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PubMed1990

Otologic disease in the acquired immunodeficiency syndrome.

It appears that true otologic manifestations of AIDS are rare and that incidental otologic disease associated with AIDS is more common. A review of the literature revealed that otitis externa, acute otitis media, recurrent acute otitis media, otitis media with effusion, chronic suppurative otitis media with cholesteatoma, and herpes zoster oticus may all represent incidental otologic disease occurring in patients with AIDS. Chronic otitis media without cholesteatoma (P carinii-infected aural polyps), sensorineural hearing loss, acceleration of otosyphilis from the latent stage, and development of Kaposi's sarcoma of the external auricle or nasopharynx may represent true otologic manifestations of AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1979

Management of acute ear infections.

The differential diagnosis between the usual acute otitis externa and acute suppurative otitis media is presented. Other important and sometimes frequently seen entities that present as infections in the ear are also discussed. It is emphasized that a patient complaining of ear pain with normal findings on examination must be more thoroughly investigated because of the possibility of a more ominous condition such as carcinoma of the pharynx.

Acute Disease↗

PubMed1998

Acute on-chronic middle ear disease.

The discharging ear is a common presenting symptom to GPs and otologists. The commonest causes are otitis externa and otitis media. Less common is cholesteatoma, which presents with a chronic offensive mucopurulent discharge and deafness. Acute mastoiditis as a presenting symptom of cholesteatoma is rare and, with the introduction of antibiotics, the incidence has declined even further. We present three cases of cholesteatoma presenting as mastoiditis.

Acute Disease↗

PubMedDate not supplied

Subtotal ear canal ablation in 18 dogs and one cat with minimal distal ear canal pathology.

A modified technique for performing total ear canal ablations is described. This technique requires less dissection than the standard technique and maintains a portion of the distal vertical ear canal. Subtotal ear canal ablations were performed in 18 dogs and one cat for the treatment of otitis externa or masses of the horizontal ear canal. Animals with otitis externa had minimal involvement of the distal ear canal. Dermatological problems associated with the remaining ear canal and pinnae occurred in eight animals and resolved with medical management. Normal ear carriage was maintained in all animals with erect ears. Further investigation is required before the procedure can be recommended as a treatment for otitis externa not caused by masses or anatomical abnormalities of the horizontal ear canal in dogs with pendulous ears.

Animals↗

PubMed2003

A benefit-risk assessment of ofloxacin otic solution in ear infection.

Ofloxacin is a fluoroquinolone antibacterial with potent bactericidal activities and the topical otological preparation of this drug has been clinically utilised since the late 1980s. The rate of eradication with ofloxacin ranges from 83.3% to 100% for all pathogens commonly isolated from middle ear effusions in cases of otitis media and otitis externa. Despite the significant length of its usage, emergence of resistant pathogens has been rarely encountered in clinical trials; only two strains of Pseudomonas aeruginosa have been documented with decreased susceptibility to ofloxacin following the use of the otic solution.Ear infections, including otitis externa, chronic suppurative otitis media and otorrhoea associated with tympanostomy tubes, are common problems in clinical practice. The potential complications associated with ear infection can be otological, extratemporal, or even psychosocial. They are sometimes fatal and the effect can be long-lasting and detrimental. The use of an effective topical antibacterial with high cost-effectiveness is definitely warranted. As regards various clinical aspects, including overall success rate, symptomatic relief of otalgia and otorrhoea, ofloxacin otic solution was found to be more effective than comparator agents, be it a topical antibacterial, a systemic antibacterial or combination drugs. The systemic absorption of fluoroquinolones is minimal after topical application. Ofloxacin otic solution 0.3% has been shown to have a low rate of adverse drug reactions. Adverse reactions to ofloxacin otic solution were generally mild. The lack of ototoxic effect from ofloxacin eardrops, even in the concentration higher than 0.3%, has been demonstrated in animal studies. In the clinical setting, no increase in bone-conduction threshold has been shown after the treatment of topical ofloxacin otic solution. There have not been any reports of ototoxicity with ofloxacin otic solution since its approval. To conclude, ofloxacin otic solution 0.3% is clinically effective in the treatment of otitis externa and chronic suppurative otitis media in particular with respect to the overall cure rate, relief of otalgia and otorrhoea. It is well tolerated, with minimal adverse effects. It is not associated with any ototoxicity both experimentally and clinically.

Administration, Topical↗

PubMed2001

Behavioural pattern of malignant otitis external: 10-year review in Ibadan.

Malignant externa otitis is a rapidly progressive infection of the external ear canal, mastoid and the base of the skull caused by Pseudomonas aeruginosa in elderly diabetics and other immunosuppressive conditions. Thirteen cases of malignant externa otitis seen in the E.N.T. Dept University College Hospital, Ibadan between 1988 and 1997 were reviewed. The mean age was 62 years and the mean duration of diabetes was 14 years. The most frequent symptoms were otalgia 13 (100%) and otorrhoea 12 (92%). The complications include multiple cranial neuropathy 11 (85%), meningitis (31%), brain abscess (8%), and infratemporal abscess 1 (8%). There were 8 deaths (62%) showing that this is still a dangerous condition in our environment. The problems identified were late presentation of cases and inavailability of facilities for prompt control and monitoring of patients. It is hoped that the outlook of the disease can be improved if there are corrected.

Aged↗

PubMed1984

"Swimmer's ear" among children of kindergarten age and water quality of swimming pools in 11 Kibbutzim.

In an effort to determine if bacterial water quality was related to the incidence of otitis externa ("swimmer's ear") in kindergarten children, a prospective study was conducted between May and September 1980 in 11 communal agricultural settlements (kibbutzim) in Israel. High total bacterial count, total coliforms and fecal coliform counts were found to be positively associated with otitis externa. This association was enhanced when nondivers were separated from divers. Among the divers, the rate of ear inflammation was high regardless of water quality. Among nondivers at the time of the study, the rate of otitis externa was as high as 35.7% in swimming pools with poor quality water, and as low as 17.0% in those with good quality water (P = 0.03). Younger children had a slightly higher risk of otitis externa than had older children.

Age Factors↗

PubMed1995

Blood group phenotype determines lectin-mediated adhesion of Pseudomonas aeruginosa to human outer ear canal epithelium.

Pseudomonas aeruginosa is the most frequent bacterial pathogen causing acute diffuse otitis externa. In a recent prospective phase II study we demonstrated that lectin-mediated bacterial adhesion can be blocked by receptor-analogue carbohydrates in patients suffering from Pseudomonas aeruginosa-induced acute otitis externa. In this investigation, human ABO blood group antigens were analysed on outer ear canal epithelial cells with standard routine histological procedures by monoclonal antibodies for the blood groups A and B, and with Ulex europaeus I lectin for the blood group O, respectively. In all cases (n = 20) the blood groups could be shown immunohistologically. P. aeruginosa-specific adhesion and inhibition assays were performed in the presence of N-acetylgalactosamine (GalNAc), N-acetylglucosamine (GlcNAc), D-mannose and A-like substance. Outer ear canal tissue sections were incubated with P. aeruginosa (strain PA 60), presenting lectin-specificity for GalNAc. Sections from patients presenting with blood group A were closely settled with bacteria in the presence of non-specific GlcNAc, D-mannose and PBS however, GalNAc and A-like substance inhibited the microbial adhesion. Amongst others, P. aeruginosa present adhesion molecules (lectins) with specificity for GalNAc. Thus, the correlation between blood group A phenotype and P. aeruginosa-induced acute diffuse otitis externa was investigated. Statistical evaluation proved a highly significant association. These data support the hypothesis that P. aeruginosa lectins with GalNAc specificity apparently adhere to GalNAc moieties, representing the terminal blood group A-determinant and further indicate that patients presenting with blood group A may have a genetic disposition for this form of otitis externa.

ABO Blood-Group System↗

PubMed1996

Pseudomonas aeruginosa outbreak associated with a contaminated blood-gas analyser in a neonatal intensive care unit.

Over a 10 month period in a neonatal intensive care unit there was an outbreak of infection caused by Pseudomonas aeruginosa (resistant to ticarcillin, timentin) which involved 24 newborns. There was extensive morbidity and mortality (38%) associated with the infections, which presented as septicaemia (N = 6) (five succumbed and four had coexisting pneumonia), pneumonia (N = 6), meningitis (one, died), conjunctivitis (N = 1), otitis externa (N = 1), conjunctivitis plus otitis externa (N = 1). In addition there were two pseudosepticaemias and six colonized infants, three of whom were treated for the presence of P. aeruginosa in endotracheal aspirates. There was always at least one baby colonized or infected with P. aeruginosa during the outbreak. Environmental surveillance and genomic DNA fingerprinting of isolates identified the blood gas analyzer port as the likely reservoir for the outbreak. Further spread of the organism did not occur after commencement of staff education on vigilant and careful handwashing, especially after use of the blood-gas analyser.

Blood Gas Analysis↗

PubMed1992

A pathologic and bacteriologic study on otitis media in swine.

A pathologic and bacteriologic study on otitis media in swine was performed on 237 swine, ranging in age from 1 day to 1 year. These 237 swine from eight selected farms were slaughtered due to unfavorable prognosis associated with clinical signs of illness. One hundred sixty-three (68.8%) of the 237 swine were found to be affected with otitis, though only a few swine showed clinical signs characteristic of the disease. One hundred fifty-one (63.7%), 53 (22.4%), and 39 (16.5%) had lesions in the middle, external, and internal ear, respectively. Of the 151 cases with otitis media, bilateral and unilateral infection accounted for 114 (75.5%) and 37 (24.5%), respectively. Only 5/53 swine with otitis externa and 6/39 swine with otitis interna failed to show otitis media. All swine with infection in the tympanic cavity had inflammatory lesions in the auditory tube. Examination of the swine grouped by age revealed that, regardless of age, incidence of otitis media was 50-70%. In swine younger than 1 month old, otitis media tended to center on the auditory tube, where a mild infiltration of neutrophils into the mucous membrane was frequent. Thereafter, otitis media increased in degree and extent with age. Forty (26.5%) of the 151 swine affected with otitis media were accompanied by a substantial amount of inflammatory exudate in the tympanic cavity and bulla. Purulent exudate was found in 20/40 (50%) swine. Severe otitis media prevailed in swine between 1 and 4 months of age, showing inspissation of a suppurative exudate in the tympanic cavity and lysis of the underlying osseous wall of the tympanic bulla with subsequent fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Actinomyces↗

PubMed2005

Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation.

OBJECTIVE: We sought to document the diagnostic and management difficulties in masked skull base osteomyelitis secondary to malignant otitis externa, with emphasis on establishing diagnostic criteria in recurrence. STUDY DESIGN: Retrospective analysis of 3 cases of inadequately treated malignant otitis externa in elderly diabetic individuals leading to recurrence and atypical manifestations of skull base osteomyelitis on contralateral side with or without multiple cranial nerve involvement. RESULTS: Two of the 3 cases died of the disease despite aggressive treatment. One case was treated successfully with combination of antipsuedamonal microbial drugs for 8 to 12 weeks and hyperbaric oxygen therapy. Major complications such as thrombosis of lateral sinus and internal jugular vein, meningitis, ophthalmoplegia, blindness, cervical spine erosion and paralysis of all cranial nerves with exception of Ist cranial nerve were observed. CONCLUSION: There is high morbidity and mortality associated with skull base osteomyelitis. In partially treated cases of malignant otitis externa, atypical symptoms and findings of unilateral severe otalgia, unremitting headache, and presence of high ESR, unilateral OME, constitute diagnostic clues of skull base osteomyelitis. Such cases require further investigation with CT, MRI, Technetium 99 and gallium 67 scintigraphy and aggressive management.

Aged↗

PubMed1992

Optimum management of the discharging ear.

Discharge from the ear can be the result of many disease processes. The ear may discharge blood, pus, cerebrospinal fluid (CSF) or wax. Keratosis obturans, stenosis of the external meatus and benign tumours of the external meatus all lead to wax build-up, which may cause recurrent attacks of otitis externa. Malignant tumours, such as basal cell carcinoma, squamous cell carcinoma and tumours of ceruminous gland origin may also present with discharge. Tumours should be excluded by submitting all material removed from the external canal for histological examination. Single or multiple abscesses (known as furuncles) may occur in the hair follicles in the skin of the external acoustic meatus (EAM). Compulsive scratching, hearing aids and foreign bodies placed in the ear predispose to otitis externa, which is also often associated with infection by Pseudomonas aeruginosa, Staphylococcus aureus and faecal organisms. Management may be with aluminium acetate 14%, topical antibiotic/steroid drops, a gauze wick soaked with icthammol 10% in glycerin or polymyxin B sulphate--neomycin sulphate--hydrocortisone acetate cream placed into the EAM and replaced every 24 to 48 hours, or systemic antibiotics according to severity. Malignant (necrotising) otitis externa causes progressive destruction of the temporal bone, and cranial nerve palsies (usually facial first). Treatment is limited debridement of infected bone, accompanied by intravenous aminoglycosides, and local antibiotic treatment and aural cleanout or oral ciprofloxacin. Middle ear conditions causing discharge include acute otitis media, infected grommets, traumatic perforations and chronic suppurative otitis media, as well as tumours of the ear canal skin and middle ear, radiation-induced otitis externa and osteoradionecrosis of the temporal bone, tuberculosis, Langerhans cell histiocytosis, spontaneous or post-traumatic CSF leaks, Wegeners granulomatosis and immune deficiency states. Topical application of aminoglycoside antibiotics to the middle ear of laboratory animals such as rats, guinea pigs and chinchillas causes sensorineural hearing loss, an effect rarely seen clinically in humans. If the external acoustic meatus and tympanic membrane are obscured by discharge cotton buds, microsuction equipment or syringing are used to remove it. It is often useful to initiate treatment (usually with topical drops, wicks or an oral antibiotic) with a provisional diagnosis. A full examination and adequate visualisation of the tympanic membrane must eventually be performed, if necessary under anaesthesia, or else serious progressive conditions may be neglected. The most useful initial investigation is a swab sent for bacteriological assessment; other investigations are usually indicated by clinical findings and the provisional diagnosis.

Ear Diseases↗

PubMed1988

Diseases of the pinna.

Many diseases can affect the pinna of the dog and cat. These diseases represent most categories of cutaneous disease, from infectious to neoplastic. Although some diseases affect primarily the pinna, most pinnal dermatoses occur in conjunction with other integumentary disorders. One should approach the diagnostic work-up of pinnal disease in an organized manner, obtaining first a thorough history and physical examination. A systematic approach is required in the diagnostic evaluation in order to arrive at a tentative or definitive diagnosis. Skin scrapings, cytologic examination, and culture for dermatophytes provide the minimum database. A variety of diagnostic tests, including hematology, serum biochemical profiles, urinalysis, serology, intradermal skin testing, hypoallergenic diet trials, histopathology, and direct immunofluorescence, may be necessary in some cases before a definitive diagnosis is reached. The ears are somewhat difficult to biopsy, although in many instances histopathologic examination is essential to the diagnosis. In this author's opinion, it is preferable to use a no. 15 scalpel blade rather than a punch biopsy when obtaining a pinnal biopsy. This allows the veterinarian to obtain an elliptical or wedge biopsy, which can frequently be sutured. In some instances, biopsies are required from the ear margin and a full ear thickness biopsy is obtained. Sutures may not hold in this situation, and cautery may be necessary for hemostasis. As in other situations in which the ear is bleeding (aural hematomas, vasculitis, fly bite dermatitis, and so on), bandaging and immobilization of the ear may be necessary to prevent further trauma. Although symptomatic therapy is sometimes helpful when treating pinnal diseases, a definitive diagnosis is preferred. This is especially important following the second or third presentation of an animal for ear disease. Although ear diseases are frequently viewed as a nuisance rather than a serious condition, anyone who has owned or worked closely with an animal suffering from chronic otitis externa should appreciate the animal's discomfort and the owner's frustration. All too frequently, the chronic otitis externa is the result of a hypersensitivity (either inhalant or food) that has been overlooked in the attempt to treat the subsequent infectious otitis. Thus, in animals with recurrent otitis externa, every attempt should be made to identify and treat the underlying etiology.

Animals↗

PubMedDate not supplied

A epidemiological assessment of water quality and "swimmer's ear".

In an effort to determine if bacterial water quality was related to the incidence of otitis externa (swimmer's ear), a retrospective study was conducted from July, 1980 to September, 1980. Data from 29 cases and 29 controls matched for age and sex were collected. Warm air, warm water, age of less than 18 yr, swimming, and length of time spent swimming were associated positively with cases of otitis externa. Water quality, as measured by fecal coliforms, enterococci, and Pseudomonas aeruginosa was not found to be associated with otitis externa.

Adolescent↗

PubMed1995

Pseudomonas aeruginosa infections of intact skin.

Pseudomonas aeruginosa infections of healthy skin are uncommon. We report four cases of P. aeruginosa infections of intact skin. These cases illustrate the clinical spectrum of these cutaneous infections: localized, mild epidermal infections (the green nail syndrome and webbed space infections), moderately serious infections (cutaneous folliculitis and otitis externa), and, in immunocompromised patients, extremely serious infections (malignant otitis externa, perirectal infection, and ecthyma gangrenosum).

Adult↗

PubMed1999

Ofloxacin otic solution: a review of its use in the management of ear infections.

UNLABELLED: Ofloxacin is a synthetic fluoroquinolone antibacterial agent that inhibits the supercoiling activity of bacterial DNA gyrase, halting DNA replication. Ofloxacin has been formulated as a 0.3% otic solution for the treatment of ear infections. Topical administration of ofloxacin otic solution 0.3% produces very high concentrations of drug in the ear, thus broadening the spectrum of activity of ofloxacin greatly, to cover most common ear pathogens. Results of clinical trials indicate that ofloxacin otic solution 0.3% is as effective as topical neomycin/polymixin B/hydrocortisone preparations in the treatment of otitis externa (clinical cure rate >80% in adults and >95% in children for both treatments) and oral amoxicillin/clavulanic acid in the treatment of otitis media in the presence of tympanostomy tubes in children (clinical cure rates 76 and 69% for ofloxacin and amoxicillin/clavulanic acid, respectively). It is also effective in the treatment of chronic suppurative otitis media in adolescents and adults with perforated tympanic membranes (75 to 91% clinical cure rate). Because of the limited systemic absorption after topical administration, ofloxacin otic solution 0.3% is well tolerated. Adverse events were usually classed as mild to moderate, with < or =2% considered severe. The most frequent adverse events were bitter taste (5%), primarily in patients with non-intact tympanic membranes, and pruritus (2%). The incidence of adverse events with ofloxacin otic solution 0.3% was similar to that with other ototopical preparations and significantly less than that with oral amoxicillin/clavulanic acid. Unlike comparative ototopical antibacterials, ofloxacin was not ototoxic or chondrotoxic in animal studies. In addition, no ototoxicity was detected in clinical studies in humans. CONCLUSIONS: Ofloxacin otic solution 0.3% is clinically effective in the treatment of otitis externa and otitis media in patients with tympanic membrane perforations or tympanostomy tubes. The high concentrations achieved with this ototopical solution render it active against a broad spectrum of organisms. It is well tolerated, avoiding many systemic adverse events, and is not associated with ototoxicity. As the first ototopical agent approved for use in patients with non-intact tympanic membranes, ofloxacin otic solution 0.3% provides a valuable advantage over current treatment alternatives.

Anti-Infective Agents↗

PubMed1994

Otic administration of amphotericin B 0.25% in sterile water.

OBJECTIVE: To report otic administration of parenteral amphotericin B 0.25% in sterile water. CASE SUMMARY: A 44-year-old HIV+ man was diagnosed with otitis externa. The patient's past medical history was remarkable for positive Coccidioides immitis serology for more than five months, essential hypertension, and Barrett's esophagitis. Culture results from an ear swab revealed 4+ Aspergillus fumigatus and 3+ Staphylococcus, coagulase negative. Antiinfective therapy for the otitis externa included oral and topical antibacterial and antifungal medications. Amphotericin B 0.25% in sterile water was prepared by the pharmacy for topical otic administration. The otic amphotericin B was dispensed with instructions to refrigerate and assigned a one-week expiration date. The prescription called for instillation of 1-2 drops in each ear three times a day. The patient's signs and symptoms of otitis externa resolved during several weeks of antiinfective therapy. Topical administration of amphotericin B 0.25% in sterile water was not associated with any local adverse effects in this patient. DISCUSSION: The rationale for use of the parenteral amphotericin B formulation to prepare an otic dosage form, and the rationale for the specific concentration and expiration date chosen are discussed. CONCLUSIONS: This patient tolerated topical otic administration of amphotericin B 0.25% in sterile water when administered three times daily.

Administration, Topical↗

PubMed1979

Histiocytosis X of the ear and temporal bone: review of 22 cases.

Histiocytosis X encompasses three syndromes characterized by the idiopathic proliferation of histiocytes: eosinophilic granuloma, Hand-Schuller-Christian syndrome, and Letterer-Siwe disease. At the Mayo Clinic between 1926 and 1978, 22 patients with histiocytosis X had involvement of the ear or temporal bone. These patients comprised 15% of all patients with histiocytosis X seen during that period. The ages at onset of the disease ranged from 2 months to 49 years. The most frequent otologic symptom was aural discharge (15 patients), followed in frequency by swelling in the temporal region (11 patients), vertigo (6 patients), and deafness (5 patients). Clinical findings included otitis media (13 patients), otitis externa with or without granulation tissue (10 patients), and osteolytic lesions of the temporal bone (9 patients). A high index of suspicion is required to recognize the otologic manifestations of histiocytosis X for two reasons: the systemic manifestations of the disease are often so dramatic that the ear findings are overlooked, and the otologic findings of histiocytosis X can mimic more common diseases, including simple otitis externa, aural polyps, acute mastoiditis, chronic otitis media, and metastatic lesions.

Adolescent↗