Empirical antibiotics with Gram-negative cover will be appropriate as adjunctive therapy.

Arteriovenous malformation (AVM) involving the external ears is relatively uncommon in adults. Arteriovenous malformations typically present during childhood and rarely manifest during adulthood in the head and neck region. Symptomatic arteriovenous malformations often pose difficult therapeutic challenges. We report a case of large arteriovenous malformation of the external ear in a 21-year-old female.

Background: Chronic otorrhea in chronic suppurative otitis media (CSOM) has become a difficult task to treat for ENT specialists because of emerging resistance to the available antibiotics and patient's affordability for its cost. Also biofilms have been responsible for the chronicity of disease. Use of vinegar as an antiseptic and altering the pH of middle ear to treat otorrhea in CSOM needs to be studied. Methods: 120 patients with active CSOM were recruited randomly for either vinegar wash or antibiotic therapy. Vinegar diluted with water in 1:1 ratio at pH 4 was used twice a day for 3weeks to one group. Oral antibiotics based on culture sensitivity report were given to other group for 3weeks. Both groups were followed up for a month and observed for resolution of ear discharge. Results: Pseudomonas (40%) and Staphylococcus aureus (25%) were the most common organisms detected. 96.2% of Pseudomonas and 50% of Staphylococcus aureus ears became dry with vinegar wash. 81.67% of antibiotic group and 68.33% of vinegar group ears became dry in 3weeks. No statistically significant difference between vinegar wash and culture based oral antibiotic therapy in resolution of ear discharge was seen in active CSOM (p >0.05). Conclusions: Management of otorrhea is long term in CSOM and vinegar can be used as an alternative to costly oral antibiotics for resolution of ear discharge in active CSOM. Two fold dilution of vinegar prevents chance of ototoxicity.

CT scan showing well-demarcated homogeneous cyst in the left maxillary sinus with expansion and thinning of the anterior and posterior walls of the maxilla Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. The disease is endemic in the Middle East, the South Asia and South America. The larvae usually cause cystic lesions in the lung and liver. Hydatid cysts are known to affect the head and neck region. The presence of this cyst in the maxillary sinus is extremely rare and should be suspected in cases presenting from endemic countries.

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