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PubMed1984

Pseudomonas aeruginosa infections of the skin.

Otitis externa, green nail syndrome, toe web infections, hot tub folliculitis, superinfections in chronic antibiotic-treated acne and infectious eczematoid dermatitis are examples of mild cutaneous infections due to Pseudomonas aeruginosa. These may occur in otherwise healthy persons. In persons with lowered resistance, more severe infections such as malignant otitis externa, blastomycosis-like pyoderma and necrotizing fasciitis are observed. Ecthyma gangrenosum, the pathognomonic skin sign of Pseudomonas septicemia, occurs in debilitated or terminally ill patients and must be treated immediately.

Acne Vulgaris↗

PubMed2002

A semiquantitative cytological evaluation of normal and pathological samples from the external ear canal of dogs and cats.

Numbers of desquamated epithelial cells, yeast cells and bacterial organisms were counted in samples collected from the external ear canal of 37 normal dogs and 16 normal cats, and from 24 dogs and 22 cats with otitis externa. The aims of the study were to establish quantitative reference ranges and to correlate these data with the clinical status of the dogs and cats. Numbers of yeast cells and bacterial organisms were significantly increased in dogs (P = 0.05; P = 0.0001) and cats (P = 0.0001; P = 0.0001) with otitis externa, and in most cases high counts were correlated with clinical signs. Mean Malassezia counts per high-power dry field of > or = 5 in the dog and > or = 12 in the cat were considered abnormal. Mean bacterial counts per high-power dry field of > or = 25 in the dog and > or = 15 in the cat were considered abnormal. When used to differentiate normal from inflamed external ear canals, these figures provided a low sensitivity but a specificity of > or = 95%.

Animals↗

PubMed1988

The draining ear. Otitis media and externa.

Otorrhea, or discharge from the ear, may be associated with otitis media or otitis externa. Each episode of otorrhea requires examination of the external ear canal and middle ear to determine the origin and extent of disease, a complete understanding of the pathogenesis, and a therapeutic approach that considers the microbiology and the extent of tissue invasion. This review focuses on infections of the middle ear and external ear commonly associated with otorrhea. The pathogenesis, clinical manifestations, methods of diagnosis, and medical and surgical therapies are presented.

Acute Disease↗

PubMed1991

Surgery of the external ear canal.

Otitis externa may account for up to 20% of presenting complaints in small animal practice. Many of these cases are non-responsive to medical therapy and require surgical intervention. The modified Zepp procedure or lateral wall resection should be considered early in the course of the disease. Performing this procedure in advanced cases of otitis externa, which involve both the medial and lateral walls of the ear canal, is responsible for 34-47% of these cases showing no improvement. Vertical ear canal ablation is the procedure of choice when the entire vertical canal is involved but the horizontal canal is free of disease. If the disease involves both the vertical and horizontal canals, a total ear canal ablation, along with removal of the lateral aspect of the bony bulla should be performed. By removing this portion of the bulla, improved drainage is achieved, and the complication rate following total ear canal ablations is decreased.

Animals↗

PubMed1990

Otogenic Münchausen syndrome.

Münchausen syndrome is uncommon in otolaryngology. Self-induced otitis externa has rarely been reported, and nothing is known concerning the true incidence of feigned vertigo. We present a patient who has been hospitalized several times and who has undergone ear surgery and treatment at different institutions along the eastern seaboard. She has suffered complications of therapy, including a profound sensorineural hearing loss, and was referred to us for surgical treatment of bizarre intractable otitis externa. The infection failed to respond to medical treatment and was ultimately found to be self-inflicted. Despite psychotherapy, the patient continues to seek further treatment at still other hospitals. This entity must be considered whenever a thorough evaluation fails to yield a reasonable organic diagnosis.

Adult↗

PubMed1987

Allergies to ear moulds. A study of reactions encountered by hearing aid users to some ear mould materials.

In recent years, a number of people have encountered some form of otitis externa due, it was suspected, to the use of acrylic ear moulds. The intention of this study was to discover whether the reaction was purely allergic or if it was due to various other causes. Having eliminated reactions due to ill-fitting ear moulds, friction sores or lack of hygiene, a study of 25 people with ear mould problems was carried out. These consisted of three groups; those who had no other ear or skin trouble, those who had existing otitis externa and/or other skin trouble, and those who suffered with ear infections or were prone to ear infections. A sample of the population who did not wear hearing aids was taken as a control.

Dermatitis, Contact↗

PubMed1998

Potential factors affecting the outcome of dogs with a resection of the lateral wall of the vertical ear canal.

The records of 60 dogs that had a resection of the lateral wall of the vertical ear canal (Zepp) were examined. The surgical outcomes were evaluated in association with the following variables: breed, sex, age of onset of the otitis externa, duration of the disease before the surgery was performed, treatment received for the otitis externa, the status of the ear and tympanic membrane at the time of the surgery, the culture results, and concurrent medical problems. The outcome of surgery was acceptable in 45% and unacceptable in 55% of the cases. Breed was the only factor that could be correlated with the outcome. The procedure failed in 86.5% of the cocker spaniels. When surgical outcomes in breeds other than cocker spaniels were evaluated, 63% were acceptable and 37% were unacceptable. Sharpeis were found to have an ear canal of small diameter compared with that of other breeds and a tendency to have better outcomes.

Animals↗

PubMed2000

Topical fluoroquinolones for eye and ear.

Topical fluoroquinolones are now available for use in the eye and ear. Their broad spectrum of activity includes the common eye and ear pathogens Staphylococcus aureus and Pseudomonas aeruginosa. For the treatment of acute otitis externa, these agents are as effective as previously available otic preparations. For the treatment of otitis media with tympanic membrane perforation, topical fluoroquinolones are effective and safe. These preparations are approved for use in children, and lack of ototoxicity permits prolonged administration when necessary. Topical fluoroquinolones are not appropriate for the treatment of uncomplicated conjunctivitis where narrower spectrum agents suffice; they represent a simplified regimen for the treatment of bacterial keratitis (corneal ulcers). When administered topically, fluoroquinolones are well tolerated and offer convenient dosing schedules. Currently, bacterial resistance appears limited.

Acute Disease↗

PubMed1983

Action of EDTA-Tris and antimicrobial agent combinations on selected pathogenic bacteria.

The concentration of EDTA-Tris (3.22 mM EDTA and 0.05 M Tris) used as a lavage to treat otitis externa, cystitis or other persistent infections in dogs and cats, was found to prevent the growth of Pseudomonas aeruginosa, Staphylococcus aureus and beta streptococci when present in growth media. Pseudomonas aeruginosa was rapidly lysed in this solution. Escherichia coli and Proteus vulgaris grew in the presence of EDTA-Tris, but to a lesser extent than the controls without these compounds. Minimal inhibitory concentrations (MIC) for 8 antimicrobial agents with and without EDTA-Tris were determined for E. coli and P. vulgaris. A potentiation effect on E. coli (greater than 50% decrease MIC) was observed when EDTA-Tris was combined with penicillin, oxytetracycline or chloramphenicol. A similar effect was observed with P. vulgaris when combinations of EDTA-Tris plus gentamicin, oxytetracycline, polymyxin-B or triple sulfa were used. The results of this study indicate that EDTA-Tris appears to have merit in selected cases of otitis externa, cystitis or other persistent infections where lavage might be used.

Animals↗

PubMed2006

Prospective study of the microbiological flora of hearing aid moulds and the efficacy of current cleaning techniques.

INTRODUCTION: Wearing hearing aid earmoulds has been implicated as a predisposing factor in the development of chronic otitis externa. Audiologists come into contact with a large number of hearing aid earmoulds and these could potentially harbour pathogenic micro-organisms, with the risk of subsequent cross infection. Cleaning with dilute alcohol is widely used in an attempt to break the chain of infection. OBJECTIVE: To determine the presence and nature of microbial flora on hearing aid earmoulds and the efficacy of cleaning methods used to prevent cross infection. SETTING: Secondary health care within the audiology department of Addenbrooke's Hospital, Cambridge, UK. DESIGN: A prospective, observational study. METHODS: Hearing aid earmoulds were swabbed before and after cleaning. Samples were cultured to determine qualitatively and quantitatively the microbiological flora present before and after cleaning. RESULTS: Twenty out of 21 (95 per cent) earmoulds had microbes present and, of these, 19/20 (95 per cent) had a polymicrobial profile. Coagulase negative staphylococci and diphtheroids were the most frequent microbial isolates, but pathogenic bacteria and fungi were also demonstrated on earmoulds both before and after cleaning. CONCLUSIONS: The polymicrobial flora, including recognized pathogens, that colonizes earmoulds may lead to chronic otitis externa. Cleaning with 70 per cent alcohol solution was ineffective, in particular for pathogenic fungi on earmoulds.

Aged↗

PubMed2002

Randomized prospective comparative study: short-term treatment with ciclopiroxolamine (cream and solution) versus boric acid in the treatment of otomycosis.

Sixty-four patients with symptomatic otomycosis (80 infected ears) confirmed by direct microscopy and culture were randomly treated for I week with ciclopiroxolamine cream 11% (group A, 20 infected ears, 17 patients), ciclopiroxolamine solution 1% (group B, 20 infected ears, 17 patients) and boric acid (group C, 40 infected ears, 30 patients) and daily mechanical suction aspiration of the debris. An attempt was made to match 11 clinical parameters with both the mycological and bacteriological findings. There was no significant association between the fungal species cultured and the clinical parameters did not vary with the presence or absence of different bacteria; pus was never present in fungal otitis externa (Fisher's test, P < 0.001). Before therapy, a significant number of ears had completely sterile bacterial cultures (p < 0.01, chi2 test); saprophytic Gram-positive bacteria increased after treatment, whilst Gram-negative bacteria, Pseudomonas aeruginosa and Proteus species, decreased after treatment. Clinical total cure rates 3 days after the end of therapy ranged from 50% in group A, 25% in group B to 22.5% in group C. Mycological cure rates were 80% (group A), 95% (group B) and 72.5% (group C). Two weeks after the end of therapy the clinical cure rates were 60% (group A), 65% (group B) and 80% (group C) and the mycological cure rates was 65% for group A and 75% for both group B and C. Eleven patients relapsed with otitis externa: four (20%) in groups A and C and three (15%) in group B. In four cases the infection was due to bacteria and the remaining seven were due to fungi. Six sites relapsed with the same fungal species as that isolated at the start of the study. In this short-term assessment the relapse rate was not significantly associated with predisposing conditions. The tolerance was excellent in group A. Four patients (20%) in group B had mild (two patients) or moderate (two patients) burning and itching with each application. Twelve patients (30%) in group C had severe stinging and five of these patients who had perforated tympanic membranes also experienced pain. In terms of clinical and mycological effectiveness, there were no significant differences between the three treatment groups, although group A (ciclopiroxolamine cream 1%) and B (ciclopiroxolamine solution 1%) both showed significantly better tolerance (Fisher's test, P < 0.05) when compared with boric acid (group C).

Administration, Topical↗

PubMed1977

The epidermis of the drumhead in some otologic conditions.

In a study of the behavior of the keratin layer of the drumhead epidermis in some otologic conditions, a marker dye was applied to the tympanic membrane, and migration and/or desquamation of the dotted spots observed. Decelerated migration with desquamation in situ was observed during the quiescent phase of recurrent otitis externa, with or without myringitis. The same findings were observed in most cases of chronic secretory otitis media and its sequelas (retraction pockets, atrophic membranes, and scarring). The remnants of drumhead with keratotic and hyperplastic changes in the middle ear cleared themselves of the dye very slowly.

Adolescent↗

PubMed1988

Preventive ear care for dogs and cats.

Prevention of ear disease in dogs and cats depends on early detection of factors that predispose these animals to otitis externa. This article reviews the conditions and diseases that place the dog and cat at risk for otitis externa. Routine care of the ears is discussed, and otoscopic examination and techniques for cleaning the external auditory canals are described. Avoidance of potentially harmful therapeutic procedures and irritating or ototoxic pharmacologic substances is emphasized.

Animals↗

PubMed1989

Atypical osteomyelitis of the skull base.

Most cases of osteomyelitis of the skull base occur as a result of inadequately treated localized malignant otitis externa. We present four patients with osteomyelitis of the skull base who did not present initially as malignant otitis externa. Increased morbidity may occur when these atypical cases are not promptly recognized and treated.

Adult↗

PubMed1988

Surgical management of otitis media and otitis interna.

Surgical management of otitis media and otitis interna includes the following options: lateral bulla osteotomy, ventral bulla osteotomy, or curettage of the tympanic cavity. Because otitis media frequently accompanies chronic nonresponsive otitis externa, one of the above procedures may be combined with operative procedures of the external ear canal. Also, gentle selective curettage of the tympanic cavity may be combined with either lateral or ventral bulla osteotomy in the treatment of otitis media and interna. The choice of surgical procedure(s) should be based on the condition of the external ear canal (vertical and horizontal parts), the duration of clinical signs, response to previous surgery, and the familiarity of the surgeon with the different approaches and techniques. With the increased reporting of long-term results following surgical management of otitis externa, media, and interna, more meaningful conclusions concerning selection of surgical procedure may be made in the future.

Animals↗

PubMed1978

External auditory canal cholesteatoma.

Cholesteatoma of the EAC is a rare otologic problem, particularly when keratosis obturans otica is excluded. The predominant features of EAC cholesteatoma are acute external symptoms, severe pain, recurrent physician visits, and paucity of X-ray findings. Poorly responding otitis externa should always alert the physician to the possibility of neoplasm, diabetes, or some other underlying condition which will not respond to just topical treatment. Cholesteatoma of the external auditory canal should also be considered in refractory cases of otitis externa. Three patients with EAC subperiosteal cholesteatoma are reviewed.

Adult↗

PubMed1986

Ticarcillin and clavulanic acid in serious infections.

In an open, non-comparative study 40 patients with severe, often life-threatening infections, were treated with Timentin 5.2 g (5 g ticarcillin plus 200 mg potassium clavulanate) by iv infusion every 6 or 8 h. They were suffering from septicaemia (9), obstructed UTI (8), non-obstructed urinary tract infection (10), respiratory tract infection (6), infected burns (4) or malignant otitis externa (3). Many patients had important aggravating factors such as renal transplantation, peritoneal or haemodialysis, leukaemia, extensive burns, renal stones, tracheostomy and diabetes. Pathogens included Pseudomonas aeruginosa (21), Escherichia coli (7), and other Enterobacteriaceae (6). Twenty-four pathogens (13 P. aeruginosa) were ticarcillin-resistant. Thirty-six patients were clinically cured including all cases of malignant otitis externa, infected burns and non-obstructed urinary tract infection. Three patients improved and one patient with obstructed urinary tract infection failed. In 32 patients the pathogen was eradicated, in one patient it persisted and in seven it reappeared. In particular, 11 of 13 patients with infections due to ticarcillin-resistant P. aeruginosa were cured and two improved. There was, however, bacteriological relapse in five. There were no side-effects or evidence of toxicity in any of the patients. In an in-vitro study a synergistic effect between ticarcillin and clavulanate was noted against Enterobacteriaceae but only a slight synergistic effect against P. aeruginosa. Studies in patients with normal liver and kidney function showed pharmacokinetic compatibility of the two agents. Timentin can be recommended for the initial treatment of serious infections.

Adult↗

PubMed2001

The genetic diversity of clinical isolates of Malassezia pachydermatis from dogs and cats.

Molecular investigation of 110 clinical isolates of non-lipid-dependent Malassezia pachydermatis from dogs and cats was carried out by random amplification of polymorphic DNA (RAPD) and chitin synthase 2 (CHS2) gene sequence analyses. The RAPD analysis indicated that the clinical isolates of M. pachydermatis constituted four distinct genetic types (A, B, C and D). Moreover, the results from CHS2 gene analysis completely agreed with those from the RAPD analyses. The clinical isolates of M. pachydermatis were obtained from normal external ears, lesions of atopic dermatitis, flea allergic dermatitis, otitis externa, pyoderma and seborrheic dermatitidis in dogs and cats. Type A consisted of 93 clinical isolates as well as the ex-neotype strain of M. pachydermatis. The isolates of type A M. pachydermatis originated from lesions of all kinds of diseases. They were predominant on dog and cat skin. The other types, B, C, and D were isolated mainly from otitis externa.

Animals↗