A rare case of nasal polyposis requiring urgent tracheostomy is reported. A70-year-old male presented to the hospital with stridor. He had a 10-year history of nasal obstruction. A large proliferative mass was found to be occupying both the nasal cavities. An emergency tracheostomy and biopsy of the lesion was performed. A computerized axial scan (CT) demonstrated that the lesion occupied the pharynx reaching up to the laryngeal inlet. To our knowledge this is the first case reported in the literature. Upper airway obstruction from nasal polypsis uncommon but can cause significant morbidity if not appropriately managed.

Pyomyositis (PM) is an uncommon cause of acute bacterial infection occurring in skeletal muscle. This disease is rare in non-tropical areas, and PM caused by Mycobacterium is very rare in a non-immunocompromised person. The presence of temporal area swelling may lead to a differential diagnosis toward more common pathologies, such as a complication of mastoiditis or a neoplasm of the temporal area. This article describes a case of tuberculous pyomyositis in a non-immunocompromised woman, the diagnosis of which was confirmed by sonographically guided fine-needle aspiration.

The value of high resolution computerized tomography (CT) prior to routine mastoid surgery for cholesteatoma remains controversial. Doubts about sensitivity and specificity, in detecting the extent of underlying pathology and in predicting asymptomatic complications, prevent widespread adoption.

This retrospective study looks at the influence of pre-operative scanning on the surgical management of chronic suppurative otitis media over an 18-month period. The radiological findings determined the choice of surgical approach, but contributed less to the decision to operate and the prediction of potential hazards. CT is of most value when the otologist can be flexible in surgical technique, tailoring it to imaging findings.

Imaging is an important component in the investigation of unilateral watery rhinorrhoea suspicious of cerebrospinal fluid (CSF). Whilst the demonstration of the presence of beta 2 transferrin confirms that CSF is present it may prove difficult to demonstrate the exact site of origin. Fine detail coronal computed tomography (CT) with sections of 1-2 mm thickness through the anterior skull base may show small dehiscences and fractures. The commonest site for congenital dehiscences is the cribriform niche adjacent to the vertical attachment of the middle turbinate anteriorly and the superior and lateral walls of the sphenoid posteriorly. In the presence of frequent or constant CSF rhinorrhoea a CT cisternogram can be helpful in defining the exact site of the leak. Magnetic resonance imaging (MRI) is reserved for defining the nature of soft tissue i.e. inflammatory tissue, meningoencephalocele or tumour. Finally, per-operative intrathecal fluorescein is helpful when imaging does not prove positive. A management algorithm for CSF rhinorrhoea is presented.

Most necrotizing (malignant) external otitis (NEO) occurs in diabetic patients and is commonly caused by Pseudomonas aeruginosa. We report an acquired immunodeficiency syndrome (AIDS) patient with NEO caused by Aspergillus fumigatus in which computed tomography (CT) showed destructive petrous bone involvement and magnetic resonance imaging (MRI) of the ear discovered extensive soft tissue and facial nerve involvement. Dedicated MRI studies of the ear in this type of pathology provide new insights relating to nerve dysfunction, that cannot be obtained with CT.