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PubMed1991

Clinical efficacy of budesonide in the treatment of eczematous external otitis.

Sixty patients with mild to moderate forms of eczematous otitis externa were treated with budesonide and placebo in a double-blind controlled study using parallel groups. Each treatment period was preceded by otomicroscopic examination and thorough cleaning of the ear canal. The symptoms and signs were assessed with a score system ranging from 0 (no symptoms/signs) to 3 (severe symptoms/signs). Budesonide treatment was associated with a reduction in severity of all symptoms recorded and a marked improvement in erythema, swelling and discharge. Mechanical cleaning of the ear canal and placebo was not a sufficient treatment for this group of patients.

Administration, Topical↗
PubMed2006

[MRI of the temporal bone].

Lesions arising within the temporal bone, where audition and balance receptors are located, are multiple. Beginning with a short clinical and technical overview, this presentation aims to review the most common temporal bone lesions, according to their location. Tumors and malignant otitis externa are the most common lesions of the external auditory canal. MRI features of cholesteatoma redux, transtegmental masses, and paragangliomas are described in the middle ear MRI study. The diagnosis of petrous apex abnormalities is emphasized: cholesterol granuloma, malignant tumor, epidermoid cyst, cholesteatoma, and petrositis. The diagnostic value of CT scan associated with MRI is stressed. This study also includes the main aspects of facial nerve lesions and vascular abnormalities of the area on MRI. The conclusion summarizes the main indications of temporal bone MRI.

Anticoagulants↗
PubMed2001

M-meatoplasty: results and patient satisfaction in 125 patients (199 ears).

OBJECTIVE: Is M-meatoplasty the solution for chronic otitis externa caused by wax retention? This study discusses acceptance of this operation and whether sedation is necessary. STUDY DESIGN: Between October 1994 and October 1997, 199 successive M-meatoplasties (125 patients) were studied, and 79% of the patients completed a questionnaire in which patient satisfaction with the procedure and outcome was assessed. SETTING: Local hospital, functioning as a secondary referral center. PATIENTS: All patients had narrowing of the lateral part of the outer ear canal resulting from anterior displacement of the cavum conchae cartilage. INTERVENTION: The aim of M-meatoplasty is to increase the lumen of the entrance to the external ear canal by reducing the conchal cartilage on the posterior wall MAIN OUTCOME MEASURES: Reduction of visits to the outpatient clinic, patient satisfaction on a scale from 1 (very bad) to 10 (excellent). RESULTS: The number of preoperative visits was 7 (range 1-153). The median number of postoperative visits for the same problems more than 3 months after surgery was 1 (range 0-14). The patient score for the surgery and the final result was a median of 9 (very good). CONCLUSIONS: Wax obstruction and related external otitis can be cured by M-meatoplasty if the conchal cartilage is too prominent on the posterior wall. It is a simple outpatient operation and is very well tolerated. After the operation, there is an enormous reduction in outpatient visits.

Adolescent↗
PubMed1994

Patient compliance with short-term topical aural antibiotic therapy.

Little is known about patient compliance with topical aural antibiotic regimens. The compliance of 50 patients with unilateral otitis externa attending an otolaryngology clinic was studied by comparing the weight of dispensed topical ear preparations before and after completion of a 7-day-course of treatment. A standard was obtained from controlled administration of the preparation under laboratory conditions and the performance of different delivery systems evaluated. Thirty-seven patients re-attended for review with their medication. A total of 34 of 50 patients entering the study (70%) satisfied conventional criteria for compliance. However, over-use of preparations was common and stricter criteria are proposed and applied. Compliance was significantly increased when someone other than the patient administered the preparation.

Administration, Topical↗
PubMed2000

First isolation of Stephanoascus ciferrii from a cat.

The present study deals with the first isolation of Stephanoascus ciferrii from a cat. A 2-year-old female Persian cat weighing 2.25 kg was referred to an animal hospital with a chief complaint of otitis externa of the left ear. Microscopic examination of specimen from the left ear disclosed yeast cells. The colony of the clinical isolate was cream-colored, rough, raised and wrinkled. The microscopic examination of the clinical isolate revealed abundant branched and septated mycelia with small ramified chains of oval blastoconidia, variable in size, and arranged alongside the hyphae. Amplification of the isolate DNA with LSU rDNA primers yielded a fragment of about 570 bp, whose nucleotide sequence of the isolate showed 100% similarity to that of Stephanoascus ciferrii in the GenBank database. Therefore, the isolate was identified as Stephanoascus ciferrii, confirming the result of mycological examination by molecular analysis.

Animals↗
PubMed2006

Atypical presentation of cutaneous tuberculosis and a retropharyngeal neck abscess.

A 70-year-old Asian man with noninsulin-dependent diabetes presented with a 4-month history of left-sided otitis externa and right-sided facial palsy. Physical examination of the left ear revealed a punched-out ulcerative lesion on the tragus, an edematous and inflamed external auditory canal, and a purulent nonmucoid discharge. Computed tomography of the brain and neck demonstrated a large retropharyngeal abscess, an abscess in the left parapharyngeal space, and a small collection adjacent to the right carotid sheath at the level of C4; the cervical vertebrae and lungs were normal. Microscopy of drained pus and histology of left ear and neck node biopsies identified tuberculosis. The patient was started on antituberculosis drug therapy, but he died within 2 weeks of treatment. We discuss the characteristics of this unusual presentation of tuberculosis infection.

Aged↗
PubMed2004

Trends of ear syringing at Ibadan, Nigeria.

Ear syringing is a procedure by which the external auditory canal is irrigated with a normal saline at body temperature. It is a procedure which every doctor or nurse should be able to perform proficiently. A study of 622 patients that needed ear syringing was done between December 1999 and June 2001 to determine its trend. There were 341(55%) males and 281(45%) females with age ranged from 3.5months to 89 years: 44.4% were in the first decade of life. Cerumen auris 99% remained the commonest indication for syringing in this study with bilateral cerumen auris constituting 53.1% while right and left cerumen auris constituted 24.4% and 21.5% respectively. Cerumen auris constituted 66% of total 933 Otologic cases seen during the study period. Other indications were otitis externa 0.7% (otomycosis 0.5%; bacterial 0.2%) and foreign body 0.3%. The majority of patients (86%) required between 500mls and 1000mls of fluid for irrigation and 94.9% required not more than one attempt at syringing. The complications recorded were mainly vertigo 0.2% and tympanic membrane perforation 0.2% respectively. Thus ear syringing, though simple and sometimes taken for granted may be fraught with dangers; it is a very safe procedure in trained hands and that after at least three attempts of ear syringing for cerumen auris and if it persists despite effective applications of cerumenolytic agents prior to irrigation, the procedure should be discontinued and other methods of imparted cerumen auris removal should be employed.

Adolescent↗
PubMed1988

The microbial environment of the ear canal in health and disease.

Otitis externa is an important disease of dogs and, to a lesser degree, cats. The yeast Malassezia canis is the most common organism demonstrated in ear infections. Coagulase-positive staphylococci are the most common bacteria isolated, often occurring with M. canis. Pseudomonas aeruginosa and Proteus are gram-negative bacteria that are frequently encountered. Other bacteria, such as beta-hemolytic streptococci, enterococci, Escherichia coli, and Corynebacterium are also important. Malassezia canis, coagulase-positive staphylococci, and Pseudomonas aeruginosa commonly occur as monoinfections, whereas other bacteria are typically associated with mixed infections. Smears may provide rapid diagnosis on which to base empiric treatment. Cultures should be considered in recurrent or refractory cases, especially those involving gram-negative bacteria. In practices that are not equipped to perform culture and susceptibility tests, it is advisable to seek the advice of a microbiology laboratory.

Animals↗
PubMed1993

Effect of total ablation of the external acoustic meatus and bulla osteotomy on auditory function in dogs.

Seven dogs with end-stage bilateral otitis externa were evaluated for auditory function before and after bilateral total ear canal ablation and lateral bulla osteotomy. Evaluations were performed by owner questionnaire and by recording brainstem auditory-evoked responses. Prior to surgery, all dogs could hear a loud voice or noise, however, only 3 dogs responded to a voice spoken at a normal level. Of the 14 ears tested electrodiagnostically, only 1 did not have a response, using air-conducted or bone-conducted stimuli. After surgery, 2 dogs responded to a normal voice, but all 7 responded to loud voices or noise. Three ears that had recordable brainstem auditory-evoked responses to air-conducted stimulation prior to surgery, failed to respond after surgery. Ears that responded to bone-conducted stimulation prior to surgery also responded after surgery.

Animals↗
PubMed2004

[Otosialorrhoea - diagnostics and therapy of a salivary fistula of the external auditory canal].

PATIENT: We report the case of a 49 year old female patient who suffered from frequent secretion of the left external canal of the ear after the treatment of a chronic mycotic otitis externa. The secretion was seen in connection with food intake. An operative revision in another hospital remained without success. The diagnostics covered the biochemical verification of saliva-amylase in the secretion, but also a high resolution MRI of the parotid gland. By this diagnostics it was easy to locate the salivary fistula during the operation. DISCUSSION: Salivary fistulas of the parotid gland to the external ear-canal are very rare. These fistulas develop after injury of the parenchyma or the gland ductus and also after surgery of the head- and neck-region. A otosialorrhoea rarely originates from a chronic inflammatory of the ear canal. These fistulas are assigned to the fissures of Santorini and the foramen of Huschke. The therapy of salivary fistulas to the external ear canal reaches from clossure of the fistula to total parotidectomy. But also a medicamental suppression of salivation, irradiation and a tympanic neurectomy are discussed in the literature.

Chronic Disease↗
PubMed2004

Otic cytology in health and disease.

Accurate characterization of the primary cause and perpetuating factors is essential for successful management of ear disease in dogs and cats. Cytology is a simple, rapid, and practical diagnostic test that should be performed routinely on any and all patients presented for clinical signs consistent with otitis externa. In combination with clinical signs, otoscopic evaluation, and diagnostic testing of primary disease, serial cytology enhances the ability of veterinarians to diagnose secondary infections, monitor progression of disease, evaluate response to therapy, and make appropriate management decisions. Cytologic specimens should be evaluated for the presence, numbers, and characteristics of three key features: yeast, bacteria, and leukocytes. More than five yeast organisms or more than 25 bacteria per high-powered field is suggestive of significant microbial activity warranting therapeutic intervention. The presence of leukocytes, particularly with phagocytized bacteria, indicates "true infection" rather than overgrowth; if suppurative discharge is present, systemic therapy is needed. Cytology combined with culture and susceptibility is the best method for identification of bacterial overgrowth and infection; however, if only one test can be performed, always choose cytology. Culture results assist in the selection of appropriate antibiotic therapy, but cytology determines whether systemic antibiotics are indicated, which organisms are most significant, and when therapy can be discontinued.

Animals↗
PubMedDate not supplied

[Study of the effectiveness and tolerance of Pevaryl 1 % milk in the treatment of mycoses of the external auditory meatus (author's transl)].

Otomycoses account for approximately 20 % of cases of otitis externa. Often unrecognised, they may be induced by various factors, in particular local antibiotic and corticosteroid therapy. The authors studied the effectiveness and tolerance of Econazole (1 % milk) in the treatment of otomycoses. In each of 30 cases, a bacteriological examination was made before and one week after treatment, the latter consisting of the insertion into the E.A.M. of a wick soaked in Econazole (1 % milk) every night. From a mycological standpoint, the fungus disappeared in all cases. Clinically, in relation to the criteria of assessment, a successful result was recorded in 28 cases out of 30. In 87 % of cases, cure was obtained in less than 2 weeks, and apart from a transient and brief subjective sensation of an increase in certain symptoms (17 %), tolerance was perfect. Econazole (1 % milk) would appear to be the drug of choice in the treatment of otomycoses of the E.A.M., being effective against the fungi usually responsible (Aspergillus niger, fumigatus, flavus, Candida albicans, krusei etc.), as well as having a bactericidal action against Gram + bacteria.

Adult↗
PubMed1991

Use of quinolones for treatment of ear and eye infections.

Malignant otitis externa is a severe, necrotizing infection of the external auditory canal which is sometimes fatal. The traditional antimicrobial treatment has usually been the combination of an antipseudomonal beta-lactam and an aminoglycoside, given intravenously for 4 to 8 weeks. Over 100 patients have been treated with a fluoroquinolone alone, most commonly ciprofloxacin given by mouth in a dosage of 750 mg b.i.d. for 6 to 12 weeks. About 90% of patients have been cured. Treatment with a quinolone has the advantage over older treatments that it can be given orally and has a low rate of side-effects. The ocular penetration of the fluoroquinolones has been studied in patients with unifected eyes. After the administration of a single dose of ciprofloxacin, pefloxacin, ofloxacin or norfloxacin, penetration into the aqueous humor, expressed as the ratio of the peak concentration in the aqueous humor to that in the serum, is about 20%. The penetration of ciprofloxacin into the vitreous humor, based primarily on the data from one report, is about 20%. The concentrations are likely to be higher after repeated doses or in the inflamed eye. Whether the concentrations achieved will be adequate for therapeutic or prophylactic purposes has not been determined.

4-Quinolones↗
PubMedDate not supplied

Passive drainage versus primary closure after total ear canal ablation-lateral bulla osteotomy in dogs: 59 dogs (1985-1995).

OBJECTIVE: Compare passive wound drainage to primary closure of total ear canal ablation-lateral bulla osteotomy (TECA-LBO) in dogs. STUDY DESIGN: Retrospective analysis of medical records. SAMPLE POPULATION: Fifty-nine dogs with end-stage otitis externa or neoplasia of the external and middle ear. METHODS: Medical records of dogs with TECA-LBO were reviewed. Dogs were divided into postoperative drain and primary closure groups. Statistical analyses were performed to identify differences in data for signalment, preoperative treatment, duration of hospitalization, immediate complications, and long-term complications between groups. RESULTS: No significant differences were detected in signalment, diagnosis, and duration of medical management between groups (P > .05). Duration of hospitalization was greater for dogs in the drain group (P < .05). Immediate postoperative complications occurred in 26 of 59 dogs and included ipsilateral facial palsy, incision swelling, vestibular signs, premature drain removal, and one dog died of aspiration pneumonia. Long-term (> 6 months) complications were identified in 12 of 50 dogs and included dermatitis of the medial aspect of the pinna, chronic fistula formation, and permanent facial paralysis. No association between immediate or long term complications and method of closure was identified. CONCLUSIONS: Primary closure is an acceptable alternative in dogs undergoing TECA-LBO when surgical wound dead space can be managed with meticulous hemostasis, complete debridement of devitalized tissue, and accurate apposition of tissue planes.

Animals↗
PubMed2004

Heat-induced formulation inhomogeneity of a three-component suspension.

A suspension formulation containing sarafloxacin HCl, triamcinolone acetonide, and clotrimazole was developed for the treatment of otitis externa in dogs. The potency for the three active ingredients in this suspension was monitored at 25 degrees C and 40 degrees C for up to 3 months. The potencies of triamcinolone and clotrimazole were found unchanged, but the potency of sarafloxacin HCl in the samples stored at 40 degrees C for 1 month varied significantly between samples. However, assay inconsistency for sarafloxacin HCl was not seen in samples stored at 25 degrees C. Under an optical microscope, large crystals were found in the 40 degrees C stability samples but not in the 25 degrees C samples. The large crystals in 40 degrees C samples were identified as sarafloxacin by high-performance liquid chromatography (HPLC). This finding suggests that crystal growth of sarafloxacin took place at 40 degrees C during storage, leading to the formation of larger crystals and the consequent sampling nonuniformity and assay inconsistency. The solid-state properties of these crystals were further evaluated using hot-stage microscopy and Fourier transform infrared (FTIR) analysis. The results indicate that the crystal growth of sarafloxacin was most likely attributed to a change in the hydration form of sarafloxacin.

Animals↗
PubMed1953

External otitis.

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Humans↗
PubMed1951

External otitis.

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Humans↗