case was suspected before surgery.

Several variations in the path and branches of the recurrent laryngeal nerve have been reported in the literature. The frequency of occurrence of a non-recurrent laryngeal nerve is about 1 per cent, for patients undergoing thyroid surgery. Other surgically relevant anatomical variations of the recurrent laryngeal nerve include associations with the inferior thyroid artery and the presence of nerve branches.

The recurrent laryngeal nerve must be carefully dissected and totally exposed during thyroid surgery in order to best preserve its function. Moreover, the thyroid surgeon must be aware of the existence of anatomical variations, which are not as rare as one may think.

We present a rare case of a jugular foramen meningocoele in a 48-year-old female, with neurofibromatosis type 1, presenting with positional vertigo. We also postulate possible underlying pathophysiological mechanisms.

We describe the imaging findings of this rare entity and review the literature on skull base meningocoeles, particularly in the context of neurofibromatosis type 1.

A computed tomography scan revealed smooth expansion of the jugular foramen. Magnetic resonance imaging showed a fluid filled lesion expanding the jugular foramen and communicating with cerebrospinal fluid of the cerebellomedullary cistern superiorly.

Skull base meningocoeles are a rare entity and we believe that this is the first reported case of a meningocoele causing enlargement of the jugular foramen in a patient with neurofibromatosis type 1. The meningocoele may have resulted from a severe form of dural ectasia or from dysplastic, weakened bone at the skull base.

To describe a unique presentation of a predominantly extracranial glomus faciale tumour. To discuss the role of imaging in the differential diagnosis and evaluation of a hypervascular parotid mass. To review the previous literature concerning the glomus faciale tumour.

A 54-year-old woman presented with a six-month history of facial weakness, pain and a parotid mass. Ultrasound revealed a hypervascular parotid mass and pre-operative core biopsy suggested a paraganglioma. Computed tomography defined its deep extent and demonstrated involvement of the petrous temporal bone along the descending portion of the facial nerve canal with a pattern of permeative lucency. A tumour was surgically removed which arose from the facial nerve from the second genu to the proximal divisions within the parotid gland and histology confirmed a paraganglioma.

A facial nerve glomus faciale tumour should be considered in the differential diagnosis of a hypervascular parotid mass and may present in a predominantly extracranial location. Computed tomography will prove helpful in such a case in order to limit the differential diagnosis and to define the extent of skull base involvement.

We describe the emergency use of a covered, expandable, removable tracheal stent in a patient who developed a large posterior tracheal tear complicating endobronchial therapy for large airway obstruction.

Case report and review of the literature concerning management of acute tracheal tear.

Our patient demonstrates that endotracheal stenting is an option for managing acute large airway tear. Moreover, the use of a removable stent allows not only for rapid closure of the defect but also removal once the defect has healed, thus avoiding long-term complications of stent deployment.

We report two unusual and contrasting cases of Wegener's granulomatosis involving the orbit, requiring urgent endoscopic orbital decompression surgery.

Both patients presented with an acute deterioration in visual function which failed to improve with medical management. Case one presented with systemic features of the condition, in contrast with case two, who presented with a more localised form of the disease. Whereas case one exhibited primary orbital disease with maxillary sinus extension (i.e. focal disease), case two illustrates orbital involvement secondary to sinus disease extension (i.e. contiguous disease). Prompt diagnosis, assisted by the presence of systemic features, led to a good visual outcome in case one. In case two, in which diagnosis was difficult and surgery delayed, the outcome was poor.

These cases of orbital Wegener's granulomatosis illustrate the diagnostic challenge, the requirement for early intervention following acute visual deterioration and the importance of heightened awareness of the rarer ENT manifestations of this disease.

Acute sinusitis is a relatively common condition, which usually responds to medical therapy. In most cases, there are no sequelae or complications subsequent to this infection. However, like many acute illnesses, there are well documented complications of acute sinusitis, and in particular these include peri-orbital and intracranial spread.

The purpose of this paper is to highlight the importance of vigilance regarding both peri-orbital involvement of sinusitis and the limitations of imaging techniques such as computed tomography. An illustrative case is presented to demonstrate this.

Magnetic resonance imaging is a valuable modality in assessing complex presentations of peri-orbital complications of acute sinusitis.

We report an adult case of cystic lymphangioma treated with OK-432 (Picibanil®).

A case report and review of the literature concerning the use of OK-432 to treat cystic lymphangioma is presented.

A 31-year-old woman developed a cystic lymphangioma four weeks post-partum. This was treated initially by aspiration, for diagnostic purposes. Investigation suggested that surgery would be challenging. A review of the literature demonstrated success with OK-432 in the treatment of this condition, although primarily in the paediatric population. This patient was successfully treated thus, and at the time of writing remained symptom free. A suggested management plan is outlined.

Treatment with OK-432 is useful in the management of cystic lymphangiomas in adults and should be considered as first line treatment.