PubMed · 3394562
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J Helms. 1988. Inner ear surgery.. https://doi.org/10.1159/000415659
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A case is presented of a child who initially presented with genuine aural symptoms and pathology. Over a period of time it became apparent that the persistent aural bleeding, which is an uncommon feature of Chronic Suppurative Otitis Media, was the result of trauma inflicted by its mother; a case of Munchausen syndrome by proxy (MSBP).
A novel machine learning system, Galactica, has been developed for knowledge discovery from databases. This system was applied to discover diagnostic rules from a patient database containing 564 cases with vestibular schwannoma, bening paroxysmal positional vertigo, Ménière's disease, sudden deafness, traumatic vertigo and vestibular neuritis diagnoses. The rules were evaluated using an independent testing set. The accuracy of rules for these diagnoses were 91%, 96%, 81%, 95%, 92% and 98%, respectively. Besides being accurate, the rules contained the five most important diagnostic questions identified in the earlier research. The knowledge presented with rules can be easily comprehended and verified.
A diagnosis of Wegener granulomatosis requires granulomatous manifestations in the respiratory tract. With the increasing use of antineutrophil cytoplasmic autoantibodies as a diagnostic tool, Wegener granulomatosis is diagnosed earlier than in the past, and not infrequently when only ear, nose and throat manifestations are present, placing the otorhinolaryngologist in a central role in diagnosis and management. Diagnostic biopsies should be obtained from active lesions in the nose and paranasal sinuses and concomitant infection should be identified. Because of the apparent relation between infection and activation of disease, the management of infections-especially those due to Staphylococcus aureus-requires special attention. The increasing numbers of early cases identified warrants further investigations of whether less toxic treatment regimens will be of advantage in such cases. Medical and surgical treatment of the acute and chronic manifestations presents specific problems because of altered immune competence, prevalent superinfection, and tissue destruction, and is therefore best taken care of by specially dedicated otorhinolaryngologists.