A 47-year-old woman presents with right-sided tinnitus and a sensation of fullness in the ear for 8 months. Audiometry reveals mild conductive hearing loss. Otoscopic examination shows a vascular-appearing retrotympanic lesion that becomes pale with pressure changes in the ear canal. High-resolution CT of the temporal bone reveals a small, enhancing soft-tissue density over the cochlear promontory, with no erosion of the jugular foramen or internal auditory canal. Which of the following best characterizes the histopathological appearance of this lesion?

A 6-year-old boy with a 2-year history of intermittent foul-smelling right ear discharge presents with recent onset diplopia, low-grade fever, and difficulty walking for the past 3 days. On examination, he is alert but has ataxia, right-sided sensorineural hearing loss, and a lateral rectus palsy on the right. There is no mastoid tenderness, and tympanic membrane appears perforated with active discharge. A contrast MRI brain shows a ring-enhancing lesion in the posterior cranial fossa, compressing the 4th ventricle with perilesional edema. Which of the following is the most likely diagnosis?

A 3-year-old boy is brought to the emergency department after a witnessed episode of swallowing a small, shiny, coin-like object while playing. He appears uncomfortable and repeatedly points to the lower neck when asked where it hurts. He has mild drooling but is otherwise stable. A chest X-ray (AP view) shows a round radiopaque object with a double rim sign at the level of the thoracic inlet. Which of the following is the most time-sensitive and potentially fatal complication that must be urgently anticipated?

What is the recommended procedure for removing an esophageal foreign body in a child?

A 17-year-old male is brought to the emergency department after a high-speed motor vehicle collision. Neck inspection shows multiple abrasions and lacerations around his cervical region. As you evaluate him further, you notice his voice is significantly hoarse, and he struggles with swallowing. Concerned about potential neural injury, you decide to investigate which structure has likely been compromised. Which of the following nerve components is the most probable culprit in his presentation?

A 8-year-old child with Down syndrome presents with restricted painful neck movements that began 3 days after undergoing an adenoidectomy and tonsillectomy. He denies throat pain or headache. His parents report that his oral intake is limited to small amounts of clear liquids. He is afebrile and can speak normally but is uncooperative, making it impossible to assess Kernig and Brudzinski signs. What is the most likely diagnosis?

A 25-year-old man presents with worsening nasal congestion. He purchased an over-the-counter intranasal decongestant, which he initially found helpful but now reports provides minimal benefit. His vitals are heart rate 80 bpm, blood pressure 118/68 mm Hg, respiratory rate 14 breaths/min, and temperature 98.6 °F (37 °C). The physical examination demonstrates nasal mucosal edema and erythema. He is advised to discontinue the intranasal decongestant. Which of the following best explains the pathophysiology of this patient's condition?

A 71-year-old woman with a 40-pack-year history of smoking presents with hoarseness and a (9 kg) weight loss over the past 2 months. Laryngoscopy reveals a 2 cm exophytic mass from the infrahyoid supraglottis and extending inferiorly to involve the true glottis, which has impaired but still preserves a small degree of mobility. Multiple firm, immobile, 1.5 cm to 2 cm lymph nodes corresponding to levels II and III are also palpated. Contrast-enhanced computed tomography of the neck shows extension of the tumor anteriorly into the pre-epiglottic space and inferiorly to approximately 7 mm below the true vocal cord. Biopsy specimen analysis confirms squamous cell carcinoma and further imaging is negative for distant metastasis. Concurrent chemotherapy and radiation for laryngeal preservation are planned. What lymphatic levels are most appropriate for this patient to be covered by the radiation fields?

A 65-year-old man presents with hoarseness, pain with swallowing, and earache. The physical examination demonstrates a 3.5 cm node on the left side of the neck. Endoscopy and biopsy results are consistent with squamous cell carcinoma of the right side of the laryngeal surface of the epiglottis. A positron emission tomography/computed tomography scan shows hypermetabolic lesions corresponding to the epiglottic lesion and the palpable node only. What is the nodal staging of this tumor?

A 67-year-old woman with a history of laryngeal cancer shows signs of respiratory distress 1 hour after a routine tracheostomy tube change. Her respiratory rate is 28 breaths/min, and pulse oximetry shows an oxygen saturation of 88%. On further inspection, the tracheostomy ties appear loose. What is the best next step in management?

A 5-year-old boy is referred with difficulty in hearing and mild right-sided earache. He has had no acute infections. On otological examination, the right side eardrum is immobile with a fluid level behind it. When the clinician performs a myringotomy in preparation for tube placement, profuse and continuous flow of clear fluid ensues. What is the next course of action for this patient?

A 60-year-old man with left-sided facial weakness is diagnosed with Bell palsy. His vitals are heart rate 76 bpm, blood pressure 125/79 mm Hg, temperature 99 °F (37.2 °C), respiratory rate 16 breaths/min, and oxygen saturation 99% on room air. On the physical examination, which of the following is this patient expected to have difficulty performing?

A 75-year-old man presents with chills and severe ear pain for 7 days. His medical history is notable for hypertension and poorly controlled type 2 diabetes mellitus. Physical examination reveals an erythematous, tender auricle with an intact tympanic membrane and edema, as well as granulation tissue at the bony-cartilaginous junction of the external auditory canal. Which of the following treatments is most likely to be helpful?

A 9-year-old boy presents after his younger sister bumps into him while he is cleaning his ear with a cotton tip applicator. The patient had a sudden onset of pain in that ear that has since resolved. He currently denies symptoms. On physical examination, there is a small tear in the anterior and inferior portion of the tympanic membrane. Which of the following is the next best step in treating this patient?