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PubMed1975

Rerouting the external auditory canal. A method of correcting congenital stenosis.

An hourglass or funnel-shaped, stenosed, external auditory meatus with a normal tympanic membrane, middle and inner ear is one of the congenital anomalies that occasionally occurs. Such abnormality was present in both ears of a woman and caused chromic otitis externa and deafness. A routine meatoplasty on the right ear failed because of an unusual cephalad position of the drumhead in relation to a "downhill" position of the stenosed outer meatus. Rerouting the ear canal to a horizontal position by removing bone of the canal superiorly, posteriorly, and inferiorly, and grafting the now horizontal canal with skin taken from the postauricular fold produced a good result. This is a satisfactory procedure for a woman, but would be cosmetically unacceptable for a man.

Adolescent↗
PubMed2000

Fatal invasive cerebral Absidia corymbifera infection following bone marrow transplantation.

A 56-year-old dairy farmer received a fully HLA matched unrelated donor marrow transplant for high risk CML in chronic phase. His early post-transplant course was complicated by a series of massive intracerebral bleeds and by sepsis related to a malignant otitis externa. The microbial pathogen isolated from ear swabs was found to be Absidia corymbifera, but CT scan at the time showed no intracerebral extension. Despite neutrophil engraftment and aggressive antifungal management he succumbed. Autopsy revealed invasion of Absidia into the brain from the ear. We speculate that colonisation by Absidia resulted from occupational exposure.

Absidia↗
PubMed2006

Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis.

OBJECTIVE: To describe the investigation and interventions necessary to contain an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU). DESIGN: Retrospective case finding that involved prospective performance of surveillance cultures for detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase chain reaction (rep-PCR). SETTING: Level III NICU in a tertiary care center. PARTICIPANTS: Three neonates in a NICU were identified with MRSA bloodstream infection on April 16, 2004. A point prevalence survey identified 6 additional colonized neonates (attack rate, 75% [9 of 12 neonates]). The outbreak strain was phenotypically unusual. INTERVENTIONS: Cohorting and mupirocin therapy were initiated for neonates who had acquired MRSA during the outbreak. Contact precautions were introduced in the NICU, and healthcare workers (HCWs) were retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized neonates and newly admitted patients had surveillance cultures performed 3 times per week. RESULTS: Two new colonized neonates were identified 1 month later. HCW X, who had worked in the NICU since June 2003, was identified as having chronic otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing (by rep-PCR) confirmed that the isolates from HCW X and from the neonates were more than 90% similar. Retrospective review of NICU isolates revealed that the outbreak strain was initially cultured from a neonate 2 months after HCW X began working on the unit. The epidemic strain was eradicated after removing HCW X from patient care in the NICU. CONCLUSION: An outbreak of MRSA colonization and infection in a NICU was epidemiologically linked to a HCW with chronic otitis externa and nasal colonization with MRSA. Eradication was not achieved until removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed earlier recognition of the outbreak and is now standard practice in our NICU.

Bacteremia↗
PubMed1992

Life-threatening Pseudomonas aeruginosa infections in patients with human immunodeficiency virus infection.

Bacterial infections are a well-described complication of AIDS. However, relatively few reports have described infections due to Pseudomonas aeruginosa in adults who are infected with the human immunodeficiency virus (HIV). Seven cases of serious P. aeruginosa infection in HIV-infected patients occurred during 12 months in two hospitals in Houston, often in the absence of other host factors that are generally thought to predispose to this condition. One patient had no prior illness or antibody test results that were suggestive of HIV infection; for two other patients who were known to have antibody to HIV, an AIDS-defining diagnosis had never been made. Three patients had pneumonia (two with bacteremia and one with empyema), one had malignant otitis externa, and three had bacteremia that either resulted from or caused secondarily a soft-tissue focus of infection. Two patients died, and two others experienced one or more relapses after an initial course of treatment. Compromised host defense mechanisms, including loss of mucosal integrity, defects in humoral and cellular immunities, and qualitative or quantitative leukocyte abnormalities, may predispose HIV-infected patients to P. aeruginosa infections.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Otomycosis: subdermal growth in calcified mass.

Reports on clear identification of fungi in subdermal tissue in chronic fungal external otitis are rare in recent years. Our patient was an immunocompetent adult male with an 8 year history of chronic otitis externa who presented with pustules on the external auditory canal (EAC) and necrosis and perforation of the tympanic membrane. Type I tympanoplasty was performed, but wound healing was delayed and swelling of the EAC occurred. Incision biopsy and staining (Gomori-Grocott and PAS) revealed fungal hyphae within small, calcified, subepidermal masses. A 3 month course of oral itraconazole was effective in healing the lesion. Calcification, a rarely reported finding in otomycosis, may represent a protective reaction against topical use of antifungal drugs.

Biopsy↗
PubMed2004

First isolation of Cryptococcus magnus from a cat.

A 6-month-old male Japanese domestic cat with otitis externa due to Aspergillus fumigatus was treated with antifungal agents for 25 days and appeared to be cured. Many yeast colonies however developed from the ear canal samples on Sabouraud's dextrose agar at 27 degrees C for 5 days, instead of A. fumigatus. This yeast colony was cream-colored and slim in texture with smooth and highly glossy surface after 5-day incubation on Sabouraud's dextrose agar at 27 degrees C. The isolate was identified as Cryptococcus magnus by mycological analysis and 28S ribosomal analysis.

Animals↗
PubMed1998

Granulomatous meningitis caused by Coccidioides immitis in a dog.

Granulomatous meningitis attributable to Coccidioides immitis was diagnosed on postmortem examination in a 4-year-old Border Collie. Clinical signs included CNS disease, aspiration pneumonia secondary to a megaesophagus, and otitis externa. Central nervous system signs included central vestibular and cranial nerve dysfunction. Cerebellar and medullary infiltrates seen on histologic examination affected cranial nerves VIII, IX, and X. Despite extensive diagnostics, diagnosis was not made antemortem. Analysis of CSF suggested suppurative meningitis, but bacteriologic culture results were negative. Coccidioides endospores were identified on reexamination of brain tissue. The clinical course of disease and rate of Coccidioides immitis infection is variable. Causative agents of granulomatous or inflammatory CNS disease may include fungal infection more often than is currently suspected.

Animals↗
PubMedDate not supplied

A dermatosis resembling juvenile cellulitis in an adult dog.

A two-year-old, female Lhasa apso presented with an acute onset of fever, anorexia, lethargy, prescapular and mandibular lymphadenopathy, otitis externa, and a dermatitis involving the perioral and auricular skin. Histopathological examination of affected skin and a mandibular lymph node was diagnostic for juvenile cellulitis. Extensive hematological, serological, urine, skin, and fecal testing together with special staining, immunofluorescence, and electron microscopic examination of skin and lymph node biopsies failed to reveal an underlying etiology. After 15 weeks the condition resolved completely. This represents the first adult case of a dermatosis fitting the clinical, histological, and clinicopathological description ascribed to juvenile cellulitis.

Animals↗
PubMed2006

Presentation and management of aural foreign bodies in two Australian emergency departments.

OBJECTIVE: To survey and compare the type and management of foreign bodies found in adult and paediatric ears presenting to an Australian otorhinolaryngology and a general ED. METHODS: Retrospective case study with data collated from two centres. Chart reviews of a total of 330 patients presenting with aural foreign bodies to the ED of the Royal Victorian Eye and Ear Hospital and the ED of The Bendigo Hospital, both situated in the state of Victoria, Australia, were surveyed for patient demographics, foreign body description and referral and removal pattern. RESULTS: Two hundred and seventeen adults and 113 children were included in the study. The most common foreign bodies in children were beads, cotton tips, insects and paper, and in adults cotton tips, insects, cotton wool and silicone ear plugs. Flying insects were far more common in the Australian population than cockroaches found in surveys in other countries. Children were significantly more likely to have initially been seen by their Local Medical Officer than adults (P < 0.001) and to require a general anaesthetic for removal of the object(s) (P < 0.001). Adults were more likely to have associated otitis externa at the time of presentation (P < 0.05). CONCLUSIONS: Aural foreign bodies are a frequent presentation to the ED. Recognition of patients requiring early specialist referral is important. Adults present with a different profile of aural foreign objects to children and require different management. The use of cotton tips or cotton wool in the external ear canal and silicone ear plugs should be discouraged.

Adolescent↗
PubMed1989

Management of osteomyelitis of the skull base.

Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol.

Aminoglycosides↗
PubMed2000

Molecular phylogenetic evidence for noninvasive zoonotic transmission of Staphylococcus intermedius from a canine pet to a human.

rRNA-based molecular phylogenetic techniques were used to identify the bacterial species present in the ear fluid from a female patient with otitis externa. We report the identification of Staphylococcus intermedius from the patient and a possible route of transmission. Analysis of 16S ribosomal DNA restriction fragment length polymorphisms indicated that the dominant species present was S. intermedius. A pet dog owned by the patient also was tested and found to harbor S. intermedius. In humans, the disease is rare and considered a zoonosis. Previously, S. intermedius has been associated with dog bite wounds, catheter-related injuries, and surgery. This study represents the first reported case of a noninvasive infection with S. intermedius.

Adult↗
PubMed2004

Trichophyton rubrum in the external auditory meatus.

We report the case of a 28-year-old immunocompetent male suffering from otitis externa. The right external auditory meatus was filled with cerumen and detritus, the tympanic membrane covered wallpaper-like with layers of fungi. Mycological analysis revealed Trichophyton rubrum. With further examination tinea pedis of plantar and interdigital type and concomitant onychomycosis of the toenails due to T. rubrum could be detected. The auditory meatus was cleaned and treated topically with clotrimazole. Two weeks later the auditory meatus and the tympanic membrane were bare of fungi and the inflammation was resolved. Treatment of tinea pedis and onychomycosis with terbinafine (systemically and topically) is still lasting.

Adult↗
PubMed2000

Accuracy of patient self-medication with topical eardrops.

Topical eardrops are commonly prescribed by otolaryngologists and general practitioners and many believe that patient compliance is poor, although this has not been studied in a properly controlled manner. Thirty-nine patients with otitis externa were reviewed four times during a two-week course of topical eardrops and their treatment compliance studied. The patients tended to undermedicate themselves, and this tendency increased over the two-week period. Patients were administering significantly fewer drops by the end of day 11 than by the end of day 3 (p = 0.2). Compliance patterns were extremely poor, in that only 40 per cent of patients were managing to self-medicate within a 25 per cent error margin by the end of day 3. These findings may have future implications in the ongoing debate on eardrop use.

Administration, Topical↗
PubMed1997

Otomycosis: the detection of fungi in ears by immunofluorescence microscopy.

The procedure currently used to diagnose infection in otitis externa has several limitations: it is slow to culture organisms on growth media, fungal infections are often missed, and extensive laboratory facilities and mycological expertise are required. A rapid, accurate and sensitive assay would greatly improve patient care by initiating appropriate antifungal treatment at the onset of disease. We report the development of a rapid detection assay for otomycosis using fungal-specific monoclonal antibodies to detect fungi in ear swabs by immunofluorescence microscopy. This assay could form the basis of a detection assay for fungal infections of the head and neck.

Adult↗
PubMed1983

Clinical results of lateral ear resection in dogs.

Twenty-six dogs had lateral ear resection performed for the treatment of chronic otitis externa. After a mean follow-up period of 4.5 years, 17 of the 26 dogs were available for physical examination. The remaining 9 dogs died prior to this review; their owners were surveyed by questionnaire. In the examined group, the resolution of clinical signs was good in 41% of the dogs, improved in 12%, and poor in 47%. A good result was defined as the elimination of clinical signs, with minimal or no care required from the owner. An improved status was assigned to dogs that experienced occasional recurrence of signs requiring professional attention. A poor result was defined as no improvement.

Animals↗
PubMed1988

Cytologic evaluation of otic exudates.

The multifactorial nature of otitis externa requires accurate etiologic information to ensure therapeutic success. The collection and preparation of cytologic samples of otic exudates are simple to perform, and information of immediate diagnostic and therapeutic value can be attained. Evidence of epidermal hyperplasia and increased glandular secretory activity suggests a noninfectious cause. Large numbers of microorganisms and infiltrating leukocytes confirm the presence of infection. The presence of ear mites, particularly O. cynotis, is always significant. Abnormal epithelial cells that appear singly or in sheets and clusters support the diagnosis of neoplasia; the extent of cell differentiation determines malignancy. Inflammatory cells and acantholytic keratinocytes from vesicular otic lesions suggest autoimmune skin disease.

Animals↗
PubMed2006

Comparison of an antifungal agent with a mixture of antifungal, antibiotic and corticosteroid agents for the treatment of Malassezia species otitis in dogs.

Twenty dogs with otitis externa in both ears and numerous Malassezia species yeasts on cytological examination were treated in one ear with a combination product containing clotrimazole, marbofloxacin and dexamethasone, and in the other ear with a topical antifungal containing miconazole. The effects of the treatments were analysed on the basis of the scores for pruritus, erythema and amount of cerumen, and the number of yeasts on cytological smears. There were reductions in the counts of Malassezia species after both treatments, but the combination product gave significantly greater reductions in erythema, cerumen and pruritus.

Administration, Topical↗
PubMed2002

Studies of certain factors affecting the microenvironment and microflora of the external ear of the dog in health and disease.

A total of 187 dogs, 110 with clinical signs of otitis externa (OE), and 77 without history or clinical signs of OE, were examined microenvironment and microbiological analysis of their ear exudates made. The aural temperature and humidity of 160 dogs were measured. There were no significant difference between healthy dogs and OE dogs. German shepherd showed relatively lower temperature (p<0.01) and higher humidity (p<0.01). The mean log(10) number of microbial organisms of ears of OE dogs (4.16 +/- 0.31 cfu/g) was significantly increased, compared to that from the ears of non-OE group (2.55 +/- 0.24 cfu/g). Pseudomonas spp. and Proteus spp. were detected only from OE dogs. In addition, three enterotoxigenic Staphylococcus aureus were isolated from ear specimens.

Animals↗