Question:  A 4-month-old child is brought to your office with a history of intermittent stridor that worsens with agitation and a barky cough.  At rest and while asleep, he breathes quietly.  He has been gaining weight normally.  Plain films of the neck were obtained for a prior episode that showed some narrowing in the subglottic airway, which was read as "consistent with laryngotracheobronchitis (croup)" by the radiologist.  On physical exam you discover a raised red lesion at the angle of the jaw on the left side.  What is your leading differential diagnosis? [Answer will be posted with next week's new question]

Answer to last week's question, Say what...?! (Apr 20, 2015): 

You have already largely excluded conductive hearing loss with your tuning fork exam and normal physical exam.  Therefore, the presumptive diagnosis is sudden sensorineural hearing loss.  According to the AAO-HNSF Consensus Statement on Sudden Sensorineural Hearing Loss (http://oto.sagepub.com/content/146/3_suppl/S1.full) The initial next steps are as follows:

1.       Assess patient for modifying factors: bilateral sudden loss or focal neurologic symptoms.

2.       Confirm diagnosis with an audiogram.

Additional workup includes MRI, ABR or audiometric follow up to rule out retrocochlear pathology (i.e. vestibular schwannoma).  Routine CT scan and labs are not recommended.  Treatment consists of prompt initiation of systemic steroids, consideration of transtympanic dexamethasone injection, and consideration of hyperbaric oxygen therapy (HBOT) in some cases.