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PubMed1989

[Malignant otitis externa].

This is an aggressive infectious disease caused by Pseudomonas aeruginosa, especially seen in diabetics and elderly, sometimes coming to and end in those cases in which the diagnosis has been protracted or the treatment misleading. But it must be said that the diagnosis is not easy, either because of the insidiousness of the onset or the hidden difficulties when dealing with malignant growths of the meatus. The AA report a case of the kind emphasizing the importance of the real diagnosis as well as the right treatment. This should be prudently prolonged beyond the apparent healing until the cultures show a total sterilization.

Diabetes Complications↗
PubMed1995

Bone-anchored hearing aids in patients with sensorineural hearing loss and persistent otitis externa.

Recently, a new bone-conduction hearing aid has become available which can be connected percutaneously to the skull: the bone-anchored hearing aid or BAHA. Several clinical trials have shown its efficacy in patients with a conductive or mixed hearing loss. A second group of potential candidates are patients who suffer from an almost instantaneous skin reaction to any kind of earmould. Three such patients with a predominant sensorineural hearing loss were fitted with a BAHA. The aided free-field thresholds proved to be poor compared with the desired values using prescriptive rules. Speech recognition measured objectively (with tests) and subjectively (with a questionnaire) was comparable or better than with conventional bone-conduction hearing aids. Two patients were using their BAHA all day, whereas the third patient was only using it for a few hours per day. Although it did not produce optimal results, the BAHA seems to be the best solution for these patients.

Adolescent↗
PubMed1993

Characteristics of cerumen in diabetic patients: a key to understanding malignant external otitis?

Malignant externa otitis is a potentially fatal disease in diabetic and other immunocompromised patients. Cerumen contains defense properties that protect the patient against infection. We tested the hypothesis that patients with diabetes mellitus have abnormalities in their cerumen that affect the environment of their external auditory canals and may predispose them to malignant externa otitis.

Aged↗
PubMed2000

Methicillin-resistant Staphylococcus aureus: pediatric otitis.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a potentially lethal organism in pediatric patients. MRSA is an uncommon otologic pathogen that requires special diagnostic and therapeutic intervention. METHODS: Three pediatric patients with community-acquired MRSA otologic infections were identified during 1999. SETTING: Tertiary care ear institution. RESULTS: All patients required intravenous antibiotic therapy to achieve resolution of the infections. CONCLUSIONS: MRSA in children can be community acquired and can cause otitis externa, otitis media with otorrhea, or acute mastoiditis; intravenous therapy that includes vancomycin is necessary for resolution.

Anti-Bacterial Agents↗
PubMed2000

Acute otalgia: a case report of mature termite in the middle ear.

Acute otalgia during childhood is one of the most common complaints in general ENT practice. It may occur as a result of acute otitis externa, otitis media or a foreign body. Animate foreign body in the ear canal or in the middle ear usually results in otalgia and hearing loss. We present a rare case of a living mature termite in the middle ear of a 9-year-old girl complaining of intermittent attacks of otalgia associated with a loud cracking sound in the left ear. In this case, a small perforation of the tympanic membrane without a history of previous trauma, infection, or evidence of a foreign body in the external ear raises a suspicion. A careful, time-consumed microscopic examination could show the living creature in the middle ear. Immediate immobilization and removal of the living foreign body are imperative. In conclusion, tympanic membrane perforation and intermittent severe otalgia without history of otitis may lead to a suspicion of any insects in the middle ear.

Acute Disease↗
PubMed1993

Aural symptoms as primary presentation of Langerhan's cell histiocytosis.

Langerhan's cell histiocytosis is an uncommon granulomatous disease, characterized by the idiopathic proliferation of Langerhan's cells or their marrow precursors. It encompasses the diseases previously associated with histiocytosis X-eosinophilic granuloma, Hand-Schuller-Christian syndrome and Letterer-Siwe syndrome. A series of 54 patients were diagnosed with this condition in Dublin over a 33-year-period (1959-1992). Twenty-seven patients had aural symptoms, of whom 15 had no other lesions at the time of presentation. Otorrhoea was the most frequent otological symptom, followed by lesions in the temporal bone. LCH may mimic common aural conditions such as otitis externa, otitis media or acute mastoiditis and a high index of suspicion is required to recognize it on clinical presentation. The clinical presentation of multi-focal disease may be so dramatic that the otologic findings may be initially overlooked. The mortality rate was 14.8%. Therapeutic regimes included no treatment, curettage, chemotherapy, radiotherapy or multi-modality treatment.

Age Distribution↗
PubMed1989

[Ototopic agents].

In treating ear disease every otolaryngologist is familiar with topical medications. The choice of the ideal agent for a given clinical situation may be difficult. In order to make this decision more easy, we overlook the composition of ear-drops. The most important disadvantages are ototoxicity, allergy and pain. The place of ototopical agents in otitis externa, otitis media and otomycosis is discussed.

Administration, Topical↗
PubMed1998

Head and neck manifestations of AIDS in adults.

Head and neck manifestations of acquired immunodeficiency syndrome (AIDS) are among the most common complications of this disease. Some of these manifestations are the initial signs of human immunodeficiency virus (HIV) infection, and others are associated with full-blown AIDS. Otologic manifestations include otitis externa, otitis media, Kaposi's sarcoma and sensorineural hearing loss. Nasal and oral manifestations of AIDS are more common than otologic manifestations and range from infections, caused by both opportunistic and nonopportunistic organisms, to malignancies. We address common manifestations and current treatment recommendations.

AIDS-Related Opportunistic Infections↗
PubMed2002

[Current therapeutical management, new antibiotics and treatment of Pseudomonas aeruginosa in bacterial ENT-infections].

In bacterial infections of the sinuses and the middle ear Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus are most frequently isolated, whereas in tonsillopharyngitis Streptococcus pyogenes is the most important pathogen. S. aureus is found in up to 40 % in acute and chronic sinusitis and causes severe complications in otitis media, therefore antibiotics used as empirical initial treatment should also be effective against this pathogen. To decrease duration of illness and to avoid serious complications antibiotic treatment of bacterial ENT-infections is necessary. The new ketolides and the third and fourth generation quinolones are very effective and the second generation cephalosporins like cefuroxime axetil have proven excellent clinical and bacteriological efficacy in numerous clinical trials combined with an excellent resistance pattern over the years. Efficacy of short course therapy (5 days) in sinusitis and tonsillopharyngitis has been proven in clinical trials and is cost saving. In more severe infections treated in hospital sequential i. v./oral therapy offers pharmaco-economical benefits. Both regimen demonstrate cost savings while maintaining high clinical efficacy. In more severe infections like otitis externa diffusa, otitis externa maligna, otitis media chronica and perichondritis Pseudomonas aeruginosa is a dangerous pathogen that has to be covered by initial antibiotic treatment. Ciprofloxacin and Ceftazidime are widely used and effective. Ciprofloxacin resistance has increased, while Ceftazidime susceptibility is unchanged (> 90 %). A dose reduction study with ceftazidime in severe ENT-infections showed equivocal efficacy between 3 x 1 g and 3 x 2 g daily that offers a cost benefit of 50 %.

Ceftazidime↗
PubMed1991

Inflammatory middle ear disease of the dog: the pathology of otitis media.

Inflammation within the middle ear cavity was recognised in 62 of the ears of 42 dogs with chronic otitis externa and otitis media, after biopsy or necropsy of the middle ear. The pathological changes in the middle ear resembled those reported in other species or after the experimental induction of otitis media in dogs. Perforations in the tympanic membrane were rarely found; on the contrary, the membrane was often thickened. However, the question of whether a perforation in the tympanic membrane must occur before otitis externa can extend to otitis media was not resolved.

Animals↗
PubMedDate not supplied

A study of tea tree oil ototoxicity.

Tea tree oil shows promise as an effective treatment for a number of micro-organisms commonly associated with otitis externa and otitis media, but its possible ototoxicity has not been previously assessed. The ototoxicity of tea tree oil was examined in the guinea pig by measuring the thresholds of the compound auditory nerve action potential (CAP) to tone bursts before and after instillation of the oil into the middle ear. After 30 min of instillation, 100% tea tree oil caused a partial CAP threshold elevation at 20 kHz. A lower concentration of oil [2% tea tree oil dissolved in saline using 0.5% detergent (Tween-80)] did not cause any significant lasting threshold change after middle ear instillation for the same period of time. The latter concentration of oil is greater than the minimum inhibitory concentration reported for most micro-organisms in the effective spectrum of the oil and this suggests that this concentration may be safe and effective provided only short exposures (about 30 min) are used. The results suggest that high concentrations of tea tree oil applied to the round window for a relatively short time are to some extent ototoxic to the high-frequency region of the cochlea. Hence further study is needed to establish whether tea tree oil can be used with safety in the treatment of external and middle ear infections.

Animals↗
PubMed1982

The weeping ear: clinical re-evaluation of treatment.

This study was designed to compare the efficacy and safety of gentamicin otic solution versus colistin-neomycin-hydrocortisone otic suspension in the treatment of otorrhoea due to infection. Fifty-five patients (mean age 36.6 +/- 22.1 years) with sixty infected ears with otorrhoea complicating otitis externa, recurrent otitis media with tympanic membrane perforation, or infected mastoid cavities and post-operative tympanoplasties, were treated for 14 days with either an aqueous solution of gentamicin 0.3% or an aqueous suspension of colistin 0.3%, neomycin 0.33% and hydrocortisone 1.0%. The two possible treatments were assigned randomly and the results were assessed double-blind using usual ordinal scales for monitoring the severity of symptoms. Both otic preparations were found to be equally safe in the treatment of otorrhoea due to infection. No side-effects were observed and hearing status was either unchanged or improved. The antibiotic-steroid combination appeared to be more effective in relieving inflammation in a shorter period of time while gentamicin was observed to be more effective in eradicating the infecting organisms.

Adult↗
PubMed1984

Aetiological evaluation of foreign bodies in the ear and nose.

A clinical study has revealed that irritation caused by pre-existing diseases of the ear (e.g. chronic otitis externa, wax with chronic otitis externa, C.S.O.M. with otitis externa or the presence of wax in the meatus) and by those of the nose (e.g. acute or chronic rhinitis, chronic vestibulitis or the presence of dried, thick sticky mucus in the vestibule of the nose in the resolving stage of a common cold) are the major aetiological factor in foreign bodies in the ear and nose. Boredom, curiosity, whims to explore the natural cavities of the body, habit, acts of imitation, fun-making and mental retardation are only minor aetiological factors.

Boredom↗
PubMed1990

Morphologic measurements of the external horizontal ear canal of dogs.

Microscopic anatomy of the horizontal part of the external ear canal was evaluated in 24 dogs. Sixteen dogs were from breeds known to have a predisposition to otitis externa. The remaining 8 dogs were from breeds that do not have a predisposition to otitis externa. Dogs were separated into groups according to predisposition to otitis externa: group 1-predisposed dogs without otic inflammation, group 2-predisposed dogs with otic inflammation, and group 3-nonpredisposed dogs without otic inflammation. Qualitative microscopic evaluation of distribution of hair follicles revealed hair within proximal, middle, and distal regions of the horizontal ear canal in all breeds. The degree of keratinization was directly proportional to the presence of otic inflammation and was excessive in group-2 dogs. Quality of sebaceous glands within the horizontal ear canal was similar among dogs with and without otitis externa, whereas the quantity of apocrine tubular glands was significantly increased (P less than 0.05) in dogs with otitis. Quantity of apocrine tubular glands was also greater in group-1 dogs than in group-3 dogs. Thickness of the soft tissue in the external ear canal increased in direct proportion to the progression of disease and was greatest in the proximal region of the affected ear canal. Soft tissue located caudally between nonopposing ends of the annular cartilage, within the proximal region of the horizontal ear canal, contained few glands and hair follicles in dogs without otitis externa. In dogs with otitis externa, this region was infiltrated by distended apocrine tubular glands.

Age Factors↗