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PubMed1991

A randomized prospective comparison of two methods of administering topical treatment in otitis externa.

Ten patients with bilateral moderate or severe otitis externa were studied. Following aural toilet each patient was subjected to two different treatments: one ear had alternate day dressings containing a topical antibiotic/steroid mixture, while the external canal of the other was filled with the same topical preparation (sump filling). Improvement in the severity of the otitis externa was assessed after 1 week. 9 out of 10 ear canals improved in each group. An estimate of the relative cost of each treatment was made and sump filling was found to be less expensive. The results suggest that sump filling is a low cost alternative to standard treatment in moderate and severe otitis externa.

Administration, Topical↗
PubMed2002

Measurement of body temperature by use of auricular thermometers versus rectal thermometers in dogs with otitis externa.

OBJECTIVE: To compare measurements of body temperature obtained with auricular thermometers versus rectal thermometers in dogs with otitis externa. DESIGN: Prospective study. ANIMALS: 100 client-owned dogs: 50 with and 50 without clinical evidence of otitis externa. PROCEDURE: Dogs were evaluated for the presence of otitis externa on the basis of clinical signs, otoscopic examination, and cytologic evaluation of ear exudate. Auricular and rectal temperatures were obtained simultaneously in all dogs prior to and following ear examination. RESULTS: There was a high correlation between auricular and rectal temperatures in dogs with otitis externa both prior to and after ear manipulation. Significant differences were not detected in temperature measurements among dogs with different degrees of otitis externa. CONCLUSIONS AND CLINICAL RELEVANCE: Auricular temperature readings obtained by use of an auricular thermometer in dogs with otitis externa are accurate measurements of body temperature, compared with rectal temperature measurements. Temperature measurements are reliable before and after examination of the ear canal.

Animals↗
PubMed1986

Necrotizing otitis externa occurring concurrently with epidermoid carcinoma.

Malignant external otitis (necrotizing otitis externa) is an infectious process which occurs most often in middle-aged and elderly diabetic patients and is characterized by cultures positive for Pseudomonas and granulation tissue at the junction of the bony and cartilaginous portion of the external auditory canal. Epidermoid carcinoma of the external auditory canal is also seen most often in the middle-aged and elderly population. To the best of our knowledge, no case of acute necrotizing otitis externa occurring concomitantly with epidermoid carcinoma of the external auditory canal has been documented. A case is presented and discussed here and the importance of biopsy of the external auditory canal is stressed. Theoretical considerations of the possible relationship between these two disorders are discussed. This case illustrates the need to discontinue the use of the term "malignant external otitis" and replace it with the term "necrotizing otitis externa."

Carcinoma, Squamous Cell↗
PubMed2002

Microbiology of acute otitis externa.

OBJECTIVE: To isolate and characterize bacteria and fungi from acute otitis externa (AOE) and to obtain susceptibility profiles on each bacterial isolate. STUDY DESIGN: Prospective core series. METHODS: Specimens were collected from the external canals of subjects with clinically diagnosed acute otitis externa. Species-level identification for each bacterial isolate recovered was obtained by combining phenotypic and genotypic data. End point mean inhibitory concentration (MIC) testing was performed using National Committee for Clinical Laboratory Standards (NCCLS) recommended methods. RESULTS: In Alcon-sponsored clinical studies conducted in 1998 to 2000, microbiology specimens were collected from 2039 subjects (2240 diseased ears) by 101 investigators throughout the United States. A total of 2838 bacteria, 32 yeast, and 17 molds were recovered from 2048 ears clinically diagnosed as acute otitis externa. Of the 202 bacterial species recovered, the species most frequently isolated was Pseudomonas aeruginosa (38%). The next 10 species most frequently isolated were: Staphylococcus epidermidis, 9.1%; Staphylococcus aureus, 7.8%; Microbacterium otitidis, 6.6%; Microbacterium alconae, 2.9%; Staphylococcus caprae, 2.6%; Staphylococcus auricularis, 2.0%; Enterococcus faecalis, 1.9%; Enterobacter cloacae, 1.6%; Staphylococcus capitis subsp. Ureolyticus,1.4%; and Staphylococcus haemolyticus, 1.3%. Susceptibility profiles of S. epidermidis isolates revealed the greatest frequency of high-level resistance to selected antibiotics (>/=8 microg/mL): 23%, neomycin-resistant; 11%, oxacillin-resistant; and 12%, ofloxacin-resistant. Susceptibility profiles of S. aureus isolates revealed a lower frequency of high-level resistance: 6.3%, neomycin-resistant; 2.7%, oxacillin-resistant; and 4.5%, ofloxacin-resistant. P. aeruginosa with high-level resistance to quinolones (>/=128 mcg/mL for ofloxacin) was recovered from only 1 subject. Likewise, resistance of P. aeruginosa to aminoglycosides was rare. Twenty isolates had neomycin MICs >/=64 mcg/mL and 10 isolates had gentamicin MICs >/=16 mcg/mL. The coryneform isolates identified as Microbacterium otitidis had an intrinsic lack of susceptibility to quinolones (ofloxacin MICs >/=16 mcg/mL) and aminoglycosides (tobramycin MICs >/=32 mcg/mL and gentamicin MICs >/=8 mcg/mL). CONCLUSIONS: Bacterial infections of the external ear canal are most often caused by P. aeruginosa. However, there are a great number of other gram-positive and gram-negative bacterial species that are recovered from patients with acute otitis externa. Because of this diverse etiology, the best topical therapeutic choice for topical therapy is for the most potent, broad-spectrum (especially anti-P. aeruginosa) antibiotic available.

Acute Disease↗
PubMed2002

Occurrence of Malassezia spp. in the external ear canals of dogs and cats with and without otitis externa.

We studied the lipophilic microbiota of the external ear canals of 332 animals (264 dogs and 68 cats), with and without otitis externa, over an 11-year period from 1988 to 1999. Malassezia pachydermatis was isolated from 62.2% and 50% of dogs with and without otitis externa, respectively, and from 41.2% and 17.6% of cats with and without otitis externa, respectively. In the group of animals studied for lipid-dependent species, these yeasts were isolated from 4.5% of dogs with otitis externa and from 23.1% and 8.9% of cats with and without otitis externa, respectively. M. sympodialis and M. furfur were isolated from cats and M. furfur and M. obtusa from dogs. Our findings show that lipid-dependent Malassezia species may contribute to the etiology of otitis externa in dogs and cats.

Animals↗
PubMed1996

Pseudomonas aeruginosa in otitis externa. A particular variety of the bacteria?

BACKGROUND: Pseudomonas aeruginosa rarely affects the epithelium in healthy persons except for the external ear canal, raising the possibility that P aeruginosa in otitis externa is a specific variety that displays particular characteristics. DESIGN: A cohort study was designed to outline distinct characteristics of P aeruginosa in otitis externa compared with P aeruginosa in other infections. The study period was October 1, 1994, to March 27, 1995. PATIENTS: Isolates of P aeruginosa from nonhospitalized patients were collected at the bacteriological laboratory at Karolinska Hospital, Stockholm, Sweden; there were 53 strains of P aeruginosa isolated from otitis externa and 59 strains of P aeruginosa from varicose ulcers and urinary tract infections. METHODS: Pseudomonas aeruginosa was characterized by pigmentation, growth habits, production of mucoid, and biochemical characteristics. RESULTS: Pseudomonas aeruginosa in otitis externa produced less pyocyanin and less urease and exhibited no mucoid-producing strains. CONCLUSIONS: Pseudomonas aeruginosa in otitis externa displayed fewer of the usual biochemical features of the species than did the strains isolated from other infections. Some of these features, such as the production of pyocyanin, are influenced by nutritional factors; strains found in otitis externa probably represent the type of strains present in the natural habitat in water, as opposed to the strains that have adapted to the environment of other human infections. Increased knowledge of the characteristics of the strains found in otitis externa is important in understanding the pathogenesis of the disease and why P aeruginosa is the dominant infectious agent in otitis externa.

Humans↗
PubMed2003

External auditory canal pH in chronic otitis externa.

Several risk factors have been postulated to play a part in the progression of acute into chronic otitis externa, including changes towards alkalinity of the skin pH of the external auditory canal. These changes have been previously reported to occur in the acute stage, and their persistence may predispose to a chronic status of this condition. This prospective control study was designed to look at this possible relationship in more depth, by comparing the external auditory canal pH of individuals with chronic otitis externa, but with no current exacerbation, with an age-/sex-matched control group. Analysis of the data revealed a significantly higher external auditory canal pH in the chronic otitis externa group (P < 0.004) when compared with the controls, with no concomitant difference in body skin pH. Within this chronic otitis externa cohort, a statistically significant correlation was found between external auditory canal pH and the severity of the condition, as assessed using a multiparameter scoring system (r = 0.562; P < 0.02). Importantly, the pH was not related to the length of time since the last exacerbation. There was a significant age relationship present within our sample. Younger patients displayed more severe chronic otitis externa(r = -0.813; P < 0.001), with correspondingly higher external auditory canal pH values (r = -0.550; P < 0.02). The results suggest that alkaline ear canal skin is a local risk factor for the progression into chronic otitis externa, occurring, in this study, with greater severity in younger individuals.

Adult↗
PubMed1979

The role of Pityrosporum pachydermatis in otitis externa of dogs: evaluation of a treatment with miconazole.

The bacterial and mycotic flora were assessed in 158 ears of dogs with otitis externa and in 101 ears of healthy control dogs. Pityrosporum pachydermatis occurred in 57 per cent of ears with otitis externa and in 17 per cent of clinically healthy ears. Staphylococci and Pseudomonas aeruginosa were the predominant bacteria in otitic ears, micrococci and Bacillus spp were the most frequent isolates from clinically healthy ears. P pachydermatis, Ps aeruginosa and Candida tropicalis occurred in monoculture in a significant number of mainly chronic cases of otitis externa. A combination preparation, containing miconazole, polymyzin B and prednisolone, was highly effective in controlling the clinical signs of otitis externa and eliminating flora from the affected ears. The data presented suggest that yeasts, and especially P pachydermatis, may be significant pathogens in otitis externa and that antimycotic treatment is an essential part of the treatment of otitis externa in dogs.

Animals↗
PubMed1990

Gentamicin iontophoresis in the treatment of bacterial otitis externa in the guinea pig model.

Pseudomonas otitis externa is one of the most common infections treated by otolaryngologists. Infections induced in 30 guinea pigs appeared similar to that seen in humans. The ears were then placed into four treatment groups: group A, which received a single cleaning; group B, which received a single cleaning followed by gentamicin drops 4 times daily; group C, which received a single cleaning followed by a single gentamicin iontophoresis treatment; and group D, the control group, which received no treatment. Infections were analyzed by grading edema, purulence, and erythema. An average of 10.2 days was required for control group to return to normal appearance. Groups A, B, and C had mean resolution times of 5.9, 4.7, and 4.3 days, respectively. Gentamicin iontophoresis appears to be promising, with results as good as drop therapy in otitis externa in the guinea pig model.

Animals↗
PubMed1986

[Malignant otitis externa].

Malignant external otitis is a progressive Pseudomonas infection starting in the external auditory canal. It tends to occur in the elderly diabetic patient and to invade cartilage, bone, nerves and adjacent soft tissues. Aggressive medical management and surgical debridement is curative in most cases as it appears in the case reported in the following communication.

Aged↗
PubMed1985

Otitis externa. A common, often self-inflicted condition.

Otitis externa can be caused by trauma to the ear canal, skin disorders, and viral and bacterial infections. Often the disease is self-inflicted; insertion of an object into the canal in an attempt to clean the ear interferes with the ear's own cleansing mechanism and causes inflammation and infection. Swimmers, persons who wear a hearing aid, and persons who have had an ear disorder are especially prone to infection and may need to take special precautions. Appropriate treatment, including instillation of drops, cleansing of the canal, and drug therapy, usually prevents recurrence. Surgical intervention may be necessary to enlarge a tiny canal or remove exostoses and osteomas. A rare form of otitis externa is "malignant" external otitis, which usually affects diabetic patients and has a high mortality.

Adolescent↗
PubMed1990

Contact hypersensitivity in patients with chronic otitis externa.

Thirty-seven patients with chronic otitis externa were investigated for contact hypersensitivity to 49 agents using standardized patch testing. Positive reactions were found in 22 (58%) patients. This incidence is higher than the 40% found in the only previous similar study and is within the range of 32-72% found in patients with contact dermatitis. The average age of subjects showing sensitivity was 56.7 years compared with 34.9 years for those with negative tests. This significant age difference suggests that contact hypersensitivity is not an aetiological factor in the younger patient. There was no significant difference in the duration of otitis externa between those with positive and negative tests. This feature has not been previously examined or reported. Neomycin was the commonest sensitizing agent, sensitization occurring in 12 (32%) patients.

Adolescent↗
PubMed1981

Incidence of otitis externa in dogs and cats in Japan.

The incidence of otitis externa in dogs and cats admitted to the animal hospital of the University of Osaka Prefecture was investigated and the bacteria isolated were tested for antibiotic susceptibility. Of the various breeds examined, the incidence of otitis externa was highest in miniature poodles and cocker spaniels and Himalayan and Persian cats. The organisms most commonly associated with otitis externa were coagulase-negative staphylococci, followed by coagulase-positive staphylococci, streptococci and Escherichia coli. Most staphylococci were susceptible to the antibiotics tested, but 15 per cent of staphylococci were resistant to more than three antibiotics. Pseudomonas and Alcaligenes species were resistant to almost all antibiotics except gentamicin and colistin.

Animals↗
PubMed2003

Evaluation of an ear cleanser for the treatment of infectious otitis externa in dogs.

Thirty-one ears (16 dogs) with otitis externa originating from bacterial or yeast infections were enrolled in a study to evaluate the in vivo efficacy of an ear cleanser containing 2.5% lactic acid and 0.1% salicylic acid for the treatment of infectious otitis externa. The affected ears were treated with the ear cleanser twice daily for 2 weeks and evaluated after 1 and 2 weeks of treatment. The ear cleanser was effective in resolution of infection in 67.7% of the ears, and clinical signs of infectious otitis externa were significantly reduced within 2 weeks.

Animals↗
PubMed1988

Surgical management of otitis externa.

The surgical management of otitis externa is discussed in conjunction with failed medical management, primary causes, and proper case selection. The techniques of lateral ear canal resection and vertical ear canal ablation are described in detail.

Animals↗
PubMed1977

Necrotizing otitis externa.

Three cases of Necrotizing Otitis Externa are described and a suggestion made of a possible relation between the severity and progress of the disease and the degree of pneumatization of the mastoid.

Cellulitis↗
PubMed2000

Study of lipid in the ear canal in canine otitis externa with Malassezia pachydermatis.

An epidemiological investigation of 120 canine otitis externa cases in 1,370 dogs was done on the incidence rate, ear pinna shapes, breeds and their relationships. Eighty-five cases (12.6%) in 672 dogs with pendulous ears and 35 cases (5.0%) in 698 dogs with erect ears had otitis externa, and the difference between them was significant (P<0.05). Ninety-five auditory cerumen specimens were cultured for Malassezia pachydermatis (M. pachydermatis) and analyzed for concentrations of major fatty acids. Although rates of cases positive for M. pachydermatis in both ear pinna shapes were almost the same, i.e. 55.2% in the pendulous group and 53.6% in the erect group, the average total fatty acid level of the pendulous ear group was significantly (P<0.05) higher than that in the erect ear group after dismissing extraordinary levels in the Siberian husky. Isolated M. pachydermatis strains were examined for the effects of fatty acid supplementation on their growth. The majority of the strains utilized fatty acids and grew faster in fatty acid supplemented broth. These results suggest that M. pachydermatis, the predominant causative agent of canine otitis externa, prefers the auditory canal of dogs with lipid-rich earwax and grows fast, but growth strongly depends upon the canine breed.

Animals↗
PubMed1997

Use of gallium-67 in the assessment of response to antibiotic therapy in malignant otitis externa--a case report.

Malignant Otitis Externa (MOE) can cause considerable morbidity and mortality in affected individuals. The outlook is now much improved with the use of ciprofloxacin, but it is important to ascertain that the infection has been completely eradicated before stopping treatment, as undertreatment may lead to a recurrence which is usually more resistant than the initial infection. Gallium-67 Single Photon Emmision Computerised Tomography (SPECT) is a sensitive and cost effective tool in monitoring the disease activity of MOE, and should be used in the assessment of the response to antibiotic therapy.

Anti-Infective Agents↗