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PubMed1984

[Role of azlocillin in the treatment of Pseudomonas aeruginosa otitis in children].

From May, 1978 to October, 1983, 88 children with otitis due to Pseudomonas aeruginosa were seen at Paediatric Unit E.N.T. consultation of the University Hospital of Tours. Epidemiologically, it is worth mentioning that the majority of these infections was not of nosocomial origin: 56 children were infected outside the hospital and 26 during their stay in hospital; 3 neonates were referred directly from the Maternity Unit. Most strains of Ps. aeruginosa, with various serotypes, were sensitive to azlocillin. Twenty-four children received a systemic treatment required by their local or general condition. Azlocillin was used in 24 cases on the basis of positive sensitivity tests and was occasionally combined with topical treatment using antiseptics or the antibiotic itself. Or the 3 failures observed, 2 were due to acquired resistance to azlocillin and 1 to chronic otitis. An incomplete result was obtained in a case of otitis externa caused by a strain of intermediate sensitivity. The remaining 19 cases were cured, including 3 neonates with otitis externa or media, 1 child with otitis externa, 1 with combined otitis externa and media, 10 with otitis media, usually protracted, 2 with mastoiditis medically cured and 1 with superinfection following mastoidectomy for cholesteatoma. Secretions dried up within 3 to 4 days and treatment was discontinued after clinical cure was obtained in 9 to 19 days. Fever, which was present in 7 cases, abated within 2 to 8 days. The only relapse that occurred, one month after treatment of an otitis media, responded to a second course of azlocillin.

Adolescent↗
PubMed1986

The pathology of the external ear canal in dogs and cats.

A survey of factors which predispose the canine ear to otitis externa is presented. In resected ear specimens of 106 dogs, otitis externa without tumour was found on 58 occasions. In 46 dogs tumours were diagnosed in 15 cases with an otitis externa. In two dogs an inflammatory polyp was found. In the resected ear specimens of 48 cats, otitis externa was diagnosed 27 times, in 6 cases combined with an inflammatory polyp. In 21 cases neoplasia was present. The otitis externa was mainly a chronic proliferative inflammation characterised by hyperkeratinization, hyperplasia of the sebaceous and ceruminous glands, fibrosis and infiltration with plasma cells, lymphocytes and macrophages, often containing ceroid pigment.

Animals↗
PubMed1987

The use of fluoroquinolones in chronic otitis suppurativa.

The present review covers fluoroquinolone usage in chronic otitis suppurativa (COS) in case of chronic otitis media, cholesteatoma, radical mastoid cavity infection and chronic or relapsing otitis externa. A total of six publications were included in the final evaluation. Enoxacin was effective in 35%; ciprofloxacin (five publications) was used in 82 patients with 67% effectivity in otitis externa and otitis media and 61% effectivity in radical mastoid cavity infection. No serious adverse reactions were reported. The promising efficacy of otitis media and otitis externa and safety profile needs further confirmation in double blind prospective clinical studies, that will provide a firm basis for changing the current treatment schedules of COS.

Cholesteatoma↗
PubMed1985

Acute otalgia in Nigerian children.

A study of 112 referred children with acute otalgia labeled 'acute otitis media' by the referring physicians was carried out at the E.N.T. clinic of Lagos University Teaching Hospital in 1981-1982. Only 11% of these were actually due to acute otitis media, reflecting poor technique at otoscopy. Of the acute otalgia cases 56% were due to ear pathology while 44% resulted from referred pain. Otological causes included foreign body in the ear (23%), acute otitis media (11%), otitis externa (10%), secretory otitis media (6%) and myringitis bullosa haemorrhagica (4%). Cases due to referred otalgia were from tonsillitis (21%), foreign body in the pharynx (5%), traditional uvulectomy (5%), and foreign body in the nose (2%). Thus, there is a need for more careful examination of the ear in all cases of acute otalgia.

Acute Disease↗
PubMedDate not supplied

Has cerumen a protective role in recurrent external otitis?

PURPOSE: We investigated the bactericidal activity of the cerumen in patients with recurrent otitis externa. MATERIALS AND METHODS: Cerumen samples were collected from 2 groups. Group A (n = 20) consisted of patients with recurrent otitis externa (2 or more acute otitis externa attack in the current year) and group B (n = 30) consisted of cerumen from a healthy population. We examined the bactericidal activity against the common microorganisms (Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus) that encounter the recurrent otitis externa. RESULTS: A significant decrease in the count of S epidermidis was observed in group A (P <.05) and B (P <.01) was observed. A comparison of decreases and increases in the percentages of microorganisms between the groups A and B showed that there was a significant difference only in the count of E coli (P <or=.05). The count of E coli decreased in cerumen suspension in group A, but it increased in the normal population. CONCLUSION: We did not confirm that cerumen from patients with recurrent otitis externa had less bactericidal activity than from a healthy population.

Cerumen↗
PubMedDate not supplied

[Descriptive study of infectious ear disease in relation to summer].

A descriptive study was made of infectious ear disease (including diffuse otitis externa, otomycosis, acute-on-chronic otitis media, and superinfection of a radical mastoidectomy cavity) in relation to changes of weather and habits in summer. During the months of June, July, and August 1996, 179 patients were evaluated in the emergency room of the Alicante General University Hospital, Spain. Average patient age at presentation was 30.52 (+/- 20.08) years and 56% were men. The most frequent disease was diffuse otitis externa (78%) followed by acute-on-chronic otitis media (12%), otomycosis (8%), and superinfection of a radical mastoidectomy cavity (2%). The most frequently involved microorganisms were Pseudomonas aeruginosa in diffuse otitis externa, Aspergillus niger and Candida in otomycosis, Escherichia coli, Haemophilus influenzae, Proteus mirabilis, and Staphylococcus aureus in acute-on-chronic otitis media. Patients were treated by cleaning detritus and secretions, usually followed by topical antibiotics for a maximum period of one week.

Administration, Topical↗
PubMed2003

[Effects of Burow's solution as an ear drop on Intractable chronic suppurative diseases of the external ear canal and middle ear].

OBJECTIVE: Burow's solution was developed by Karl August von Burow in the 19th century as an ear drop. Thorp et al. reported its excellent effect on chronic suppurative otitis media in 1998. We applied Burow's solution to intractable chronic purulent diseases of the external and middle ear in the 12 months from February 2001. SUBJECTS: Subjects were 25 ears of 21 patients--35-79 years old, 10 men's ears and 15 women's ears--whose disease has continued for an average of 3.78 years. Diseases and patients are as follows: 1) 11 ears with postoperative mastoid cavity problems, 2) 7 ears with chronic external otitis and chronic eczema of the external ear canal, 3) 7 ears with fungal otitis externa, 4) 6 ears with chronic otitis media with perforation, and 5) 2 ears of chronic granulated myringitis. METHOD: The solution was dropped into the ear canal once a day for 10 min or cotton balls soaked with the solution were applied to the canal wall. Criteria of efficacy were divided into cured, effective and unchanged. RESULTS: 8/11 ears with a cavity problem were cured (72.7%) and 3 ears showed treatment to be effective. All 7 ears with chronic external otitis and chronic eczema were cured. All 7 ears with fungal otitis externa were cured. 4/6 ears (66.6%) with chronic perforated otitis media were cured and 1 ear each showed treatment to be effective and 1 unchanged. Two chronic granurated myringitis were cured. Twenty of 25 ears (80%) were cured. Pre- and posttreatment audiometries showed almost the same. The cure appeared within 3 days to 3 weeks. The solution was not effective against mucoid secretion, cholesteatoma, or residual mastoid cells. The day after treatment, serous secretion appears temporarily. CONCLUSION: Burows's solution is seemed to be very effective and nonototoxic as an otic drop for treating suppurative ear diseases.

Acetates↗
PubMed2002

[External otitis].

Otitis externa is one of the most common diseases in ORL practice, during summer; the treatment of otitis externa may be simple and easy or protracted and frustrating, also with fatal outcome. Many local factors may interfere with the normal defences against infections in the external auditory canal. Removing or dissolving the cerumen by water or other instruments eliminates an important barrier to infections: its acids inhibit the growth of bacteria (Staphylococcus aureus and Pseudomonas aeruginosa) and fungi (Aspergillus). Also skin abrasions or irritation, allergic diseases and many systemic condition like anaemia, vitamin deficiency, endocrine disorders (diabetes) and various forms of dermatitis cause a lower resistance to infections in external auditory canal. Even if the prognosis remains benign in the majority of cases, important complications could appear like: malignant otitis externa, facial nerve paralysis, tympanic bone osteomyelitis, pericondrytis. Successful treatment depends on a proper diagnosis and therapy: the most important factor in the treatment is repeated debridement of the external auditory canal by the physician. The use of Castellani' Tintura rubra, hydroalcoholic solution of phenic fuchsin, can be very effective for bacteria and mycotic eradication. Culturing of ear canal infection could be performed on the second or third visit if the otitis externa is not responding to therapy. Complication are not frequent, but malignant otitis externa can be mortal. Dermatological consultation is often necessary for correct diagnosis.

Diagnosis, Differential↗
PubMed1991

The painful ear.

The painful ear is caused commonly by otitis media, otitis externa and temporomandibular joint dysfunction. Difficulty in visualising the tympanic membrane due to debris in the ear canal can make diagnosis difficult, especially when otitis externa and otitis media co-exist. Another problem is determining the origin of referred pain. Due to the complex innervation of the ear, referred pain can arise from most sites in the head and neck, especially the upper cervical spine, the teeth and the throat.

Acetaminophen↗
PubMed2001

Outcome of 22 cases of perforated tympanic membrane caused by otomycosis.

Twenty-two cases of perforated tympanic membrane due to fungal otitis externa were observed over a five-year period. The diagnosis of fungal otitis externa was made on clinical grounds due to the obvious presence of fungal bloom in the external ear canal. Some perforations were noted at the first treatment after the fungal debris had been removed from the external ear canal using a microscope. Other perforations were observed to develop over a few days. Initially, a discrete area of the tympanic membrane appeared white and opaque. As time progressed the white area disintegrated, forming a perforation. Once the otitis externa had resolved most perforations healed spontaneously. Two that were observed to develop during treatment required a myringoplasty. Another one closed significantly but a tiny persistent perforation required cauterization with trichloracetic acid to encourage it to close over completely. The only residual hearing loss was in a case with almost total disintegration of the tympanic membrane requiring a myringoplasty. Treatment of fungal otitis externa for the patients in this series was aural toilet using suction under a microscope and insertion of a gauze wick saturated in a combination of hydrocortisone, clotrimazole, framycetin and gramicidin.

Administration, Topical↗
PubMed1998

Microbial flora and antimicrobial susceptibility patterns of isolated pathogens from the horizontal ear canal and middle ear in dogs with otitis media.

OBJECTIVE: To compare microbial flora and antimicrobial susceptibility patterns of isolated pathogens from the horizontal ear canal and middle ear in dogs with otitis media. DESIGN: Prospective study. ANIMALS: 23 dogs with chronic bilateral otitis externa. PROCEDURES: Swab specimens of the horizontal ear canal and middle ear were obtained for cytologic analysis, bacterial culture, and antimicrobial susceptibility testing. Integrity of the tympanic membrane was observed. If the tympanic membrane was intact, myringotomy was performed to collect specimens. RESULTS: Otitis media was diagnosed in 38 of 46 (82.6%) ears evaluated. The tympanic membrane was intact in 71.1% of the ears with otitis media. The 3 most common organisms isolated from the horizontal ear canal and middle ear were Staphylococcus intermedius, yeast, and Pseudomonas spp. A difference in total isolates or susceptibility patterns between the horizontal ear canal and middle ear was found in 34 (89.5%) ears. Compared with results of bacterial culture, cytologic examination of swab specimens was not as effective for detection of rods and cocci from the middle ear. CLINICAL IMPLICATIONS: In dogs with chronic otitis externa, otitis media often exists even when there is an intact tympanic membrane. In our study, the same isolates were rarely found in the horizontal ear canal and middle ear. Therefore, to choose appropriate antimicrobial agents, in addition to cytologic examination, bacterial culture and susceptibility testing of swab specimens from the horizontal ear canal and middle ear should be performed.

Animals↗
PubMedDate not supplied

Inflammatory polyps of the middle ear in 5 dogs.

OBJECTIVE: To describe inflammatory polyps of the middle ear in 5 dogs. STUDY DESIGN: Case series. ANIMALS: Five dogs with ear disease. METHODS: Medical records (1995-2001) were reviewed to identify dogs with inflammatory polyps of the middle ear. Signalment, clinical signs, ancillary diagnostic procedures, treatment, postoperative complications, and outcome were recorded. Owners and referring veterinarians were contacted to document outcome. RESULTS: Dogs with inflammatory polyps of the middle ear were male and aged 4 to 13 years. Two dogs had bilateral polyps, whereas 3 had unilateral polyps. The most common clinical presentation was otitis externa and media, with radiographic evidence of otitis media. Polyps were treated by ventral bulla osteotomy (VBO) in 1 dog and total ear canal ablation with lateral bulla osteotomy (TECA-LBO) in 4 dogs. Polyps consisted of a fibrovascular stroma infiltrated with neutrophils, macrophages, lymphocytes, and plasma cells. The overlying epithelium was frequently ulcerated. Immediate postoperative complications included a seroma after VBO (1 dog) and transient unilateral facial nerve paralysis after bilateral TECA-LBO (1 dog). No recurrence occurred within 9 to 69 months. CONCLUSIONS: Unilateral or bilateral, inflammatory polyps can occur in the middle ear of dogs in association with otitis externa and media. No recurrence occurred after surgical removal of the polyps. CLINICAL RELEVANCE: Inflammatory polyps of the middle ear in dogs can be a cause of otitis externa/media. Surgical removal of aural polyps has a good prognosis.

Animals↗
PubMed2001

Uses and indications for video-otoscopy in small animal practice.

Acute and chronic otitis externa and otitis media are common disorders in dogs and cats. In combination with other diagnostic and therapeutic procedures, the video-otoscope is a useful and effective tool in the management of clinical cases. The enhanced illumination and magnification provide the practitioner with more detailed information for diagnosis and prognosis, and the configuration of the working channel facilitates sampling, improves efficacy of cleaning procedures, and decreases risks of iatrogenic injury to structures of the middle and inner ear. Photographic documentation of clinical cases enhances the medical record, communication with colleagues, and client education. Although video-otoscopy facilitates diagnosis and therapy, it does not replace other important diagnostic tests such as evaluation for atopy, adverse food reactions, and immune-compromising disease. Failure to identify the underlying primary cause usually results in treatment failure regardless of the technology employed.

Animals↗
PubMedDate not supplied

Tympanometry.

The basic principles essential for interpreting two-component, multiple frequency tympanograms first are reviewed. These principles then are applied to an analysis of tympanometric shape (conductance, susceptance, and admittance tympanograms) as a function of probe frequency in subjects with normal middle ear transmission systems. The final section presents tympanometric data from patients with confirmed middle ear pathologies that produce an increase in resonant frequency (e.g., middle ear effusion, otosclerosis, ossicular adhesions, and tympanic membrane retraction) or a decrease in resonant frequency (e.g., otitis externa, serous otitis media, tympanic membrane pathology, and ossicular discontinuity). The advantages and disadvantages of a particular probe frequency and/or admittance component are illustrated with individual cases. The cases further demonstrate that the same tympanometric pattern can be recorded from ears with different pathologies (e.g., tympanic membrane perforation with cholesteatoma, tympanic membrane retraction, ossicular adhesions, and middle ear effusion), and conversely, that the same pathology can result in different tympanometric shapes (e.g., tympanic membrane perforation, middle ear effusion, and otosclerosis). Caution, therefore, must be exercised in ascribing a tympanometric abnormality to a specific middle ear lesion.

Acoustic Impedance Tests↗
PubMedDate not supplied

Otologic disease in patients with acquired immunodeficiency syndrome.

A 5-year retrospective study evaluating otologic disease in patients with acquired immunodeficiency syndrome (AIDS) was conducted at the New York University Medical Center-Bellevue Hospital Center. Twenty-six patients with documented otologic disease who met the Centers for Disease Control criteria for AIDS were identified and their charts were analyzed according to presenting complaints, physical examination, diagnostic modalities, pathologic condition, management, and outcome. A marked diversity of otologic diseases of varying severity was noted. The majority of patients complained of hearing loss and otalgia during their hospitalization for treatment of AIDS-related opportunistic infections. The most frequent diagnoses were otitis externa, acute otitis media, and otitis media with effusion. Sensorineural hearing loss frequently appeared to be related to ototoxic medications and neurologic infections.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Otological manifestations of Wegener's granulomatosis.

The otological manifestations of Wegener's granulomatosis were studied in 13 patients; diagnosis was confirmed histologically in 10, and in 1 patient periarteritis nodosa presented similar appearances. One patient had destruction of the external ear, and several had refractory otitis externa, usually associated with otitis media: 3 patients had serous otitis media, 4 had purulent otitis media of a fairly mild course, while 6 had otitis media of a fulminant and long-lasting course, accompanied in 5 cases by cranial nerve palsy and in 2 by widespread destruction. Most patients had major sensory hearing loss. Two had short-lasting anacusis during exacerbation of the pulmonary lesions. Often, otological manifestations were the initial signs of the disease. It is important to bear this diagnosis in mind in cases of long-lasting and atypical inflammations and in the presence of peculiar constellations of symptoms from several different organ systems.

Adult↗
PubMed2005

Applications of disease benchmarks and case presentations.

A large dataset of integrated pharmacy and medical claims, extracted from independent third-party databases, is being combined with disease benchmarking technology to facilitate analysis of inpatient, outpatient, ancillary services, and pharmaceutical utilization and costs. The Disease Benchmarks Program was developed to create opportunities for health care decision makers to evaluate the entire health care continuum in a disease-specific fashion. The Benchmarks program is valuable because of its flexibility and because it depicts what is occurring in clinical practice. It can be customized and also show regional variations in treatment. The possible applications of benchmarking applications are discussed in the case presentations of otitis externa, acute otitis media with tympanostomy tubes, and Sjorgren's syndrome.

Benchmarking↗
PubMed1998

Which culprit is causing your patient's otorrhea?

Otorrhea varies in appearance and can be accompanied by a multitude of symptoms. Recognition of what various combinations indicate--whether otitis externa, chronic otitis media, Langerhans' cell histiocytosis, or basal or squamous cell carcinoma--is essential. Physicians must also be familiar with the tests appropriate for confirming otorrhea's cause. Once proper diagnosis is made, effective treatment can follow.

Anti-Infective Agents↗