⭕️Case 4.
18 years old male complain of dull aching pain over the forehead for last 3 years. The pain is increased in morning and decreased in the afternoon together with intermittent nasal discharge. 10 days ago the pain become very severe with complete nasal obstruction and fever. By the 10th day he become drowsy with some mental behavior changes. There is also vomiting and blurred vision.

⭕️Case 5.
3 years old child suddenly complained of a sore throat and enlarged left upper deep cervical lymph node. Later he suffered from marked body weakness and mild respiratory distress that become progressively severe. Oropharnygeal examination revealed grayish membrane on the left tonsil, soft palate and posterior pharyngeal wall. 2 days later he developed nasal regurge. His temperature was 38 c and pusle 150 beat/minute.

On physical examination, you see the following characteristics feature for this disease

A 28-year-old Caucasian woman presents to her primary care physician due to decreased hearing of the right ear. She reports that her hearing has progressively worsened over the course of a year. In addition to her current symptoms, she has also noticed ear ringing of the affected ear, as well as dizziness. She states that her hearing is improved in a noisy environment and that her friends have noted that she usually speaks quietly during conversations. Medical history is significant for multiple episodes of acute otitis media and seasonal allergies. Family history is significant for her father having "ear surgery" when he was approximately 30-years-old. Otoscopy findings are seen in Figure A.

A 42-year old female comes to the emergency room complaining of facial droop. She reports that she first noticed the facial droop this morning while she had been getting ready for work. Her smile appeared asymmetric and she could not fully close her left eye. A review of systems is also significant for one month of foul otorrhea. The patient’s medical history is significant for recurrent childhood ear infections. The patient’s temperature is 99.0°F (37.2°C), blood pressure is 110/65 mmHg, pulse is 72/min, and respirations are 14/min with an oxygen saturation of 99% O2 on room air. On physical exam, the patient’s mouth is drooping downward on the left, and the patient cannot fully close her left eye. She also has drainage from the left ear, and otoscopic examination demonstrates the finding seen in Figure A. An audiometric evaluation reveals conductive hearing loss in the left ear.