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Skull base osteomyelitis (SBO) is a serious and rare condition most commonly seen in elderly diabetic or immunocompromised patients as a complication of otitis externa. We present the case of a previously healthy 3-year-old girl who presented to the paediatric emergency department with vomiting, fever, lethargy, headache and left-sided facial nerve palsy. The initial CT head revealed left-sided otitis media with otomastoiditis and she was managed with intravenous antibiotics and myringotomy with grommet insertion with initial improvement. Two weeks later she re-presented having deteriorated and a dedicated mastoid CT and temporal bone MRI showed SBO. She underwent urgent cortical mastoidectomy where microbiological analysis of the cultures and specimen grew Candida albicans. She was subsequently treated with long-term antifungals and antibiotics, and eventually recovered with good effect. The diagnostic dilemma and the empirical treatment of such a rare case are discussed.

We present a case of a Caucasian woman aged 67 years referred with a 4-day history of sore throat, dysphagia, fever and nasal blockage. Examination revealed a swollen neck and pharyngeal pseudomembrane. A throat swab was positive on culture for Corynebacterium ulcerans, with toxin expression confirmed on PCR and Elek testing. A diagnosis of classical respiratory diphtheria was made, with subsequent confirmation of the patient's domesticated dog as the source of infection. The dog had recently been attacked by a wild badger and was being treated for an ear infection. The patient made a good recovery with intravenous antimicrobial and supportive therapy; however, she subsequently developed a diphtheritic polyneuropathy in the form of a severe bulbar palsy with frank aspiration necessitating percutaneous endoscopic gastrostomy feeding. A mild sensorimotor peripheral neuropathy was also diagnosed. The patient eventually made an almost complete recovery.

A “difficult airway” is defined as a clinical situation in which a trained medical practitioner has problems using a face mask on a patient and performing endotracheal ventilation.1 Its incidence during routine anaesthesia has been estimated at 3-18%, with higher figures reported in emergencies.2 Failure to recognise and intervene appropriately in a case of a patient with a difficult airway can have catastrophic repercussions. The Difficult Airway Society has therefore produced guidelines and algorithms that include recommending the creation of a surgical airway in such situations.3 However, this procedure lies outside the comfort zone of most trainees, being performed infrequently even by experienced clinicians. In addition, postoperative airway management requires subspecialised knowledge and skills that doctors from other specialties who are providing cross cover …