We report 2 cases of tuberculous otitis media that were diagnosed at Stony Brook University Hospital in New York since 1999. Both patients were women, aged 30 and 31 years. One p atient had grown up in Russia, the other was a native-born American who had never left the East Coast region ofthe United States. Both p atients had been symp tomaticfor many months; one comp lained ofchronic otorrhea, and the other reported otorrhea, hearing loss, and discomf ort. Ne ither patient responded to medical management, and both ultimately underwent surgery. One was diagnosed after surgicalp athology revealedacid-fast bacilli on frozen-section analysis. In the other, pathology revealed chronic inflammation andgranulomata, but stains were negat ive and her diagnosis was delay edfor almost 2 years. We also review 9 other cases of tuberculous otitis media in the United States that have been reported in the literature since 1990. Our review suggests that the number ofcases is rising in areas where tuberculosis is most common-that is, in major U.S. cities.Although 3 ofthese 9cases occurred as reactivation disease in immigrants, most might have occurred as a result of local transmission. Clinicians should maintain a high degree ofsuspicionfor tuberculosis in patients with chronic otitis symp toms, particularly those who are at higher risk of exposure to tuberculosis.

In this retrospective study, triptans and DHE were used with no reported, subsequent acute/subacute ischemic vascular events for the abortive treatment of migraines with basilar and hemiplegic-type features. Although the small sample sizes generated theoretical statistical event rates of 4.5% for BM and 23% for HM, there has been no clear evidence that BM and HM carry an actual elevated risk for vascular events compared with migraine with aura.

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The branch of medicine known as osteopathy was founded by Andrew Taylor Still in the mid to late 19th century. Osteopathy is a philosophy of medicine. Osteopathic physicians use techniques collectively referred to as osteopathic manipulative medicine (OMM). One of the most common diseases suffered by those residing in westernized nations is hypertension. Although osteopathic physicians are taught to incorporate OMM into the management of medical disorders, the usefulness of OMM in treating hypertension is less clear. This review reflects on the past 90 years of biomedical literature and attempts to address the utility of OMM used alone, or in combination with other treatments including antihypertensive medication, for the effective management of hypertension. Preliminary evidence may suggest a role for OMM in treating hypertension within the context of a multifaceted and long-lasting treatment regimen that may include traditional pharmacotherapeutics. To have universal acceptance, controlled and blinded outcome studies are needed to determine the effectiveness of OMM for the routine treatment of hypertension.