Differential diagnosis of otitis media and externa.
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Changes in bacteriology of discharging ears.
A bacteriological study on 161 consecutive out-patients presenting with otorrhoea was performed prospectively at a local teaching hospital in Taiwan between August 2000 and June 2001. A total of 177 isolates were recovered. Staphylococcus aureus was found in 77 (43.5 per cent) isolates, and non-Staphylococcus aureus in 100 (56.5 per cent) isolates. Pseudomas sp was found to be the most common pathogen (28.8 per cent) in the non-Staphylococcus aureus group. Staphylococcus aureus had become more common than Pseudomonas aeruginosa in acute otitis externa, granular myringitis, and chronic otitis media in Taiwan. Methicillin-resistant Staphylococcus aureus (MRSA) was also an increasing problem in all three disease entities. The prevalence of community-acquired MRSA infections in discharging ears was found to be 13.7 per cent (22/161). MRSAs were highly susceptible to vancomycin, teicoplanin, fusidic acid, and minocycline. More studies should be done to determine the susceptibility of MRSA to ofloxacin in the future.
Acute Disease↗
[Epidemiologic study on hearing impairment and ear diseases in old people].
OBJECTIVE: To investigate the prevalence of hearing impairment and ear diseases in old people and provide scientific data for drawing up the prevention and treatment strategies. METHODS: Using the probability proportion to size (PPS) method, 1261 people over 60 years were investigated in 40 clusters in Jiangsu Province with the WHO protocol. RESULTS: The prevalence of hearing impairment was 58.1% (the standardized rate: 59.5% in the whole country, 60.9% in Jiangsu province). Degrees of hearing impairment were mild (33.1%), moderate (17.8%), severe (5.9%) and profound (1.3%). The prevalence of hearing disability was 25.0% (the standardized rate: 26.6% in the whole country, 28.1% in Jiangsu province). There were significant difference of the prevalence between male and female, as well as urban and rural, and different ages. The prevalence of the ear diseases was auricle malformation (0.2%), wax (1.7%), otitis externa (0.1%), fungi (0.5%), serous otitis media (1.2%), chronic suppurative otitis media (1.6%), dry perforation of tympanic membrance (2.3%). The causes of hearing impairment were ear diseases (2.9%), non-infectious condition (92.6%), genetic condition (0.3%) and undetermined causes (4.2%). Of which, 31.1% of persons needed hearing aids while 2.3% of persons needed medicine treatment, but 0.9% of persons needed non-urgent surgery and 1.0% of persons needed other treatment. CONCLUSIONS: The prevalence of hearing impairment and disability in the old rised obviously than the last investigation in 1987. It was a heavy burden for social development in China. The government and the whole society should take more concern about the problem. The scientific strategies of prevention and treatment were urgently needed and implemented.
Aged↗
Squamous cell carcinoma in situ of the external auditory canal.
We report two cases of carcinoma in situ in the external auditory canal (EAC), presenting with symptoms such as pain, long-term itching of the ear, easy contact bleeding, canal otorrhea and hearing loss. Otoscopic examination revealed granulation tissue and a greyish-black tumour with irregular surface. The first patient had previously been diagnosed with otitis externa with persistent ear itching for the past three years. The second patient had received tympanoplasty for treatment of chronic otitis media on the right ear ten years ago. The first case was treated with wide excision, whereas the second patient received resection of the skin of the EAC together with its adjacent soft tissue, followed by skin grafting. No tumour recurrence was noted in the fourth and third post-operative year for the first and second patient respectively. We suggest that EAC carcinoma can be detected early and treated.
Adult↗
Malignant external otitis: early scintigraphic detection.
Pseudomonas otitis externa in elderly diabetics may extend aggressively to adjacent bone, cranial nerves, meninges, and vessels, leading to a clinical diagnosis of "malignant" external otitis. Early diagnosis is necessary for successful treatment. This study compares the findings of initial radiographs, thin-section tomography of temporal bone, CT scans of head and neck, technetium-99m methylene diphosphonate (MDP) and gallium-67 citrate scintigraphy, and single-photon emission computed tomography (SPECT) for detection of temporal bone osteomyelitis in ten patients fulfilling the clinical diagnostic criteria of malignant external otitis. Skull radiographs were negative in all of the eight patients studied. Thin-section tomography was positive in one of the seven patients studied using this modality. CT scanning suggested osteomyelitis in three of nine patients. Both Tc-99m and Ga-67 citrate scintigraphy were positive in 10 of 10 patients. Three patients who were considered to be in clinical remission had positive Tc-99m scans and normal Ga-67 scans. These results suggest that technetium and gallium scintigraphy are more sensitive than radiographs and CT scans for early detection of malignant external otitis. Gallium scintigraphy appears to be more specific for follow-up evaluation of these patients.
Adult↗
Infective causes of facial nerve paralysis.
OBJECTIVE: To review the functional recovery in a cohort of patients with facial nerve paralysis (FNP) due to infective cause. STUDY DESIGN: Retrospective review based on patients identified from a prospectively maintained database of patients with FNP. The case notes of identified patients were reviewed. SETTING: Tertiary referral center. PATIENTS: The patients were identified from a database of 1074 patients with FNP. One hundred twenty of the 150 patients identified as having FNP due to an infectious disease caused by herpes zoster oticus were excluded from the study. The remaining 30 patients were included in the study. INTERVENTIONS: Patients were treated both operatively and nonoperatively. Operative treatment included myringotomy and ventilation tube placement, cortical mastoidectomy, modified radical (canal wall down) mastoidectomy, petrous apicectomy, and lateral temporal bone resection. MAIN OUTCOME MEASURES: This study used the House-Brackmann (HB) grade of facial function at 1 year after initial assessment. The patients were identified from a prospectively maintained database of all patients presenting with FNP to a single specialist otolaryngologist (G.R.C.) between June 1988 and April 2005. The database contains information including demographic details, dates of presentation, diagnostic modalities used, diagnosis, interventions, and HB grade. The patients in this series presented between August 4, 1989 and August 26, 2003. RESULTS: Twenty-nine patients with 30 facial nerve paralyses were identified. The causes of FNP were acute otitis media (n = 10); cholesteatoma (n = 10 [acquired, 7; congenital, 3]); mastoid cavity infections (n = 2); malignant otitis externa (n = 2); noncholesteatomatous chronic suppurative otitis media (CSOM; n = 2); tuberculous mastoiditis (n = 1); suppurative parotitis (n = 1); and chronic granulomatosis (n = 1). The patients with noncholesteatomatous CSOM who presented sooner after the onset of facial nerve symptoms had greater facial nerve recovery when assessed using the HB grade at 1 year. CONCLUSION: FNP due to infective causes other than herpes zoster oticus is rare. Patients with noncholesteatomatous CSOM and FNP have a better outcome than those with FNP due to cholesteatoma. Patients with FNP due to acute otitis media tend to have a good prognosis without surgical decompression of the facial nerve being required.
Administration, Topical↗
Pseudomonas otitidis sp. nov., isolated from patients with otic infections.
A novel Pseudomonas species, for which the name Pseudomonas otitidis sp. nov. is proposed, was identified from clinical specimens of infected human ears. Forty-one pseudomonads (34 from patients with acute otitis externa, six from patients with acute otitis media with otorrhoea and one from a patient with chronic suppurative otitis media) were recovered that did not match any known species. On the basis of genetic analyses and biochemical characterization, these isolates were shown to belong to the genus Pseudomonas. 16S rRNA gene sequence analysis and DNA-DNA hybridization studies indicated that this novel bacterium is closely related to, but different from, Pseudomonas aeruginosa. A description of this species is based on polyphasic studies of 11 clinical isolates. The type strain of Pseudomonas otitidis is MCC10330T (=ATCC BAA-1130T = DSM 17224T).
DNA, Bacterial↗
Prevalence of Malassezia spp. in the ears of asymptomatic cattle and cattle with otitis in Brazil.
Yeasts of the genus Malassezia are lipophilic microorganisms that are saprophytes that can act as opportunistic pathogens in animals. Malassezia pachydermatis is commonly isolated from the ear canal and skin of healthy dogs, or in association with seborrheic dermatitis and otitis externa conditions. The objective of the present study was to determine the occurrence of Malassezia spp. in the ears of healthy bovines and bovines with otitis. Specimens (secretion or cerumen) were collected with sterile swabs, inoculated onto Mycosel medium, supplemented with olive oil, and incubated at 35 degrees C for 1 week. Yeasts were identified according to morphological characteristics, growth in Dixon medium at 32 degrees C and Sabouraud glucose medium modified by the addition of Tween 20, 40 or 80. The results showed that 54.7% of the cultures were positive in bovines with otitis (75) and 34.6% were positive in healthy bovines (378). Analysis of the positive cultures (41) from animals with otitis allowed presumptive identification of 24 strains corresponding to M. globosa (12), M. slooffiae (5), M. furfur (5) and M. sympodialis (2). Further studies on a larger number of animals may confirm the trend verified thus far, i.e. a higher frequency of isolation of Malassezia spp. from animals with otitis than from healthy animals (P<0.01) and a predominance of the species M. globosa.
Animals↗
Management of stenosis and acquired atresia of the external auditory meatus.
The aim of this study was to investigate the aetiology of acquired atresia and stenosis of the external auditory meatus and to present our results for surgical management. Over an 18-year period (from 1986 to 2004), data were collected prospectively from patient cohorts in Dundee and Edinburgh. Stenosis of the auditory meatus was due to chronic otitis externa in 64 per cent of cases, compared with 37 per cent of cases with acquired atresia; the latter had instead a history of chronic suppurative otitis media in 43 per cent. Surgical treatment of canal stenosis with meatoplasty alone achieved a widely patent ear canal in 80 per cent of cases, with 78 per cent of ears remaining free of discharge. Cases of acquired atresia treated with simple surgical excision of the soft tissue plug experienced a 100 per cent failure rate. The additional use of a split skin graft achieved a patent meatus in 70 per cent of cases, with hearing improvement in 79 per cent. However, the ear canal remained unstable and late recurrence was observed.
Adult↗
Osteomyelitis of the ear canal caused by Staphylococcus lugdunensis.
Osteomyelitis of the temporal bone caused by Staphylococcus lugdunensis has never been reported before. This infection was diagnosed in a 51-year-old diabetic man. S. lugdunensis is an unusually virulent coagulase negative staphylococcus and has been implicated in a variety of severe infections. Considering the serious morbidity and mortality associated with osteomyelitis and in particular with S. lugdunensis, special awareness and alertness are required when otitis externa, which predisposes to osteomyelitis, is refractory to treatment.
Humans↗
A survey of 120 isolates of Malassezia (Pityrosporum) pachydermatis. Preliminary study.
The morphological, cultural and biochemical characteristics of 120 isolates of Malassezia (Pityrosporum) pachydermatis, isolated from chronic otitis externa in the dog, are discussed.
Animals↗
Effects of ear type, sex, age, body weight, and climate on temperatures in the external acoustic meatus of dogs.
OBJECTIVE: To investigate effects of ear type, sex, age, body weight, and ambient climatic conditions on external acoustic meatus (external ear canal) temperatures in dogs. ANIMALS: 650 dogs without clinical signs of ear disease. PROCEDURE: Dogs were assigned to 5 groups on the basis of auricular conformation and amount of hair in the external ear canal and 4 groups on the basis of body weight or age. External ear canal temperatures (EECT) were measured, using an infrared thermometer. Mean EECT determined for each group were compared to evaluate effects of ear type, age, weight, and sex, and EECT measured at different ambient temperatures and humidities were compared to determine climatic effects. RESULTS: Dogs with hirsute ear canals had significantly lower EECT than dogs with hairless ear canals, whereas significant differences were not detected between dogs with erect and pendulous auricles. Dogs < 6 years old had higher EECT than older dogs, and dogs that weighed < 6 kg had lower EECT than larger dogs. External ear canal temperatures measured when ambient temperatures were < 25 C were less than those measured at warmer temperatures. Sex and relative humidity did not affect EECT CONCLUSIONS AND CLINICAL RELEVANCE: EECT of dogs without ear disease were affected by weight and age, amount of hair in the external ear canal, and ambient temperature. However, hirsute ears had lower, not higher, EECT than hairless ears, suggesting that EECT may play less of a role in the development of otitis externa than believed.
Age Factors↗
Severe hypertrichosis of the external ear canal during minoxidil therapy.
Minoxidil is a potent peripheral vasodilator used to treat patients with severe hypertension that is unresponsive to other medications. Hypertrichosis of the forehead, face, neck, shoulders, upper part of the arms, and legs is a frequent side effect that occurs in the majority of patients that use this drug. This phenomenon appears to be due to increased blood flow to hair follicles, with resultant excessive hair growth. We describe a patient with severe hypertrichosis of the external ear canal resulting in chronic otitis externa and hearing loss.
Ear, Middle↗
External otitis among swimmers and nonswimmers.
Studies were undertaken between the summers of 1970 and 1974 to determine the effects of swimming on the incidence of external otitis and on the isolation of Pseudomonas aeruginosa from infected outer ears. The frequency of "earaches" reported by swimmers during a telephone survey conducted during the summer of 1971 was 2.4 times the frequency reported by nonswimmers. Furthermore, the risk of a swimmer acquiring external otitis, determined from reports of outer-ear infections received from physicians during the same period, was approximately five times as great as the risk to nonswimmers. Swimming also increased the risk of P aeruginosa involvement in otitis externa, and reported infections among swimmers tended to be more severe than infections among nonswimmers.
Environmental Exposure↗
[Microbiological results of ear swabs from dogs and cats].
413 swabs of dogs and cats ears were examined microbiologically. Bacteria could be isolated in 82% and yeasts or moulds in 28% of the cases. The most common bacteria species were coagulase-positive Staphylococci, Pseudomonas spp., beta-hemolytic streptococci, and Proteus spp. with Staphylococci being the most common isolate. Within the group of yeasts and moulds Malassezia pachydermatis was isolated most frequently (90%). From the results of in vitro antibiotic tests, a general recommendation for the treatment of otitis externa nonparasitaria could not be given.
Animals↗
[High-resolution computed tomography in the diagnosis of bone-destroying processes of the external ear].
Eleven patients with known malignant tumours of the outer ear and three patients with otitis externa maligna were examined by high resolution CT. CT provided accurate information concerning soft tissue infiltration into the parotid or subtemporal tissues, and of the bony destruction in the mastoid, meatus and tympanic cavity. Absolute differentiation between a malignant tumour and otitis cisterna maligna is not possible, not even by high resolution CT.
Carcinoma, Adenoid Cystic↗
Care of the ear canal and mastoid.
Zinc sulfate has been used for therapy of granulations of the trachea and ear that have not responded to usual treatment. This paper will report on current indications for zinc sulfate and the resulting success in managing granulomata of the ear canal and mastoid bowl. Some mastoid bowls have been large and hard to clean, especially in the posterior and lateral parts. A method of cleaning using indirect otoscopy and curved aspirators in conjunction with adequate lubrication will be described. Treatment of otalgia in both the ear canal and mastoid bowl due to otitis externa sicca and results of proper lubrication and avoidance of patient instrumentation to restore the normal wax will also be discussed.
Cerumen↗
Necrotizing fasciitis: a rare occurrence in the external auditory meatus.
The diagnosis and management of a patient with a sloughing otitis externa thought to be necrotizing fasciitis is described. The clinical characteristics of this condition, diagnostic difficulties faced and a brief literature review are presented.
Adult↗