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Mastoiditis caused by mycobacterium tuberculosis (TB) has an extremely low incidence in paediatric patients and intracranial complications are even rarer. We report the case of a 2-year-old Caucasian male who presented to a tertiary ENT centre with a left sided mastoid swelling and drowsiness after having been treated unsuccessfully for unresolving ear pain and discharge for 6 weeks. He was subsequently found to have mastoiditis with intracranial complications caused by mycobacterium TB. This report aims to increase awareness of TB as a potential cause of chronic unresolving ear pain in the paediatric age group, as well as the importance of multidisciplinary team management. [ABSTRACT FROM AUTHOR]

Rhabdomyosarcoma is a rare malignant tumour of striated muscle accounting for 3% of all primary soft tissue tumours of the middle ear cavity. We describe a unique case of a rhabdomyosarcoma of the middle ear cavity in a four-year-old boy, presenting as an otherwise asymptomatic ipsilateral Horner's syndrome. This case involved tumour erosion through the tensor tympani semicanal, accessing the carotid canal and the sympathetic plexus running through it. This child was treated successfully with chemotherapy and proton beam therapy, and remains disease free at six years of follow-up. This case highlights the importance of investigating patients with non-resolving ear infections, polyps or granulation tissue.

Streptococcus pneumoniaeis one of the key pathogens responsible for otitis media (OM), the most common infection in children and the largest cause of childhood antibiotic prescription. Novel therapeutic strategies that reduce the overall antibiotic consumption due to OM are required because, although widespread pneumococcal conjugate immunization has controlled invasive pneumococcal disease, overall OM incidence has not decreased. Biofilm formation represents an important phenotype contributing to the antibiotic tolerance and persistence ofS. pneumoniaein chronic or recurrent OM. We investigated the treatment of pneumococcal biofilms with nitric oxide (NO), an endogenous signaling molecule and therapeutic agent that has been demonstrated to trigger biofilm dispersal in other bacterial species. We hypothesized that addition of low concentrations of NO to pneumococcal biofilms would improve antibiotic efficacy and that higher concentrations exert direct antibacterial effects. Unlike in many other bacterial species, low concentrations of NO did not result inS. pneumoniaebiofilm dispersal. Instead, treatment of bothin vitrobiofilms andex vivoadenoid tissue samples (a reservoir forS. pneumoniaebiofilms) with low concentrations of NO enhanced pneumococcal killing when combined with amoxicillin-clavulanic acid, an antibiotic commonly used to treat chronic OM. Quantitative proteomic analysis using iTRAQ (isobaric tag for relative and absolute quantitation) identified 13 proteins that were differentially expressed following low-concentration NO treatment, 85% of which function in metabolism or translation. Treatment with low-concentration NO, therefore, appears to modulate pneumococcal metabolism and may represent a novel therapeutic approach to reduce antibiotic tolerance in pneumococcal biofilms., (Copyright © 2016, American Society for Microbiology. All Rights Reserved.)

With the increasing role of evidence-based medicine we, as ENT surgeons, are being asked more and more to justify the practice of grommet insertion in children with glue ear. The audiological improvement which follows this operation is often only moderate at best. When judged solely in terms of hearing improvement, one may miss the often dramatic all-round improvement in a child which the parents frequently report to us postoperatively. We set out to confirm this clinical observation by using a retrospective questionnaire, seeking parental opinion after their children had undergone grommet insertion. We found a wide range of reported benefits as a result of grommet insertion; these include an improvement in hearing (92.1%), a reduced frequency of ear infections (74.1%), a reduction in postoperative GP visits (87%), less time missed from school (70.7%), as well as a variety of improvements in children's speech, education and general behaviour. Overall, we found that 96.7% of parents were satisfied that the decision to insert grommets in their child was correct. We feel that these non-audiological factors should be taken into account when judging the potential benefit to a child, or population of children, from grommet insertion.