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Idiopathic inflammatory medial meatal fibrotizing otitis.

BACKGROUND: Idiopathic inflammatory medial meatal fibrotizing otitis (IMFO) is rare. Only a few cases with unknown cause have been reported. OBJECTIVE: To report 3 cases of IMFO as a specific diagnostic entity. PATIENTS AND METHODS: Two adults and 1 child with bilateral IMFO were observed for several years at the Department of Otorhinolaryngology of Helsinki University Hospital, Helsinki, Finland. RESULTS: Only the osseous part of the external ear canals was affected by IMFO. The skin and skin organs over the lateral cartilage of the ear canals remained rigorously and constantly uninflamed through the active, relentless progression of the disease over several years, resulting in the formation of a fibrous plug of the medial meatal canal. The middle ears and mastoid air cells were not affected during the active inflammatory phase. CONCLUSION: IMFO has its own specific pathophysiologic characteristics, and perhaps also etiopathologic characteristics, which are still unknown.

Adult↗

Ear canal hyperostosis--surfer's ear. An improved surgical technique.

The increased populatiry of surfing has produced a marked augmentation in the incidence of ear canal exostosis. However, when it becomes moderately severe, I prefer to call it "hyperostosis." Exposure to cold ocean water for many years can be an important etiologic factor in hyperostosis. There is a serious risk, and a high incidence of tympanic membrane perforations during the removal of large external canal hyperostosis. This injury can be prevented by placing a sheet of Silastic against the tympanic membrane beforehand. I describe the method. Serious degrees of hyperostosis, causing transient hearing loss and otitis externa, are increasingly common in coastal towns, where cold-water surfing is a popular year-around sport.

Adult↗

Verrucous carcinoma of the middle ear.

A case of a highly destructive, cytologically nondysplastic squamous epithelial lesion of the middle ear is presented. The cranial nerve involvement and bone destruction are more extensive than has been seen in cholesteatoma. Cultures are negative for Pseudomonas, and the patient does not have the reported diathesis for malignant otitis externa. The gross and microscopic features are those of verrucous carcinoma. To our knowledge, the middle ear has not been previously reported as a site of involvement by verrucous carcinoma.

Aged↗

Moxalactam therapy. Its use in chronic suppurative otitis media and malignant external otitis.

Moxalactam disodium is a new broad-spectrum antibiotic structurally related to the cephalosporins. Eleven patients with chronic suppurative otitis media with mastoiditis and four patients with malignant external otitis were treated with moxalactam. Pseudomonas aeruginosa was isolated from external ear or mastoid in all patients. Twelve of 15 patients had undergone prior surgical procedures and 11 of 15 had failed recent antibiotic therapy. Three patients with malignant external otitis did not respond to parenteral carboxypenicillin and aminoglycoside therapy. Success rate for chronic suppurative otitis media was 73% as judged by eradication of P aeruginosa and resolution of symptoms 30 days after moxalactam therapy. Two patients with malignant external otitis were cured, and two were unevaluable since they may have died of noninfectious causes. Moxalactam disodium, at a dosage of 9 g/day, may be useful for serious Pseudomonas ear infections, including those refractory to other antibiotic therapy.

Aged↗

Otologic manifestations of Langerhans' cell histiocytosis.

Eighteen of 62 children diagnosed with Langerhans' cell histiocytosis at the Children's Hospital of Pittsburgh (Pa) between 1970 and 1986 demonstrated ear and temporal bone involvement. In six children, such otologic disease was their sole presenting manifestation. Common signs and symptoms included aural discharge, postauricular swelling, and conductive hearing loss. The otologic findings in these children, if not investigated properly, could easily be attributed to acute or chronic infectious ear disease. Computed tomography with contrast enhancement proved to be particularly valuable as a diagnostic study because of its clear delineation of both osseous and soft-tissue temporal bone involvement. Computed tomographic findings could also be used to enhance local treatment by guiding surgical biopsy and curettage procedures or defining low-dose radiation therapy portals. Eleven of these 18 children with otologic Langerhans' cell histiocytosis additionally required chemotherapy due to the systemic nature of their disease.

Child↗

Langerhans' cell histiocytosis: head and neck manifestations in children.

BACKGROUND: Langerhans' cell histiocytosis (LCH) is an uncommon, poorly understood granulomatous disease, characterized by the idiopathic proliferation of Langerhan's cells or their marrow precursors. In 1985, the Philadelphia Work-shop adopted the term "Langerhans' cell histiocytosis" (LCH) to differentiate it from reactive and neoplastic causes of histiocytosis. METHODS: This study includes 73 pediatric patients diagnosed with this condition in Dublin, Ireland, and Nottingham, England, during a 34-year period (1959 to 1993). These patients are reviewed with respect to clinical presentation, difficulty with making a histological diagnosis, their management, and outcome. RESULTS: A total of 49 patients (67%) had head and neck involvement. Bony involvement was the most frequent sign, most frequently located in the skull. There were 11 deaths (15%) in this series, all associated with multisystem disease, and nine of these deaths were in children younger than 2 years of age. CONCLUSIONS: The role of otolaryngologists is important in the early and accurate evaluation, staging, and diagnosis of LCH. It may mimic more common diseases, such as otitis externa, acute mastoiditis, skin rash, gingivitis, or cervical lymphadenopathy. Patients with multisystem disease may be so ill at presentation that the head and neck lesions may be overlooked. The current management of LCH has become increasingly conservative, and in the 1990s, fewer cases are given chemotherapy or radiotherapy. The prognosis is very good for single-system disease and poor for multisystem disseminated disease with early onset.

Adolescent↗

Potential therapeutic effect of yeast killer toxin.

Experimental infections were produced in guinea pigs, rabbits and dogs with lesions similar to those seen in human seborrheic dermatitis and otitis externa by cutaneous application of cultures of Malassezia furfur and M. pachydermatis. Infected animals were treated by topical application of a concentrated yeast killer toxin (Hansenula anomala UCSC 25F). Clinical recovery as well as negative mycological test cultures of infected animals proved to the clearly associated with the treatment by the killer toxin.

Administration, Topical↗

Atypical cases of Microsporum canis infection in the adult.

Eleven adult patients (7 males, 4 females) were found to be infected with Microsporum canis. There was involvement of the scalp in three patients: in one male and one female there were kerion-like lesions and in one male the lesions resembled seborrheic dermatitis. There were three cases of tinea barbae, males aged 28, 65 and 82 years, in the first resembling an infected single lesion of granuloma annulare, the second with a kerion-like lesion and the third with an abscess-like tumor. There were five patients with lesions in glabrous areas: one male with a lesion of the palm resembling erythema multiforme and one with an infection of the auricular lobe resembling a seborrheic dermatitis or otitis externa; of three females with tinea faciei one had a lesion simulating granuloma faciale, one simulating lymphocytic infiltration and one simulating discoid lupus erythematosus. A cat was the source of infection in three cases; in the remainder it could not be determined with certainty. It is of note that a continuous increase in infection with M. canis has been observed in Israel during the past five years.

Adult↗

Chronic myringitis and chronic suppurative otitis media.

Thirty-four chronic myringitis cases were examined by otoscopy, pure tone audiometry, tympanometry, skull X-rays, and bacteriologic study of otorrhea. Five atypical cases are presented in detail. Three of these five cases had a perforation of the tympanic membrane preceding the appearance of typical chronic myringitis. The remaining two cases showed a transient small tympanic membrane perforation during the long course of chronic myringitis. These cases suggest that chronic myringitis could occur in some chronic suppurative otitis media and that myringitis could cause tympanic membrane perforation.

Adult↗

Clinical efficacy of ofloxacin in the treatment of otorhinolaryngological infections.

A multi-centered clinical study was carried out to evaluate the efficacy of ofloxacin in otorhinolaryngological infections in Japan. Ofloxacin was used at a dosage of 300 mg to 800 mg daily for three to 20 days in 206 cases of various infectious diseases in the otorhinolaryngological field such as otitis media, external otitis, paranasal sinusitis, tonsillitis and pharyngolaryngitis. Its efficacy rate was 79.9%. Minor side effects were seen in three cases (1.5%), gastro-intestinal disorders in two and headache in one. The antibacterial activity of ofloxacin was compared with the activity of pipemidic acid, nalidixic acid and norfloxacin against clinically isolated microorganisms. Ofloxacin was highly superior to pipemidic acid and nalidixic acid, and slightly more active than or equivalent to norfloxacin.

Anti-Infective Agents↗

Experimentally induced otitis and audiogenic seizure in the mouse.

Audiogenic seizures can be induced in genetically non-susceptible 17-day-old mice (Rb/3 strain) with various results. Priming only induces 9% of seizures, auditory insulation 3,8%, while experimental otitis leads to 79%. The hypothesis concerning disuse supersensitivity subsequent to acoustic deprivation was not confirmed by the experiment. However, modification of acoustic transmission at middle ear level induced by otitis or ear physical damage during the maturation period, exposes the upper nervous centers to intense stimulation to which the reaction is a recruiting response.

Animals↗

Clinical experiences with ofloxacin sequential therapy in chronic ear infections.

Quinolones are the drugs of first choice in therapy of chronic ear infections with multiresistant bacteria, especially because of their efficacy against various Pseudomonas species and their lack of ototoxicity. According to clinical experience, best results can be obtained after application of the sequential treatment schedule. To verify this, 61 patients with acute exacerbations of chronic ear infections were treated sequentially with ofloxacin. After a single dose of 400 mg ofloxacin intravenously, the treatment was continued orally with 400 mg once a day over 7 days. Microbiological and serological examination was performed just prior to and 1 week after treatment. Predominant bacteria isolated from the patients' ears were Pseudomonas aeruginosa, Staphylococcus aureus, Proteus spp. and Enterobacteriaceae spp. Following treatment, infections were cured in 23% of cases and 59% showed improvement. Eighteen percent of the cases were persistent, mainly due to epitympanic chronic otitis media, which was an indication for surgical intervention. In general, sequential therapy with ofloxacin revealed encouraging clinical results based on improved patient compliance with the treatment schedule recommended.

Administration, Oral↗

An audit of the E.N.T. casualty service at the Royal Victoria Eye and Ear Hospital.

The only specialised Accident and Emergency unit for ENT in Ireland is at The Royal Victoria Eye and Ear Hospital, Dublin. This provides a service for the entire Republic, operating on a 9 am to 5 pm, Monday to Friday, basis. The aim of the present study was to define the role of this specialised unit. A prospective study of the service over a one month period was conducted. During this time 779 patients were seen of which 350 (45%) were new patients and 429 (55%) were return patients. Fifty two per cent were self referred, 35% were referred by their General Practitioners, 8% by other hospitals and 5% from other sources. The most common diagnosis was otitis externa (21% of new patients and 63% of returns), followed by ear wax (15% of new patients), and epistaxis (9% of new patients). Five per cent of patients required removal of foreign bodies from their ear, nose or oesophagus, and 3% received treatment for trauma to these regions. Of note during this period six new cases of head and neck cancer were detected. From these figures it is the authors' opinion that many of the problems seen could have been dealt with by General Practitioners or as non-emergency referrals to the out-patient department. This indicates the need for further training for primary care physicians and expansion of the present outpatients services. The specialised casualty service should continue to exist to provide a genuine emergency service and valuable training in the speciality.

Accidents↗

[Herniation of the soft tissue of the temporomandibular joint into the external auditory canal].

The bone between the external auditory meatus and temporomandibular joint may be destroyed as a result of canaloplasty or malignant otitis externa. This may lead to herniation of the joint capsule into the external auditory canal. Spontaneous herniation through a foramen of Huschke (bony dehiscence in the anterior wall of the tympanic bone) is rare. We present a case of spontaneous herniation with otorrhea.

Cerebrospinal Fluid Otorrhea↗