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.

A 25-year-old woman presents to the urgent care clinic for cough for the past five days. She recently moved to the area and has not yet established a primary care doctor. She has noticed worsening runny nose with congestion, sneezing, and tearing over the past few days. She initially thought that it was just due to dust from moving boxes into her new apartment, but her symptoms did not improve after cleaning her belongings and vacuuming her floor. She feels some relief after splashing her face with cold water, but her symptoms recur within ten minutes. She has no pets and does not take any medications. Her physical exam reveals examples of findings shown in Figures A-C. No rales or wheezes are appreciated on lung auscultation, but bronchial breath sounds are heard at the bases. The patient states that she will need to drive back home after this visit. What is the best initial step in management?

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Endoscopic septoplasty

3 years old child was referred to ENT specialist because of cough, difficulty in breathing and temperature 39 c of few hours duration. The child is admitted to the hospital for observation and medical treatment. 6 hours later the physician performed immediate tracheostomy. After the surgery the child was releived from the respiratory distress for 24 hours and he become dyspnic again. The physician carried out small minor procedure that was necessary to relieve child dyspnea. After days the tracheostomy tube is removed and the child is discharge from the hospital.

X ray was performed

49 years old male present with enlargement of the upper deep cervical lymph nodes on both side of the neck of 6 months duration. The nodes appear first in the right side. The patient gave a history of decreased hearing in the right ear that was intermittent then become permanent. Recently he developed reduced hearing in his left ear, nasal regurge, nasal intonation of voice, and recurrent mild epistaxis.