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.