Introduction
Silver nitrate has been used in surgical practice for centuries. It was
first described in 1829 by Hugginbottom for the management of
inflammatory wounds and ulcers.1 Silver nitrate is an
inorganic compound which, when exposed to water, ionizes into free
silver ions which act on tissues and blood vessels to cause coagulation,
necrosis and thrombus fromation.2 Its antiseptic
action is primarily related to apoptosis leading to cell
death.2 Because of its antiseptic and wound healing
properties, it is commonly used as a topical agent for cauterizing
bleeding points particularly over mucosal surfaces, burning granulations
and even cauterizing non-healing ulcers for acceleration of the healing
process.3
Granulations are considered to be one of the diagnostic criteria in
necrotizing otitis externa (NOE).4 These lesions are
common and are often managed by direct application of silver nitrate
especially after taking biopsies due to use its dual
effect.1 Silver nitrate not only provides haemostasis
but also inhibits fibroblast proliferation resulting in rapid resolution
of granulation tissues.3
The compound appears densely radio-opaque on computerized tomography
(CT) imaging mimicking bony fragments and foreign bodies. This is
particularly cumbersome when bony erosion is most relevant in diagnosis.
Despite its regular use in NOE, it is not widely known to be present as
a confusing artifact in cross-sectional imaging. Medical literature
highlights a few cases in which this phenomenon is described; however,
this is predominantly within plain radiographs. There are also no
reports in the context of NOE.