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PubMed1992

A prospective study of otitis externa.

A prospective study of otitis externa in the district of South Bedfordshire was undertaken between October 1990 and January 1991. Patients were referred untreated by general practitioners; self-referred patients with external otitis were also included. A detailed history was taken, the severity of the condition assessed, aural toilet performed, bacteriology swabs taken and the patient treated according to department protocol. 48 patients were included in the study; a similar number of age and sex-matched controls without otitis externa were randomly selected from the ENT outpatient clinics for comparison. Regular swimming emerged as a significant factor in the aetiology of otitis externa. The commonest organism cultured was Pseudomonas aeruginosa and this accounted for the most severe cases seen.

Adolescent↗

PubMed1976

Otitis externa in children.

The commonest cause of ear-ache in children is otitis externa and five new cases of otitis externa will be seen for every case of otitis media.ACUTE OTITIS EXTERNA AND OTITIS MEDIA ARE QUITE DIFFERENT AND DISTINCT CLINICAL ENTITIES IN CHILDREN: the former is a tender, dirty, pruritic ear, often recurring in children with simple febrile illnesses; the latter is more isolated than is realised, non-recurrent and usually accompanying upper respiratory catarrhal illness.The fleeting nature of otitis externa as seen in childhood is typical of clinical material in general practice that presents quite differently from that in hospital practice. The long aetiological lists quoted in all series of cases of otitis externa in adults do not apply to otitis externa as seen in children.

Adolescent↗

PubMed1992

Otitis externa in general practice.

Otitis externa seen in general practice is most commonly bacterial in origin and is readily diagnosed and treated if a few simple guidelines are followed. These guidelines are discussed with emphasis on distinguishing the condition from otitis media, performing adequate ear toilet and choosing appropriate topical medications and vehicles for their application.

Adrenal Cortex Hormones↗

PubMed1998

Malignant otitis externa with optic neuritis.

Malignant otitis externa is a serious condition that presents difficulties in treatment, and also in monitoring its progress. A case of malignant otitis externa with optic neuritis is presented that remained refractory to standard treatment but was cured by adjuvant hyperbaric oxygen therapy. This is the only reported case that has survived this disease with optic neuritis. The usefulness of imaging techniques in this condition is discussed, as well as the ESR, in evaluating the effectiveness of treatment.

Blood Sedimentation↗

PubMed1989

Hyperbaric oxygenation for necrotizing (malignant) otitis externa.

Two patients with extensive necrotizing otitis externa have been treated by hyperbaric oxygenation. One patient had facial nerve palsy and the other suffered from skull base involvement. Due to severe side effects, the preferred combined intravenous antibiotic therapy was changed to monotherapy in one case and completely withdrawn in the second. This was done before the commencement of hyperbaric oxygenation, while the necrotizing infection was still active. Hyperbaric oxygenation therapy was followed by complete resolution of the necrotizing otitis externa, which did not recur. The pathogenesis of the disease and mechanisms by which hyperbaric oxygenation might be of benefit are described. We conclude that hyperbaric oxygenation should be considered as adjuvant therapy for necrotizing otitis externa whenever a therapeutic pressure chamber is available.

Aged↗

PubMed1994

Otitis externa: management of the recalcitrant case.

Most cases of otitis externa respond to routine treatment, however, there is a subset of patients who frequently develop otitis externa that is usually severe and recalcitrant to routine therapy. These patients include the immunocompromised, those with AIDS, transplant recipients, severe diabetics, patients treated with high dose steroids or chemotherapeutic agents, and those who are malnourished or are chronically ill. Local factors that lead to worsening of otitis externa include dermatitides and prior local irradiation. Patients who find topical therapy painful may be noncompliant with medications, and they too, may develop recalcitrant otitis externa. For successful treatment, a broad understanding of external auditory canal anatomy, the microbiology and pathophysiology of otitis externa, and available treatment options, including topical and systemic medications, must be attained. These topics are reviewed.

Aminoglycosides↗

PubMed1988

Medical management of otitis externa.

Successful medical management of otitis externa requires attention to all of the following points: 1. Diagnose and treat systemic or underlying disease(s). 2. Carefully clean and examine the entire ear canal before starting therapy. This includes removal of foreign bodies, parasites, hair, and other obstructions. 3. Apply carefully chosen topical preparations based on gross and microscopic examination. 4. Educate clients as to the causes of the otitis externa and their role in treating the disease. 5. Schedule regular follow-up examinations until the disease is completely cured. 6. Recommend preventive procedures such as drying ears after swimming, corrective surgery, and so on. 7. Use systemic treatment when indicated by chronicity of disease or the owner's inability to treat the patient.

Animals↗

PubMed2006

A long term follow up of conchal flap meatoplasty in chronic otitis externa.

A long-standing diffuse chronic otitis externa can lead to itching. Resultant scratching may then lead to irreversible skin changes with canal stenosis by scar tissue. The poor ventilation and increased humidity gives rise to bacterial and fungal growths leading to breakdown of the skin defences and worsening itching. This vicious itching-scratch cycle or downward spiral often fails to respond to medical treatment. For these cases a simple conchal flap meatoplasty may improve ventilation of the external auditory canal and may lead to a self cleaning ear. We reviewed 84 patients who had undergone conchal flap meatoplasty in Calderdale and Huddersfield NHS Trust Hospitals from April 1993 to June 2002. A long-term follow up of conchal flap meatoplasty in chronic otitis externa showed no records of complications or further otitis in 93.2 per cent of cases. Thus surgical intervention plays an important role in the treatment of otitis externa not responding to treatment.

Chronic Disease↗

PubMed1995

[Antibacterial activities of fosfomycin against recent clinical isolates from patients of otitis media and otitis externa].

Clinical isolates from patients with otitis media and/or otitis externa were collected at otorhinology clinics nationwide and sent to us during 1989, 1991 and 1993. Minimum inhibitory concentrations (MICs) of fosfomycin (FOM) and of reference drugs against these strains were determined to investigate year-to-year antibacterial activity of FOM. A comparative analysis of the results revealed trends described below. 1. The MIC90 of FOM against Staphylococcus aureus subsp. aureus increased 4 times by 1993 as compared to those measured for strains isolated in 1984 and 1985, when FOM for otic use was under development. This was thought to be due to the recent increase in the detection frequency of methicillin-resistant S. aureus (MRSA) which is also resistant to FOM. 2. No annual changes were seen for MIC distribution of FOM against Proteus group and Pseudomonas aeruginosa. 3. Since there was no large annual change in the antibacterial activity of FOM against recent clinical isolates obtained from patients with otitis media and/or otitis externa, FOM may be considered as one of the useful drugs even now, in the mid-1990's.

Drug Resistance, Microbial↗

PubMed2002

Malignant otitis externa: a review.

Malignant otitis externa is a rare but potentially fatal disease of the external auditory canal seen mostly among elderly, diabetic or immunocompramised patients. The causative organism is mainly Pseudomonas aeruginosa. The disease spreads rapidly, invading surrounding soft tissues, cartilage and bones causing their necrosis and even spreading to the cranial nerves. The disease can be fatal if treatment is not aggressive and timely, especially if it spreads outside the auditory canal with involvement of the cranial nerves. Treatment is mainly medical with antipseudomonal drugs like the third generation cephalosporin and the fluoroquinolones and local debridement. With aggressive treatment the mortality rate from this disease, which used to be 50% in the past has now been reduced to 10-20%. The pathophysiology of the disease, clinical presentation, diagnosis, treatment and the outcome has been discussed and reviewed.

Anti-Bacterial Agents↗

PubMed1996

Otitis externa. Management in the primary care office.

Otitis externa is a widespread problem that is most commonly caused by Pseudomonas aeruginosa. Pain, ear discharge, and edema of the ear canal are the main manifestations. The presence of granulation tissue is an ominous sign that usually indicates necrotizing otitis externa or even a neoplastic process. It is important for primary care physicians to be familiar with methods of ear cleaning and use of topical medications for otitis externa. It is equally vital to be aware of the importance of a timely referral to an otolaryngologist when a serious underlying cause is suspected.

Anti-Bacterial Agents↗

PubMed2000

Malignant otitis externa caused by Malassezia sympodialis.

BACKGROUND: Malignant otitis externa caused by fungal infections is rare. A review of the literature showed only 9 cases, and the causative fungus in all cases was Aspergillus. This article reports an unusual case caused by Malassezia sympodialis. METHODS: A 53-year-old man with non-insulin dependent diabetes presented with malignant otitis externa. He deteriorated despite treatment with intravenous antipseudomonal therapy and surgical debridement. Microbiologic tests revealed M. sympodialis. He responded rapidly to intravenous amphotericin. RESULTS: Systemic human infections caused by M. sympodialis have not been reported. M. furfur systemic infection is rare and has been associated lipid hyperalimentation by means of a central catheter. Only 1 other case of M. fungemia without these associated risk factors has been reported. CONCLUSIONS: The first case of malignant otitis externa caused by M. sympodialis is presented. It highlights the difficulty of initial biologic diagnosis and the need for lipid-enriched media to grow this fastidious organism.

Amphotericin B↗

PubMed1994

Malignant otitis externa in AIDS patients: case report and review of the literature.

Malignant otitis externa is a necrotizing infection of the external ear canal and surrounding soft tissue and bone, usually caused by Pseudomonas aeruginosa. The infection classically occurs in diabetic patients, however recently, several patients with the acquired immunodeficiency syndrome (AIDS) have been reported to have malignant otitis externa. A patient with AIDS who had malignant otitis externa with skull base osteomyelitis is presented and reported cases in patients with AIDS are reviewed. Predisposing factors include immunologic abnormalities (notably neutropenia), dermatitis, medications, neoplasm, and iatrogenic procedures, e.g., ear lavage. Treatment of malignant otitis externa has traditionally included anti-pseudomonal cephalosporins/penicillins and aminoglycosides for prolonged durations. Recently, ciprofloxacin has been shown to be effective as an oral regimen. With the increasing number of patients with AIDS being seen in the outpatient clinics, the diagnosis of malignant otitis externa should be considered in any patient with persistent ear pain or otorrhea who does not respond to conventional treatment for external otitis.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Otitis externa in UK general practice: a survey using the UK General Practice Research Database.

BACKGROUND: Otitis externa is a common clinical problem in general practice and yet there are remarkably few data available on the demographic characteristics of patients with this condition and the approaches used by general practitioners (GPs) in the United Kingdom (UK) to manage it. AIM: To define the descriptive epidemiology of otitis externa in the general population, to describe the first-line drug treatment used by UK GPs, and to determine factors related to second disease episodes. DESIGN OF STUDY: Epidemiological data survey. SETTING: All cases of otitis externa occurring in 1997 in practices contributing data to the UK General Practice Research Database. METHOD: Data were extracted on age, sex, date of episode of otitis externa, treatment prescribed, co-existing diagnoses of eczema and diabetes, referral to ear, nose, and throat departments and occurrence of subsequent episodes of disease. Arbitrarily a second episode of disease was defined as persistence if it occurred at 28 days or fewer after the first episode and recurrence if it occurred at more than 28 days after the first episode. RESULTS: A diagnosis of otitis externa was common in all age groups and, except in the elderly, was more common in females than males. There was an increase in disease episodes at the end of the summer in all age groups except the 60 years and over group. In the majority of cases GPs prescribed ear drops (85%), but a significant proportion of patients were also prescribed oral antibiotics (21%). Referral to secondary care was uncommon (3%). Among patients prescribed ear-drop formulations, those containing both steroid and antibiotic or steroid alone were used most commonly and were associated with the lower rates of disease persistence but not recurrence. Among patients prescribed antibiotics, penicillins were prescribed most commonly. Disease persistence rates, and to a lesser extent disease recurrence rates, were higher in patients prescribed oral antibiotics. CONCLUSION: Otitis externa is a common condition and GPs can expect to see an excess of cases at the end of the summer. Topical ear drops are the most common treatment used in the UK. Patients prescribed steroid or steroid/antibiotic combination ear drops have fewer subsequent consultations for otitis externa over the following 28 days.

Adolescent↗

PubMed1996

Malignant otitis externa in HIV and AIDS.

Malignant otitis externa is a necrotising infection of the external ear canal which may spread to include the mastoid and petrous parts of the temporal bone, leading to skull base osteomyelitis. It is almost exclusively caused by infection with Pseudomonas aeruginosa, and usually occurs in elderly non-insulin-dependent diabetic patients. However isolated cases have been reported in a small number of non-diabetic patients, particularly in children who are immunocompromised due to malignancy, malnutrition and severe anaemia. In 1984 a case of malignant otitis externa was reported in a child with an acquired immunodeficiency syndrome (AIDS)-like illness, prior to identification of the human immunodeficiency virus (HIV). Since that time further sporadic cases of this invasive infection have been reported in HIV and AIDS. We present two further cases and also a review of the current literature.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Skull base osteomyelitis secondary to malignant otitis externa.

PURPOSE OF REVIEW: Skull base osteomyelitis secondary to malignant otitis externa was first described in 1959. Since then, advances have been made in the diagnosis, treatment, and clinical outcomes of this condition. RECENT FINDINGS: This review discusses the pathophysiology and microbiology of malignant otitis externa. The review highlights the sometimes subtle presenting symptoms and recent advances in imaging and their practical application to diagnosing and monitoring the disease. Therapy for malignant otitis externa has changed since this entity was first described; this article reviews the medical, surgical, and adjuvant therapies and the relevant controversies. SUMMARY: The review discusses the history, pathogenesis, diagnosis, and treatment of skull base osteomyelitis in the context of malignant otitis externa with particular emphasis on HIV, children, and other immunodeficient states.

AIDS-Related Opportunistic Infections↗

PubMed1995

An audit of the management of acute otitis externa in an ENT casualty clinic.

The management of acute otitis externa is variable, despite the fact that it is one of the commonest otological emergencies. We formed the impression that many patients attending our ENT casualty clinic with otitis externa were being treated and followed up inappropriately. To test this hypothesis we performed a retrospective pilot study on our practice which revealed a lack of uniformity in the management and follow-up of these patients. And as a result of this, guidelines were developed to improve our management of otitis externa and decrease the number of unnecessary review visits. Our practice was then audited prospectively over a six-month period with the guidelines in place. An improvement in the overall management and a rationalization of follow-up for otitis externa was seen by applying basic audit principles to this common clinical problem.

Acute Disease↗

PubMed2004

Causes of otitis externa.

Dogs with long-standing, chronic, recurrent otitis externa often represent one of the most frustrating types of problems in daily clinical practice. The important aspect of this discussion is that the clinician may be presented with a patient in which the primary chief complaint is otitis externa but a wide variety of disease processes may be causing the problem, including various combinations of the primary, predisposing, and perpetuating causes as discussed previously. The use of a thorough history and general and dermatologic physical examinations often leads the clinician to establish a systematic approach to identify the specific underlying problems. Until this is accomplished, the recurrent nature of the otitis externa will remain as a persistent problem.

Animals↗